巴金森患者之吞嚥功能－和發病時間及分期的相關性研究

Swallowing Function in Parkinson's Disease: Correlation with Disease Duration and Hoehn and Yahr Stage

潘奕雅(Yi-Ya Pan) ； 王雪珮(Hsueh-Pei Wang) ； 吳瑞美(Ruey-Meei Wu) ； 王亭貴(Tyng-Guey Wang)

《台灣復健醫學雜誌》 50卷1期 (2022/06) Pp. 17-27

https://doi.org/10.6315/TJPMR.202206_50(1).0003

摘要

吞嚥困難是巴金森症常見的問題，過去雖有利用量表及電視螢光吞嚥攝影檢查、纖維內視鏡攝影檢查評估這類病人，但較缺少舌肌測量及舌骨移動相關研究。本研究利用超音波評估舌骨動作，並利用愛荷華口腔功能評量器（Iowa Oral Performance Instrument）量測舌肌力，以探討隨時間與疾病進程下巴金森患者吞嚥功能的變化。30名自覺有吞嚥問題的巴金森患者（10位男性，20位女性），依發病時長與侯葉氏分期法，藉由吞嚥篩檢問卷（Eating Assessment Tool-10）、吞嚥生活品質問卷（Swallowing Quality of Life Questionnaire）、功能性由口進食量表（Functional Oral Intake Scale）、愛荷華口腔功能評量器及超音波評估其吞嚥功能。若依發病時間分組，兩組在性別與年齡上沒有顯著差異，而且在吞嚥功能評估的各項參數也均無顯著差異。依侯葉氏分期法分組，侯葉氏分期大於等於第三期和小於第三期的2組，其吞嚥篩檢問卷分別為13.9 ± 9.5和7.4 ± 9.8（p=0.023），舌尖最大壓力值分別為34.8 ± 15.1及43.1 ± 14.0 kPa（p=0.029），舌根最大壓力值分別為29.5 ± 12.9及40.1 ± 14.4 kPa（p=0.033），皆有明顯差異。但舌骨移動距離與速度則無顯著差異。另外在吞嚥生活品質問卷的「溝通功能」面向兩組的分數分別為5.4 ± 1.8和3.5 ± 1.7（p=0.005）。本研究得知巴金森患者吞嚥困難症狀和發病時長無關，和疾病嚴重程度有關。且隨疾病進展，舌肌力明顯下降，伴隨溝通功能的變差。

關鍵字

巴金森病（Parkingson's disease） ； 吞嚥困難（dysphagia） ； 舌（tongue） ； 舌骨（hyoid bone） ； 超音波（ultrasonography）

並列摘要

Oropharyngeal dysphagia is a common complication of Parkinson's disease (PD). Swallowing assessment scales, videofluoroscopics wallowing study (VFSS), and fiberoptic endoscopic evaluation of swallowing (FEES) are used to evaluate the swallowing function of patients with dysphagia. However, few studies have been conducted that assessed tongue muscle strength and hyoid bone movement in patients with PD. To better understand the correlation between disease duration, Hoehn and Yahr (H&Y) stage and swallowing function in patients with PD, this study evaluated the swallowing function in patients with PD using ultrasonography and Iowa Oral Performance Instrument (IOPI). Ultrasonography was performed to evaluate hyoid movement, and IOPI was used to assess tongue muscle strength. In total, 30 patients with PD (10 males, 20 females) with self-reported dysphagia were enrolled. They were divided into two groups based on disease duration and H&Y stage. The swallowing assessment included Eating Assessment Tool-10 (Eat-10), Swallowing Quality of Life Questionnaire (SWAL-QOL), Functional Oral Intake Scale (FOIS), IOPI, and ultrasonography. Between the groups based on disease duration, no significant differences were noted regarding sex, age, or any other variable. However, between the two groups with H&Y stage≥3 and ＜3, we found significant correlations in terms of Eat-10 (13.9 ± 9.5, 7.4 ± 9.8, p=0.023), maximum isometric pressures of the anterior tongue (34.8 ± 15.1 kPa, 43.1 ± 14.0 kPa, p =0.029), posterior tongue (29.5 ± 12.9 kPa, 40.1 ± 14.4 kPa, p=0.033), and SWAL-QOL communication domain (5.4 ± 1.8, 3.5 ± 1.7, p=0.005), but not hyoid displacement and hyoid velocity measurement. Our results show no evidence of differences in swallowing function attributable to PD duration; however, differences were found to be related to H&Y stage. As H&Y stages advance, tongue muscle strength is affected, along with worsening of communication function.

並列關鍵字

Parkinson's disease ； dysphagia ； tongue ； hyoid ； ultrasonography