特发性帕金森病患者EAT-10评分、咽部残留严重程度与渗透-误吸之间的关系：一项基于FEES的相关性和判别性能研究。

文献信息

中文摘要

背景： 吞咽困难在特发性帕金森病（IwIPD）患者中很常见，并影响吞咽安全性和有效性。咽部残留和渗透-误吸是该人群中与吞咽困难相关的关键损害，但其在不同食团稠度和容量下的关系仍未完全明确。患者报告结局测量工具，如进食评估工具-10（EAT-10），与仪器性吞咽检查结果之间的临床作用也需进一步研究。本研究旨在（1）探讨IwIPD患者在不同食团稠度和容量下咽部残留与渗透-误吸之间的关系，以及（2）评估EAT-10相对于与这些吞咽损害相关的FEES结果的判别性能。
方法： 纳入97例IwIPD患者。参与者完成EAT-10，并接受柔性内镜吞咽评估（FEES）。根据国际吞咽障碍饮食标准化倡议（IDDSI）制备不同稠度和容量的食团，进行10次吞咽试验。FEES记录由三名临床医生使用渗透-误吸量表（PAS）和耶鲁咽部残留严重程度评定量表（YPRSRS）独立评定。
结果： 在计划内的同一稠度比较中，较大的食团容量与更高的残留严重程度和PAS评分相关。在不同稠度和容量下，PAS评分与EAT-10和YPRSRS评分均显著相关（ρ = 0.56-0.91，p < 0.01）。EAT-10相对于与咽部残留、渗透和误吸相关的FEES结果在各吞咽试验中显示出判别性能。YPRSRS和PAS评分的评定者间信度为0.58至0.87。会厌谷残留以常规固体食物最高，而PAS评分以20 mL稀薄液体最高。
结论： 在IwIPD中，吞咽有效性与吞咽安全性在不同食团稠度和容量下均密切相关。EAT-10评分相对于FEES结果显示出判别性能；然而，EAT-10应被解释为患者报告的筛查工具，而非生理性吞咽损害诊断测试。纳入一系列食团稠度和容量的综合FEES方案可能有助于该人群更准确的评估和个体化吞咽困难管理。
本文的贡献： 关于该主题已知的内容 吞咽困难在特发性帕金森病（IwIPD）患者中高度普遍，可能涉及吞咽安全性和吞咽有效性两方面的损害，包括咽部残留、渗透和误吸。已知食团稠度和容量会影响吞咽表现。患者报告结局测量工具，如进食评估工具-10（EAT-10），广泛用于吞咽困难筛查，但不能替代仪器性吞咽评估。本研究对现有知识的补充 本研究表明，在IwIPD中，不同IDDSI定义的食团稠度和容量下，咽部残留严重程度与渗透-误吸之间存在强关系。研究结果显示，较大的食团容量与更高的咽部残留严重程度和更高的PAS评分相关，而吞咽结局因稠度和解剖残留部位而异。研究还表明，EAT-10评分相对于与咽部残留、渗透和误吸相关的FEES结果显示出判别性能，同时强调在该人群中需谨慎解释EAT-10截断值。本研究的潜在或实际临床意义？ 研究结果支持在IwIPD的仪器性评估中评估吞咽安全性和吞咽有效性的重要性。EAT-10可能有助于指导进一步仪器性吞咽评估的转诊决策，但不应被解释为生理性吞咽损害的诊断测试。纳入一系列食团稠度和容量的FEES方案可能有助于该人群吞咽困难的更全面临床特征描述和个体化管理。

英文摘要

BACKGROUND: Dysphagia is common in individuals with Idiopathic Parkinson's Disease (IwIPD) and affects both swallowing safety and efficiency. Pharyngeal residue and penetration-aspiration are key impairments associated with dysphagia in this population, yet their relationship across different bolus consistencies and volumes remains incompletely understood. The clinical role of patient-reported outcome measures, such as the Eating Assessment Tool-10 (EAT-10), in relation to instrumental swallowing findings also requires further investigation. This study aimed (1) to examine the relationship between pharyngeal residue and penetration-aspiration across different bolus consistencies and volumes in IwIPD, and (2) to evaluate the discriminative performance of the EAT-10 against FEES findings related to these swallowing impairments.
METHODS: Ninety-seven IwIPD were included. Participants completed the EAT-10 and underwent Flexible Endoscopic Evaluation of Swallowing (FEES). Ten swallowing trials were conducted using boluses of varying consistencies and volumes prepared according to the International Dysphagia Diet Standardisation Initiative (IDDSI). FEES recordings were independently rated by three clinicians using the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS).
RESULTS: Larger bolus volumes were associated with higher residue severity and PAS scores across planned within-consistency comparisons. Significant correlations were observed between PAS scores and both EAT-10 and YPRSRS scores across consistencies and volumes (ρ = 0.56-0.91, p < 0.01). The EAT-10 showed discriminative performance against FEES findings related to pharyngeal residue, penetration, and aspiration across swallowing trials. Interrater reliability for YPRSRS and PAS ratings ranged from 0.58 to 0.87. Vallecular residue was highest for regular solid, while PAS scores were highest for thin liquid at 20 mL.
CONCLUSION: In IwIPD, swallowing efficiency was strongly associated with swallowing safety across different bolus consistencies and volumes. EAT-10 scores showed discriminative performance against FEES findings; however, the EAT-10 should be interpreted as a patient-reported screening measure rather than a diagnostic test for physiological swallowing impairment. Comprehensive FEES protocols incorporating a range of bolus consistencies and volumes may support more accurate assessment and individualized dysphagia management in this population.
WHAT THIS PAPER ADDS: What is already known on this subject Dysphagia is highly prevalent in individuals with Idiopathic Parkinson's Disease (IwIPD) and may involve impairments in both swallowing safety and swallowing efficiency, including pharyngeal residue, penetration, and aspiration. Bolus consistency and volume are known to influence swallowing performance. Patient-reported outcome measures, such as the Eating Assessment Tool-10 (EAT-10), are widely used in dysphagia screening, but they cannot replace instrumental swallowing assessment. What this study adds to existing knowledge This study demonstrates a strong relationship between pharyngeal residue severity and penetration-aspiration across different IDDSI-defined bolus consistencies and volumes in IwIPD. The findings show that larger bolus volumes were associated with greater pharyngeal residue severity and higher PAS scores, while swallowing outcomes varied across consistencies and anatomical residue sites. The study also shows that EAT-10 scores demonstrated discriminative performance against FEES findings related to pharyngeal residue, penetration, and aspiration, while highlighting the need for cautious interpretation of EAT-10 cut-off values in this population. What are the potential or actual clinical implications of this study? The findings support the importance of evaluating both swallowing safety and swallowing efficiency during instrumental assessment in IwIPD. The EAT-10 may help guide referral decisions for further instrumental swallowing assessment, but it should not be interpreted as a diagnostic test for physiological swallowing impairment. FEES protocols incorporating a range of bolus consistencies and volumes may support more comprehensive clinical characterization of dysphagia and individualized management in this population.