碳酸液体对帕金森病患者吞咽安全性的影响（DYSparkLE）：一项前瞻性受试者内重复测量观察性研究

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中文摘要

背景： 帕金森病（PwPD）患者使用稀液体时吞咽安全性受损是一个令人担忧的问题。感觉刺激常用于吞咽困难的康复治疗。既往研究表明，碳酸液体（CL）对吞咽功能具有有益作用。目的：本研究旨在评估饮用碳酸液体如何影响帕金森病患者的吞咽安全性。方法：于2023年7月至2024年7月在我们的帕金森日间门诊连续招募帕金森病患者。排除非典型或继发性帕金森综合征以及由其他神经系统或肿瘤疾病导致吞咽困难的患者。使用软式内镜吞咽评估（FEES）评估吞咽功能。评估方案包括5 mL和90 mL无味非碳酸液体（nCL）和碳酸液体（CL）。主要结局为90 mL时的气道侵入深度（DAI）。结果：共纳入83例帕金森病患者（25例女性）（年龄：67.8±9.4岁；UPDRS III（统一帕金森病评定量表第三部分）：34.9±14.3分；病程：7.9±5.9年）。多水平logistic回归显示，与nCL相比，使用CL时气道侵入的比值比显著降低。第二项探索性亚组分析使用二元logistic回归显示，报告吞咽困难症状较少的帕金森病患者从CL中获益的比值比更高。该分析还提示喉部感觉受损可能存在影响，其与CL改善的比值比降低相关。结论：使用CL时，帕金森病患者中观察到的不安全吞咽显著减少。将CL纳入仪器评估方案可对其效果进行个体化评估。未来研究应探讨CL在该患者群体中影响的机制，并探索CL在吞咽困难康复策略之外的附加价值。

英文摘要

Impaired swallowing safety with thin liquids is a concern in patients with Parkinson disease (PwPD). Sensory stimulation is frequently used in dysphagia rehabilitation. Previous studies suggest that carbonated liquid (CL) has beneficial effects on swallowing function. The objective of this study is to evaluate how drinking CL influences swallowing safety in PwPD. PwPD were consecutively recruited at our Parkinson day-clinic from July 2023 to July 2024. Patients with atypical or secondary Parkinsonism and other neurological or oncological diseases also causing dysphagia were excluded. Swallowing was assessed using flexible-endoscopic evaluation of swallowing (FEES). The assessment protocol included 5 and 90 mL of unflavored non-carbonated liquid (nCL) and CL. The primary outcome was the depth of airway invasion (DAI) with 90 mL. 83 PwPD (25 women) were included (age: 67.8±9.4 years; UPDRS III (Unified Parkinson's Disease Rating Scale, Part III): 34.9±14.3 points; disease duration: 7.9±5.9 years). Multilevel logistic regression showed that with CL, the odds of an airway invasion are significantly reduced compared to nCL. A second, exploratory subgroup analysis using binary logistic regression showed that the odds for PwPD to benefit from CL are higher for those reporting fewer dysphagia symptoms. It also indicated a potential effect of impaired laryngeal sensitivity, which was associated with decreased odds of improvement with CL. With CL, significantly fewer unsafe swallows were observed in PwPD. Incorporating CL in instrumental assessment protocols allows individualized assessment of its effects. Future research should look at mechanisms underlying the impact of CL in this patient group and explore the value of CL in addition to dysphagia rehabilitation strategies.