Wakasugi Y, Yamamoto T, Oda C, Murata M, Tohara H, Minakuchi S
Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
J Oral Rehabil. 2017 Oct;44(10):756-762. doi: 10.1111/joor.12536. Epub 2017 Jul 27.
We investigated the swallowing function in patients with Parkinson's disease (PD) using deteriorated tongue control because patients with PD frequently exhibit an impaired oral stage of swallowing and the tongue movement affects oral and pharyngeal stage. In total, 201 patients with PD (106 men, 95 women; mean age 70·6 ± 8·0 years; median Hoehn-Yahr Stage III) were studied. The patients swallowed 10 mL of liquid barium under videofluorography, and their oral transit time (OTT) was measured. Based on 20 healthy controls (mean age 70·3 ± 7·8 years) with an OTT + 2 standard deviation (0·89 + 2 × 0·46) of 1·81 s, the patients with PD were divided into 167 patients with an OTT < 1·81 s and 34 patients with an OTT ≥ 1·81 s. Swallowing function was compared between the groups and assessed using logistic regression analysis. The following factors were significantly associated with oral stage impairment in both groups: tongue-to-palate contact, tongue root-to-posterior pharyngeal wall contact, premature spillage into the pharynx, aspiration and onset of swallowing reflex. Logistic regression analysis showed that tongue root-to-posterior pharyngeal wall contact, onset of swallowing reflex and aspiration were independent factors. PD patients with prolonged OTT displayed poor lingual control and decreased range of motion of the tongue due to bradykinesia and rigidity. Such problems in the oral stage affected the subsequent pharyngeal stage of swallowing with aspiration. Lingual movement in the oral stage thus appears to play an important role in the sequential movement of swallowing in PD.
我们利用恶化的舌控制能力来研究帕金森病（PD）患者的吞咽功能，因为PD患者经常出现吞咽口腔期受损，且舌运动影响口腔期和咽期。总共对201例PD患者（106例男性，95例女性；平均年龄70.6±8.0岁；Hoehn-Yahr分期中位数为III期）进行了研究。患者在电视荧光透视检查下吞咽10毫升液体钡剂，并测量其口腔通过时间（OTT）。以20名健康对照者（平均年龄70.3±7.8岁）的OTT+2标准差（0.89+2×0.46）即1.81秒为标准，将PD患者分为167例OTT<1.81秒的患者和34例OTT≥1.81秒的患者。比较两组之间的吞咽功能，并使用逻辑回归分析进行评估。两组中以下因素均与口腔期损害显著相关：舌与腭接触、舌根与咽后壁接触、过早溢入咽部、误吸和吞咽反射开始。逻辑回归分析表明，舌根与咽后壁接触、吞咽反射开始和误吸是独立因素。OTT延长的PD患者由于运动迟缓及僵硬而表现出较差的舌控制能力和舌运动范围减小。口腔期的这些问题会影响随后伴有误吸的吞咽咽期。因此，口腔期的舌运动在PD吞咽的连续运动中似乎起着重要作用。
