Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.
Department of Neurology, Monash Health, Melbourne, Australia.
PLoS One. 2021 Oct 15;16(10):e0258786. doi: 10.1371/journal.pone.0258786. eCollection 2021.
To determine whether arytenoid cartilage position and dynamics change with advancing duration and severity (as graded by MDS-UPDRS part III scores) in Parkinson's disease, in a cross-sectional study design, we performed laryngeal four-dimensional computed tomography (4D-CT) in people with Parkinson's disease and controls.
31 people with Parkinson's disease covering a range of disease duration and severity and 19 controls underwent laryngeal 4D-CT whilst repeatedly vocalizing. We measured on each CT volume the glottic area (GA), inter-arytenoid distance (IAD), IAD-Area index (IAI) and arytenoid cartilage velocity ([Formula: see text]).
People with Parkinson's disease had reductions in the mean/effective minimum IAD when compared to controls, while mean/effective minimum GA and mean/effective maximum IAI were increased. Arytenoid cartilage velocities showed no difference. On Spearman correlation analyses, advancing disease duration and severity of PD showed moderately strong and significant correlations with increasing mean/effective minimum GA, increasing mean/effective maximum IAI and decreasing effective minimum IAD. Linear mixed models which considered the effects of intra and inter-individual variation showed that both disease duration (b = -0.011, SEb = 0.053, 95% CI [-0.022, 0], t(27) = -2.10, p = 0.045) and severity (b = -0.069, SEb = 0.032, 95% CI [-0.14,-0.0039], t(27) = -2.17, p = 0.039) were significant predictors for IAD, and also for transformed values of the GA and IAI.
There are progressive alterations in phonatory posturing as Parkinson's disease advances. The increases in GA despite reductions in IAD are concordant with prior observations of vocal fold bowing. Our study provides a basis for using laryngeal 4D-CT to assess disease progression in Parkinson's disease.
通过横断面研究设计，我们对帕金森病患者和对照组进行了喉部四维计算机断层扫描（4D-CT），以确定杓状软骨位置和动力学是否随疾病进展时间和严重程度（根据 MDS-UPDRS 第三部分评分分级）而改变。
31 名帕金森病患者（涵盖了不同的疾病进展时间和严重程度）和 19 名对照组在反复发声时接受了喉部 4D-CT 检查。我们在每个 CT 容积上测量了声门区面积（GA）、杓状软骨间距离（IAD）、IAD-面积指数（IAI）和杓状软骨速度（[Formula: see text]）。
与对照组相比，帕金森病患者的平均/有效最小 IAD 减小，而平均/有效最小 GA 和平均/有效最大 IAI 增加。杓状软骨速度没有差异。Spearman 相关分析显示，随着 PD 疾病进展时间和严重程度的增加，GA 增加，有效最小 IAD 减小，而最大 IAI 增加。线性混合模型考虑了个体内和个体间变异的影响，表明疾病进展时间（b = -0.011，SEb = 0.053，95%CI [-0.022，0]，t(27) = -2.10，p = 0.045）和严重程度（b = -0.069，SEb = 0.032，95%CI [-0.14，-0.0039]，t(27) = -2.17，p = 0.039）是 IAD 的显著预测因素，也对 GA 和 IAI 的转换值有预测作用。
随着帕金森病的进展，发音姿势发生了进行性改变。尽管 IAD 减少，但 GA 增加与先前观察到的声带弯曲一致。我们的研究为使用喉部 4D-CT 评估帕金森病的疾病进展提供了依据。
