Division of Neuroscience, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK.
Eur J Neurol. 2024 Jun;31(6):e16258. doi: 10.1111/ene.16258. Epub 2024 Feb 26.
Multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) show a high prevalence and rapid progression of dysphagia, which is associated with reduced survival. Despite this, the evidence base for gastrostomy is poor, and the optimal frequency and outcomes of this intervention are not known. We aimed to characterise the prevalence and outcomes of gastrostomy in patients with these three atypical parkinsonian disorders.
We analysed data from the natural history and longitudinal cohorts of the PROSPECT-M-UK study with up to 60 months of follow-up from baseline. Survival post-gastrostomy was analysed using Kaplan-Meier survival curves.
In a total of 339 patients (mean age at symptom onset 63.3 years, mean symptom duration at baseline 4.6 years), dysphagia was present in >50% across all disease groups at baseline and showed rapid progression during follow-up. Gastrostomy was recorded as recommended in 44 (13%) and performed in 21 (6.2%; MSA 7, PSP 11, CBS 3) of the total study population. Median survival post-gastrostomy was 24 months compared with 12 months where gastrostomy was recommended but not done (p = 0.008). However, this was not significant when correcting for age and duration of symptoms at the time of procedure or recommendation.
Gastrostomy was performed relatively infrequently in this cohort despite the high prevalence of dysphagia. Survival post-gastrostomy was longer than previously reported, but further data on other outcomes and clinician and patient perspectives would help to guide use of this intervention in MSA, PSP and CBS.
多系统萎缩症（MSA）、进行性核上性麻痹（PSP）和皮质基底节综合征（CBS）均表现出较高的吞咽困难发生率和快速进展，这与生存率降低有关。尽管如此，胃造口术的证据基础仍然薄弱，并且这种干预的最佳频率和结果尚不清楚。我们旨在描述这三种非典型帕金森病患者胃造口术的流行情况和结果。
我们分析了 PROSPECT-M-UK 研究的自然史和纵向队列数据，随访时间从基线最长可达 60 个月。使用 Kaplan-Meier 生存曲线分析胃造口术后的生存情况。
在总共 339 名患者（症状发作时的平均年龄为 63.3 岁，基线时的平均症状持续时间为 4.6 年）中，所有疾病组在基线时的吞咽困难发生率均超过 50%，且在随访期间迅速进展。在总研究人群中，建议进行胃造口术的有 44 例（13%），实际进行的有 21 例（6.2%；MSA 7 例，PSP 11 例，CBS 3 例）。胃造口术后的中位生存时间为 24 个月，而建议进行但未进行胃造口术的中位生存时间为 12 个月（p=0.008）。然而，在校正程序或建议时的年龄和症状持续时间后，这并不显著。
尽管吞咽困难的发生率较高，但在该队列中胃造口术的实施相对较少。胃造口术后的生存时间长于之前的报道，但关于其他结果和临床医生和患者观点的进一步数据将有助于指导 MSA、PSP 和 CBS 中使用这种干预措施。
