Abstract：
OBJECTIVE: Dysphagia in multiple system atrophy (MSA) is life-threatening and is caused by parkinsonism with cerebellar ataxia as a contributing factor. The present study investigated the relationship between dysphagia severity in MSA and the specific binding ratio (SBR) on dopamine transporter (DaT) SPECT using the Hyodo score, a qualitative scale for use with fiberoptic endoscopic evaluation of swallowing (FEES).
METHODS: Hyodo score\'s ability to predict aspiration during a FEES examination of 88 patients with MSA was first tested. Then the clinical characteristics, Hyodo score, and SBR of patients with either predominant parkinsonism (MSA-P; n = 11) or cerebellar ataxia (MSA-C; n = 25) who underwent FEES and DaT SPECT simultaneously were compared.
RESULTS: Logistic regression demonstrated that the Hyodo score was a significant predictive factor of aspiration (p = 0.003). The MSA-P group had a significantly higher Hyodo score (p = 0.026) and lower SBR (p = 0.011) than the MSA-C group while neither group demonstrated any significant difference in disease duration at the FEES examination. Linear regression demonstrated a significant, inverse correlation between the Hyodo score and SBR in the MSA-P (p = 0.044; r = -0.616) and MSA-C (p = 0.044; r = -0.406) groups. When the effect of SBR was removed by analysis of covariance, no significant difference in the Hyodo score remained between the groups.
CONCLUSIONS: Our results suggested an association between presynaptic changes in nigrostriatal dopaminergic neurons and dysphagia severity in MSA which largely contributes to the difference in dysphagia severity between MSA-P and MSA-C.
METHODS: Hyodo score\'s ability to predict aspiration during a FEES examination of 88 patients with MSA was first tested. Then the clinical characteristics, Hyodo score, and SBR of patients with either predominant parkinsonism (MSA-P; n = 11) or cerebellar ataxia (MSA-C; n = 25) who underwent FEES and DaT SPECT simultaneously were compared.
RESULTS: Logistic regression demonstrated that the Hyodo score was a significant predictive factor of aspiration (p = 0.003). The MSA-P group had a significantly higher Hyodo score (p = 0.026) and lower SBR (p = 0.011) than the MSA-C group while neither group demonstrated any significant difference in disease duration at the FEES examination. Linear regression demonstrated a significant, inverse correlation between the Hyodo score and SBR in the MSA-P (p = 0.044; r = -0.616) and MSA-C (p = 0.044; r = -0.406) groups. When the effect of SBR was removed by analysis of covariance, no significant difference in the Hyodo score remained between the groups.
CONCLUSIONS: Our results suggested an association between presynaptic changes in nigrostriatal dopaminergic neurons and dysphagia severity in MSA which largely contributes to the difference in dysphagia severity between MSA-P and MSA-C.
摘要：
目的：多系统萎缩（MSA）中的吞咽困难会危及生命，并且是由以小脑共济失调为促成因素的帕金森病引起的。本研究使用Hyodo评分调查了MSA吞咽困难的严重程度与多巴胺转运蛋白（DaT）SPECT的特异性结合比（SBR）之间的关系，用于纤维内窥镜吞咽评估（FEES）的定性量表。
方法：首先测试了Hyodo评分在对88例MSA患者进行FEES检查时预测误吸的能力。然后是临床特征，Hyodo评分,比较了同时接受FEES和DaTSPECT检查的显性帕金森病（MSA-P；n=11）或小脑共济失调（MSA-C；n=25）患者的SBR。
结果：Logistic回归表明，Hyodo评分是误吸的重要预测因素（p=0.003）。MSA-P组的Hyodo评分（p=0.026）和SBR（p=0.011）明显高于MSA-C组，而在FEES检查中，两组均未表现出疾病持续时间的显着差异。线性回归表明，在MSA-P（p=0.044；r=-0.616）和MSA-C（p=0.044；r=-0.406）组中，Hyodo评分与SBR之间呈负相关。当通过协方差分析去除SBR的影响时，两组间Hyodo评分无显著差异.
结论：我们的结果表明，黑质纹状体多巴胺能神经元的突触前变化与MSA吞咽困难严重程度之间存在关联，这在很大程度上导致了MSA-P和MSA-C之间吞咽困难严重程度的差异。
方法：首先测试了Hyodo评分在对88例MSA患者进行FEES检查时预测误吸的能力。然后是临床特征，Hyodo评分,比较了同时接受FEES和DaTSPECT检查的显性帕金森病（MSA-P；n=11）或小脑共济失调（MSA-C；n=25）患者的SBR。
结果：Logistic回归表明，Hyodo评分是误吸的重要预测因素（p=0.003）。MSA-P组的Hyodo评分（p=0.026）和SBR（p=0.011）明显高于MSA-C组，而在FEES检查中，两组均未表现出疾病持续时间的显着差异。线性回归表明，在MSA-P（p=0.044；r=-0.616）和MSA-C（p=0.044；r=-0.406）组中，Hyodo评分与SBR之间呈负相关。当通过协方差分析去除SBR的影响时，两组间Hyodo评分无显著差异.
结论：我们的结果表明，黑质纹状体多巴胺能神经元的突触前变化与MSA吞咽困难严重程度之间存在关联，这在很大程度上导致了MSA-P和MSA-C之间吞咽困难严重程度的差异。
