背景:吞咽困难常见于帕金森病(PD)的晚期,是吸入性肺炎的危险因素。尽管如此,在接受左旋多巴-卡比多巴肠凝胶(LCIG)治疗的PD患者中,吞咽困难的研究很少。我们旨在分析吞咽困难对LCIG治疗患者死亡率的影响及其与其他PD残疾里程碑的关系。
方法:我们回顾性评估了95例接受LCIG治疗的连续PD患者。使用Kaplan-Meier和log-rank检验比较吞咽困难患者的死亡率。Cox回归用于估计吞咽困难的影响,年龄,疾病持续时间,以及Hoehn和Yahr(H&Y)在整个队列中的死亡率。最后,单因素和多因素回归分析用于估计吞咽困难和年龄之间的关联,疾病持续时间,H&Y,幻觉,和痴呆症。
结果:吞咽困难患者的死亡率明显增高。在Cox模型中,吞咽困难是与死亡率显著相关的唯一特征(95CI2.780-20.609;p<0.001)。单变量分析显示吞咽困难和痴呆之间存在显著相关性(OR:0.387;p:0.033),幻觉(OR:0.283;p:0.009),和H&Y评分(OR:2.680;p<0.001);在多变量分析中,只有H&Y分期与吞咽困难相关(OR:2.357;p:0.003).
结论:吞咽困难显著增加了我们接受LCIG治疗的患者的死亡风险,独立于其他相关特征,如年龄,疾病持续时间,痴呆症,和幻觉.这些发现支持将这种症状作为晚期PD阶段的优先处理,即使在接受LCIG治疗的人群中。
Dysphagia is common in advanced phases of Parkinson disease (PD), and is a risk factor for aspiration pneumonia. Nonetheless, dysphagia has been poorly investigated in PD patients treated with levodopa-carbidopa intestinal gel (LCIG). We aimed to analyze the impact of dysphagia on mortality in LCIG treated patients and its relationship with other PD disability milestones.
We retrospectively evaluated 95 consecutive PD patients treated with LCIG. Kaplan-Meier and log-rank test were used to compare mortality in patients with dysphagia from others. Cox regression was used to estimate the impact of dysphagia, age, disease duration, and Hoehn and Yahr (H&Y) on mortality in the entire cohort. Finally, univariate and multivariate regression analyses were used to estimate the association between dysphagia and age, disease duration, H&Y, hallucinations, and dementia.
A significantly higher mortality rate was observed in patients with dysphagia. In the Cox model, dysphagia was the only feature significantly associated with mortality (95%CI 2.780-20.609; p < 0.001). Univariate analyses showed a significant correlation between dysphagia and dementia (OR: 0.387; p:0.033), hallucinations (OR: 0.283; p:0.009), and H&Y score (OR: 2.680; p < 0.001); in the multivariate analysis, only the H&Y stage was associated with the presence of dysphagia (OR: 2.357; p:0.003).
Dysphagia significantly increased the risk of death in our cohort of LCIG-treated patients, independently from other relevant features such as age, disease duration, dementia, and hallucinations. These findings support the management of this symptom as a priority in the advanced PD stages, even in people treated with LCIG.