超声测量的咬肌增厚率对帕金森病患者发生吞咽困难的诊断价值

doi:10.11958/20250931

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 659-664.doi: 10.11958/20250931

超声测量的咬肌增厚率对帕金森病患者发生吞咽困难的诊断价值

麦湘湘¹(), 李柠肖¹, 游咏²^,^△()

1 海南医科大学第二附属医院超声医学科（邮编570311）
2 海南医科大学第二附属医院神经内科（邮编570311）

收稿日期:2025-03-06 修回日期:2025-03-30 出版日期:2025-06-15 发布日期:2025-06-20
通讯作者: ^△E-mail：652797262@qq.com
作者简介:麦湘湘（1987），女，副主任医师，主要从事超声诊断方面研究。E-mail：15248936408@163.com
基金资助:
海南省卫生健康科技创新联合项目(SQ2023WSJK0032)

Diagnostic value of masseter muscle thickness fraction measured by ultrasound for dysphagia in patients with Parkinson's disease

MAI Xiangxiang¹(), LI Ningxiao¹, YOU Yong²^,^△()

1 Department of Ultrasound Medicine, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China
2 Department of Neurology, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China

Received:2025-03-06 Revised:2025-03-30 Published:2025-06-15 Online:2025-06-20
Contact: ^△E-mail: 652797262@qq.com

麦湘湘, 李柠肖, 游咏. 超声测量的咬肌增厚率对帕金森病患者发生吞咽困难的诊断价值[J]. 天津医药, 2025, 53(6): 659-664.

MAI Xiangxiang, LI Ningxiao, YOU Yong. Diagnostic value of masseter muscle thickness fraction measured by ultrasound for dysphagia in patients with Parkinson's disease[J]. Tianjin Medical Journal, 2025, 53(6): 659-664.

摘要/Abstract

摘要：

目的探讨基于超声测量的咬肌增厚率（MMTF）对帕金森病（PD）患者发生吞咽困难的诊断价值。方法选取100例PD患者作为研究组，另选择同期在我院体检的年龄、性别和体质量指数相匹配的50例健康体检者作为对照组。2组受试者均接受咬肌超声检查，测量并计算放松及强咬时咬肌厚度（MMT）和MMTF。记录PD患者的人口统计学数据和疾病特征，根据是否发生吞咽困难分为吞咽困难组（n=34）和非吞咽困难组（n=66）。比较2组患者的人口统计学数据和疾病特征，如Hoehn-Yahr（H&Y）分期、统一帕金森病评定量表（UPDRS）Ⅲ评分和左旋多巴等效日剂量（LEDD），以及基于超声测量的MMT相关参数。以单因素分析中P<0.05的指标为自变量，采用二元Logistic回归分析法探究PD患者发生吞咽困难的影响因素。通过构建受试者工作特征（ROC）曲线并计算曲线下面积（AUC）来评估各指标对PD患者吞咽困难的诊断效能。结果研究组强咬时MMT、MMTF低于对照组（均P<0.05）。与非吞咽困难组相比，吞咽困难组年龄更大，H&Y分期和UPDRS Ⅲ评分更高（均P<0.05）。吞咽困难组患者强咬时MMT、MMTF低于非吞咽困难组（均P<0.05）。多因素Logistic回归分析结果显示，UPDRS Ⅲ评分升高是PD患者发生吞咽困难的危险因素，强咬时MMT和MMTF升高是保护因素。ROC曲线分析结果显示，UPDRS Ⅲ评分、强咬时MMT和MMTF诊断PD患者发生吞咽困难的AUC（95%CI）分别为0.714（0.615~0.800）、0.744（0.647~0.826）和0.888（0.809~0.942）。MMTF诊断PD患者发生吞咽困难的AUC高于UPDRS Ⅲ评分和强咬时MMT（Z分别为2.611、2.208，均P<0.05）。结论 MMTF是PD患者发生吞咽困难的独立影响因子，可作为PD吞咽困难患者的筛查指标。

关键词: 帕金森病, 吞咽障碍, 咬肌, 超声检查, 咬肌增厚率

Abstract:

Objective To investigate the diagnostic value of masseter muscle thickness fraction (MMTF) measured by ultrasound for the occurrence of dysphagia in patients with Parkinson's disease (PD). Methods A total of 100 patients were selected as the study group, and another 50 healthy individuals who received medical checkups with matched age, gender and body mass index (BMI) in our hospital during the same period were selected as the control group. The demographic data and disease characteristics of PD patients were recorded, and patients were divided into the dysphagia group (n=34) and the non-dysphagia group (n=66) according to the occurrence of dysphagia. The demographic data, and disease characteristics such as Hoehn-Yahr (H&Y) stage, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅲ score, levodopa equivalent daily dose (LEDD) and MMT-related parameters measured by ultrasound were compared between the two groups. The indicators with P<0.05 in univariate analysis were used as independent variables, and the influencing factors of dysphagia in patients with PD were investigated by binary Logistic regression analysis. The diagnostic efficacy of each index for dysphagia in patients with PD was evaluated by constructing receiver operating characteristic (ROC) curves, and the area under the curve (AUC) was calculated. Results The MMT during forceful biting and MMTF were lower in the study group than those in the control group (all P<0.05). Compared with the non-dysphagia group, the dysphagia group was older and had higher H&Y stage and UPDRS III scores (all P<0.05). The MMT during forceful biting and MMTF in the dysphagia group were lower than those in the non-dysphagia group (all P<0.05). Multivariate Logistic regression analysis showed that increased UPDRS Ⅲ score was the risk factor for dysphagia in patients with PD, and increased MMT during forceful biting and MMTF were protective factors. The ROC curve analysis indicated that the AUC (95%CI) of UPDRS Ⅲ score, MMT during forceful biting and MMTF for diagnosing dysphagia in patients with PD were 0.714 (0.615-0.800), 0.744 (0.647-0.826) and 0.888 (0.809-0.942), respectively. The AUC of MMTF for diagnosing dysphagia in patients with PD was higher than those of UPDRS Ⅲ scores and MMT during forceful biting (Z values were 2.611 and 2.208, respectively, P<0.05). Conclusion MMTF is an independent influencing factor for dysphagia in patients with PD and can be used as a screening indicator for dysphagic patients.

Key words: Parkinson disease, deglutition disorders, masseter muscle, ultrasonography, masseter muscle thickness fraction

中图分类号:

R742.5

图/表 6

参考文献 25

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组别	n	放松时MMT/mm	强咬时MMT/mm	MMTF/%
对照组	50	9.17±0.99	11.95±1.28	30.86±11.56
研究组	100	9.12±0.99	11.35±1.08	24.93±10.29
t		0.257	3.039^＊＊	3.193^＊＊

组别	n	放松时MMT/mm	强咬时MMT/mm	MMTF/%
对照组	50	9.17±0.99	11.95±1.28	30.86±11.56
研究组	100	9.12±0.99	11.35±1.08	24.93±10.29
t		0.257	3.039^＊＊	3.193^＊＊

组别	n	性别（男/女）	年龄/ 岁	BMI/（kg/m²）		受教育程度			高血压	糖尿病		冠心病		抑郁
组别	n	性别（男/女）	年龄/ 岁	BMI/（kg/m²）		小学及以下	初、高中	大专及以上	高血压	糖尿病		冠心病		抑郁
非吞咽困难组	66	35/31	66.94±6.49	22.94±3.64		15（22.73）	28（42.42）	23（34.85）	18（27.27）	15（22.73）		12（18.18）		10（15.15）
吞咽困难组	34	19/15	70.18±9.31	22.61±2.39		11（32.35）	13（38.24）	10（29.41）	14（41.18）	13（38.24）		10（29.41）		7（20.59）
t、χ²或Z		0.073	2.029^＊	0.469		1.097			1.994	2.677		1.649		0.470
组别	焦虑		MCI	牙齿缺损		病程/年		H&Y分期		UPDRS Ⅲ 评分/分		LEDD/（mg/d）
组别	焦虑		MCI	<6颗	≥6颗	病程/年		1—2期	3—5期			LEDD/（mg/d）
非吞咽困难组	15（22.73）		17（25.76）	49（74.24）	17（25.76）	3.75（2.00，6.00）		46（69.70）	20（30.30）	UPDRS Ⅲ 评分/分	36.21±12.73		181.00（122.00，358.38）
吞咽困难组	12（35.29）		10（29.41）	23（67.65）	11（32.35）	5.25（2.75，6.25）		16（47.06）	18（52.94）	44.74±11.49		305.25（158.50，375.25）
t、χ²或Z	1.798		0.152	0.484		1.570		4.881^＊		3.276^＊＊		1.364

组别	n	性别（男/女）	年龄/ 岁	BMI/（kg/m²）		受教育程度			高血压	糖尿病		冠心病		抑郁
组别	n	性别（男/女）	年龄/ 岁	BMI/（kg/m²）		小学及以下	初、高中	大专及以上	高血压	糖尿病		冠心病		抑郁
非吞咽困难组	66	35/31	66.94±6.49	22.94±3.64		15（22.73）	28（42.42）	23（34.85）	18（27.27）	15（22.73）		12（18.18）		10（15.15）
吞咽困难组	34	19/15	70.18±9.31	22.61±2.39		11（32.35）	13（38.24）	10（29.41）	14（41.18）	13（38.24）		10（29.41）		7（20.59）
t、χ²或Z		0.073	2.029^＊	0.469		1.097			1.994	2.677		1.649		0.470
组别	焦虑		MCI	牙齿缺损		病程/年		H&Y分期		UPDRS Ⅲ 评分/分		LEDD/（mg/d）
组别	焦虑		MCI	<6颗	≥6颗	病程/年		1—2期	3—5期			LEDD/（mg/d）
非吞咽困难组	15（22.73）		17（25.76）	49（74.24）	17（25.76）	3.75（2.00，6.00）		46（69.70）	20（30.30）	UPDRS Ⅲ 评分/分	36.21±12.73		181.00（122.00，358.38）
吞咽困难组	12（35.29）		10（29.41）	23（67.65）	11（32.35）	5.25（2.75，6.25）		16（47.06）	18（52.94）	44.74±11.49		305.25（158.50，375.25）
t、χ²或Z	1.798		0.152	0.484		1.570		4.881^＊		3.276^＊＊		1.364

组别	n	放松时MMT/mm	强咬时MMT/mm	MMTF/%
非吞咽困难组	66	9.07±0.95	11.68±0.95	29.50±8.75
吞咽困难组	34	9.23±0.99	10.70±1.03	16.06±6.63
t		0.764	4.786^＊＊	7.865^＊＊

超声测量的咬肌增厚率对帕金森病患者发生吞咽困难的诊断价值

Diagnostic value of masseter muscle thickness fraction measured by ultrasound for dysphagia in patients with Parkinson's disease

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因素	β	SE	Wald χ²	P	OR	OR 95%CI
年龄	0.065	0.051	1.631	0.202	1.067	0.966~1.180
H&Y分期	0.244	0.929	0.069	0.792	1.277	0.207~7.881
UPDRS Ⅲ评分	0.104	0.040	6.870	0.009	1.109	1.026~1.199
强咬时MMT	-1.112	0.441	6.369	0.012	0.329	0.139~0.780
MMTF	-0.248	0.054	21.087	<0.001	0.780	0.702~0.867
常数项	8.616	6.455	1.782	0.182	5 517.140

指标		AUC（95%CI）			P
UPDRS Ⅲ评分		0.714（0.615~0.800）			<0.001
强咬时MMT		0.744（0.647~0.826）			<0.001
MMTF		0.888（0.809~0.942）			<0.001
指标	截断值		敏感度/%	特异度/%		约登指数
UPDRS Ⅲ评分	32分		88.2	50.0		0.382
强咬时MMT	11.13 mm		70.6	71.2		0.418
MMTF	20.28%		88.3	86.4		0.746

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