帕金森患者吞咽障碍的特点及影响因素

doi:10.3877/cma.j.issn.2095-123X.2026.04.004

目的

探讨帕金森病（PD）患者吞咽障碍的特点及影响因素。

方法

连续纳入2023年6月至2025年4月深圳市龙岗区第八人民医院康复科收治的PD患者34例。收集患者的一般资料，分析吞咽障碍临床特点及其与病程、认知功能的关系，计算各类吞咽障碍表现的发生率；采用二元Logistic回归分析PD患者发生吞咽障碍的影响因素。

结果

34例PD患者中吞咽延迟的发生率（88.2%）最高，其次为提前溢出和残留（均为55.9%），且随着摄入量的增加，3种吞咽障碍表现的发生率均呈明显上升趋势，差异均有统计学意义（P<0.05）。二元Logistic回归分析显示，患者的病程不是吞咽延迟、提前溢出及残留发生的独立影响因素（P>0.05）；MoCA评分是10 mL低稠、5 mL高稠食物发生提前溢出的独立保护因素，是5 mL高稠食物发生残留的独立危险因素（均P<0.05）。

结论

吞咽延迟是PD患者吞咽障碍常见表现；摄入量越大，患者发生吞咽障碍的风险越高。MoCA认知评分可影响PD患者提前溢出及残留的发生，而病程对PD患者吞咽障碍无影响。

关键词: 帕金森病, 吞咽障碍, 认知功能, 危险因素

Objective

To explore the characteristics of swallowing disorders and their influencing factors in Parkinson disease (PD) patients, aiming to provide a reference for the early detection, diagnosis, and intervention of swallowing disorders in this population.

Methods

Thirty-four PD patients admitted to The Eighth People's Hospital of Longgang District in Shenzhen from June 2023 to April 2025 were consecutively enrolled. Their general data, characteristics of swallowing disorders, and the relationship with disease duration and cognitive function were analyzed. The characteristics of swallowing disorders were analyzed using the incidence rates of various manifestations, and influencing factors were analyzed using binary Logistic regression.

Results

Among the 34 PD patients, swallowing delay had the highest incidence (88.2%), followed by premature spillage and residue (both 55.9%). As the intake volume increased, the incidence rates of all three swallowing disorder manifestations showed a significant upward trend (P<0.05). Binary Logistic regression analysis revealed that disease duration was not an independent influencing factor for swallowing delay, premature spillage or residue (P>0.05). The MoCA score was an independent protective factor for premature spillage with 10 mL low-thickened and 5 mL high-thickened boluses, and an independent risk factor for residue with 5 mL high-thickened boluses (all P<0.05).

Conclusions

Swallowing delay was a common feature of dysphagia in PD patients, with the risk of swallowing impairments rising as bolus volume increased. MoCA-evaluated cognitive function was associated with premature spillage and residue, whereas disease duration had no significant impact on these three swallowing outcomes.

Key words: Parkinson disease, Dysphagia, Cognitive function, Risk factors

表1 帕金森病患者在不同食团量和稠度下吞咽障碍的发生情况[例（%）]

Tab.1 Prevalence of dysphagia manifestations in Parkinson disease patients under different bolus volumes and food consistencies [n(%)]

分类	稠度	食团量			χ²值	P值
分类	稠度	3 mL	5 mL	10 mL	χ²值	P值
	低稠	4（11.76）	5（14.71）	13（38.24）	16.222	<0.001
提前溢出	中稠	0	1（2.94）	9（26.47）	16.222	<0.001
	高稠	5（14.71）	7（20.59）	12（35.29）	7.091	0.029
	低稠	11（32.35）	18（52.94）	22（64.71）	16.909	<0.001
吞咽延迟	中稠	10（29.41）	18（52.94）	23（67.65）	17.200	<0.001
	高稠	13（38.24）	22（64.71）	26（76.47）	20.462	<0.001
	低稠	5（14.71）	14（41.18）	14（41.18）	16.200	<0.001
残留	中稠	5（14.71）	8（23.53）	14（41.18）	14.000	0.001
	高稠	7（20.59）	15（44.12）	17（50.00）	15.273	<0.001

表1 帕金森病患者在不同食团量和稠度下吞咽障碍的发生情况[例（%）]

Tab.1 Prevalence of dysphagia manifestations in Parkinson disease patients under different bolus volumes and food consistencies [n(%)]

分类	稠度	食团量			χ²值	P值
分类	稠度	3 mL	5 mL	10 mL	χ²值	P值
	低稠	4（11.76）	5（14.71）	13（38.24）	16.222	<0.001
提前溢出	中稠	0	1（2.94）	9（26.47）	16.222	<0.001
	高稠	5（14.71）	7（20.59）	12（35.29）	7.091	0.029
	低稠	11（32.35）	18（52.94）	22（64.71）	16.909	<0.001
吞咽延迟	中稠	10（29.41）	18（52.94）	23（67.65）	17.200	<0.001
	高稠	13（38.24）	22（64.71）	26（76.47）	20.462	<0.001
	低稠	5（14.71）	14（41.18）	14（41.18）	16.200	<0.001
残留	中稠	5（14.71）	8（23.53）	14（41.18）	14.000	0.001
	高稠	7（20.59）	15（44.12）	17（50.00）	15.273	<0.001

表2 病程影响帕金森病患者吞咽障碍发生的二元Logistic回归分析

Tab.2 Binary Logistic regression analysis of the influence of disease duration on the occurrence of dysphagia in Parkinson disease patients

项目		偏回归系数	标准误	Wald值	P值	OR值	95%CI
提前溢出
	3 mL	0.227	0.159	2.037	0.154	1.254	0.919~1.713
低稠	5 mL	0.146	0.144	1.022	0.312	1.157	0.872~1.535
	10 mL	-0.006	0.114	0.003	0.960	0.994	0.796~1.243
	3 mL	-	-	-	-	-	-
中稠	5 mL	0.223	0.262	0.724	0.395	1.250	0.748~2.091
	10 mL	-0.038	0.129	0.088	0.766	0.962	0.747~1.239
	3 mL	0.210	0.148	2.006	0.157	1.233	0.923~1.648
高稠	5 mL	0.124	0.130	0.909	0.340	1.132	0.877~1.463
	10 mL	0.037	0.114	0.106	0.745	1.038	0.829~1.299
吞咽延迟
	3 mL	-0.087	0.127	0.477	0.490	0.916	0.715~1.174
低稠	5 mL	0.027	0.111	0.061	0.805	1.028	0.827~1.278
	10 mL	0.029	0.117	0.063	0.802	1.030	0.818~1.296
	3 mL	0.062	0.119	0.275	0.600	1.064	0.843~1.343
中稠	5 mL	0.133	0.120	1.221	0.269	1.142	0.902~1.446
	10 mL	0.087	0.127	0.477	0.490	1.091	0.852~1.399
	3 mL	-0.019	0.114	0.027	0.870	0.981	0.784~1.228
高稠	5 mL	-0.011	0.115	0.009	0.924	0.989	0.790~1.239
	10 mL	0.002	0.130	0.000	0.988	1.002	0.776~1.293
残留
	3 mL	-0.190	0.196	0.941	0.332	0.827	0.563~1.214
低稠	5 mL	-0.117	0.122	0.920	0.338	0.890	0.701~1.130
	10 mL	-0.034	0.114	0.092	0.762	0.966	0.773~1.207
	3 mL	0.125	0.144	0.751	0.386	1.133	0.854~1.504
中稠	5 mL	0.031	0.127	0.060	0.807	1.032	0.804~1.324
	10 mL	-0.074	0.117	0.403	0.526	0.928	0.738~1.168
	3 mL	0.021	0.134	0.024	0.876	1.021	0.785~1.329
高稠	5 mL	-0.132	0.122	1.173	0.279	0.876	0.690~1.113
	10 mL	-0.149	0.121	1.517	0.218	0.861	0.679~1.092

表2 病程影响帕金森病患者吞咽障碍发生的二元Logistic回归分析

Tab.2 Binary Logistic regression analysis of the influence of disease duration on the occurrence of dysphagia in Parkinson disease patients

项目		偏回归系数	标准误	Wald值	P值	OR值	95%CI
提前溢出
	3 mL	0.227	0.159	2.037	0.154	1.254	0.919~1.713
低稠	5 mL	0.146	0.144	1.022	0.312	1.157	0.872~1.535
	10 mL	-0.006	0.114	0.003	0.960	0.994	0.796~1.243
	3 mL	-	-	-	-	-	-
中稠	5 mL	0.223	0.262	0.724	0.395	1.250	0.748~2.091
	10 mL	-0.038	0.129	0.088	0.766	0.962	0.747~1.239
	3 mL	0.210	0.148	2.006	0.157	1.233	0.923~1.648
高稠	5 mL	0.124	0.130	0.909	0.340	1.132	0.877~1.463
	10 mL	0.037	0.114	0.106	0.745	1.038	0.829~1.299
吞咽延迟
	3 mL	-0.087	0.127	0.477	0.490	0.916	0.715~1.174
低稠	5 mL	0.027	0.111	0.061	0.805	1.028	0.827~1.278
	10 mL	0.029	0.117	0.063	0.802	1.030	0.818~1.296
	3 mL	0.062	0.119	0.275	0.600	1.064	0.843~1.343
中稠	5 mL	0.133	0.120	1.221	0.269	1.142	0.902~1.446
	10 mL	0.087	0.127	0.477	0.490	1.091	0.852~1.399
	3 mL	-0.019	0.114	0.027	0.870	0.981	0.784~1.228
高稠	5 mL	-0.011	0.115	0.009	0.924	0.989	0.790~1.239
	10 mL	0.002	0.130	0.000	0.988	1.002	0.776~1.293
残留
	3 mL	-0.190	0.196	0.941	0.332	0.827	0.563~1.214
低稠	5 mL	-0.117	0.122	0.920	0.338	0.890	0.701~1.130
	10 mL	-0.034	0.114	0.092	0.762	0.966	0.773~1.207
	3 mL	0.125	0.144	0.751	0.386	1.133	0.854~1.504
中稠	5 mL	0.031	0.127	0.060	0.807	1.032	0.804~1.324
	10 mL	-0.074	0.117	0.403	0.526	0.928	0.738~1.168
	3 mL	0.021	0.134	0.024	0.876	1.021	0.785~1.329
高稠	5 mL	-0.132	0.122	1.173	0.279	0.876	0.690~1.113
	10 mL	-0.149	0.121	1.517	0.218	0.861	0.679~1.092

表3 MoCA评分影响帕金森病患者发生吞咽障碍的二元Logistics回归分析

Tab.3 Binary Logistic regression analysis of the influence of MoCA score on the occurrence of dysphagia in Parkinson disease patients

项目		偏回归系数	标准误	Wald值	P值	OR值	95%CI
提前溢出
	3 mL	-0.085	0.093	0.840	0.359	0.918	0.765~1.102
低稠	5 mL	-0.067	0.083	0.646	0.421	0.935	0.795~1.101
	10 mL	-0.165	0.079	4.372	0.037	0.848	0.726~0.990
	3 mL	-0.138	0.155	0.794	0.373	0.871	0.643~1.180
中稠	5 mL	-	-	-	-	-	-
	10 mL	-0.066	0.067	0.956	0.328	0.936	0.820~1.069
	3 mL	-0.190	0.107	3.166	0.075	0.827	0.671~1.019
高稠	5 mL	-0.162	0.082	3.910	0.048	0.851	0.725~0.999
	10 mL	-0.044	0.063	0.479	0.489	0.957	0.845~1.084
吞咽延迟
	3 mL	-0.097	0.068	2.031	0.154	0.907	0.793~1.037
低稠	5 mL	-0.105	0.073	2.087	0.149	0.900	0.780~1.038
	10 mL	-0.167	0.096	3.034	0.082	0.847	0.702~1.021
	3 mL	-0.075	0.067	1.262	0.261	0.928	0.815~1.057
中稠	5 mL	-0.122	0.076	2.574	0.109	0.885	0.763~1.027
	10 mL	-0.058	0.075	0.594	0.441	0.944	0.815~1.093
	3 mL	-0.093	0.067	1.912	0.167	0.911	0.799~1.040
高稠	5 mL	-0.137	0.084	2.629	0.105	0.872	0.739~1.029
	10 mL	-0.150	0.101	2.207	0.137	0.860	0.706~1.049
残留
	3 mL	0.006	0.081	0.005	0.943	1.006	0.858~1.180
低稠	5 mL	0.057	0.064	0.780	0.377	1.058	0.933~1.200
	10 mL	0.045	0.063	0.496	0.481	1.046	0.924~1.184
	3 mL	0.261	0.158	2.721	0.099	1.299	0.952~1.772
中稠	5 mL	0.063	0.076	0.699	0.403	1.066	0.918~1.236
	10 mL	0.078	0.066	1.380	0.240	1.081	0.949~1.231
	3 mL	0.105	0.089	1.403	0.236	1.111	0.933~1.323
高稠	5 mL	0.306	0.120	6.526	0.011	1.359	1.074~1.719
	10 mL	0.128	0.072	3.187	0.074	1.136	0.988~1.308

表3 MoCA评分影响帕金森病患者发生吞咽障碍的二元Logistics回归分析

Tab.3 Binary Logistic regression analysis of the influence of MoCA score on the occurrence of dysphagia in Parkinson disease patients

项目		偏回归系数	标准误	Wald值	P值	OR值	95%CI
提前溢出
	3 mL	-0.085	0.093	0.840	0.359	0.918	0.765~1.102
低稠	5 mL	-0.067	0.083	0.646	0.421	0.935	0.795~1.101
	10 mL	-0.165	0.079	4.372	0.037	0.848	0.726~0.990
	3 mL	-0.138	0.155	0.794	0.373	0.871	0.643~1.180
中稠	5 mL	-	-	-	-	-	-
	10 mL	-0.066	0.067	0.956	0.328	0.936	0.820~1.069
	3 mL	-0.190	0.107	3.166	0.075	0.827	0.671~1.019
高稠	5 mL	-0.162	0.082	3.910	0.048	0.851	0.725~0.999
	10 mL	-0.044	0.063	0.479	0.489	0.957	0.845~1.084
吞咽延迟
	3 mL	-0.097	0.068	2.031	0.154	0.907	0.793~1.037
低稠	5 mL	-0.105	0.073	2.087	0.149	0.900	0.780~1.038
	10 mL	-0.167	0.096	3.034	0.082	0.847	0.702~1.021
	3 mL	-0.075	0.067	1.262	0.261	0.928	0.815~1.057
中稠	5 mL	-0.122	0.076	2.574	0.109	0.885	0.763~1.027
	10 mL	-0.058	0.075	0.594	0.441	0.944	0.815~1.093
	3 mL	-0.093	0.067	1.912	0.167	0.911	0.799~1.040
高稠	5 mL	-0.137	0.084	2.629	0.105	0.872	0.739~1.029
	10 mL	-0.150	0.101	2.207	0.137	0.860	0.706~1.049
残留
	3 mL	0.006	0.081	0.005	0.943	1.006	0.858~1.180
低稠	5 mL	0.057	0.064	0.780	0.377	1.058	0.933~1.200
	10 mL	0.045	0.063	0.496	0.481	1.046	0.924~1.184
	3 mL	0.261	0.158	2.721	0.099	1.299	0.952~1.772
中稠	5 mL	0.063	0.076	0.699	0.403	1.066	0.918~1.236
	10 mL	0.078	0.066	1.380	0.240	1.081	0.949~1.231
	3 mL	0.105	0.089	1.403	0.236	1.111	0.933~1.323
高稠	5 mL	0.306	0.120	6.526	0.011	1.359	1.074~1.719
	10 mL	0.128	0.072	3.187	0.074	1.136	0.988~1.308

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Characteristics and influencing factors of dysphagia in Parkinson disease patients

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Characteristics and influencing factors of dysphagia in Parkinson disease patients