To explore the risk factors of dysphagiain PD.

One hundred and seven consecutive PD patients were recruited in Henan Provincial People's Hospital from June 2018 to December 2019, and general demographic data, incidence of dysphagia and sialorrhea, disease stage and illness severity, severity of anxiety and depression, cognitive function, as well as uric acid and homocsteine were retrospectively analyzed. Risk factors of dysphagia in PD were explored using multivariate Logistic regression analysis. ROC curve analysis was used for evaluating the predictive value of independent risk factors for dysphagia in PD.

Of the 107 PD patients, 45 with dysphagia and 62 without were assigned to an observation group and a control group, respectively, with an incidence of dysphagia of 42.1% (45/107). There were significant difference in terms of age, Hoehn-Yahr classification, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅰ, Ⅱ and Ⅲ scores, incidence of sialorrhea, the 14-item Hamilton Anxiety Scale (HAMA-14) score, the 24-item Hamilton Depression Scale (HAMD-24) score, Mini-mental State Examination (MMSE) score and uric acid between these two groups (P≤0.05). Multivariate Logistic regression analysis showed that, UPDRSⅢ score≥35〔OR=7.639, 95%CI (2.750, 21.219) 〕, sialorrhea〔OR=3.336, 95%CI (1.178, 9.447) 〕, HAMA-14 score≥13〔OR=2.847, 95%CI (1.027, 7.894) 〕and uric acid <251 μmol/L〔OR=0.354, 95%CI (0.129, 0.971) 〕were independent risk factors of dysphagia in PD (P<0.05). ROC curve analysis showed that, AUC of UPDRS Ⅲ score, sialorrhea, HAMA-14 score and uric acid was 0.750, 0.682, 0.638 and 0.670 in predicting dysphagia in PD, with sensitivity of 69.4%, 56.5%, 59.7% and 64.5%, specificity of 80.0%, 80.0%, 71.1% and 66.7%, Youden index of 0.494, 0.365, 0.308 and 0.312, respectively.

UPDRSⅢ score≥35, HAMA-14 score≥13, sialorrhea and uric acid <251 μmol/L are independent risk factors of dysphagia in PD, and the above four risk factors has certain predictive value for dysphagia in PD.

探讨PD患者发生吞咽困难的危险因素。

连续收集2018年6月至2019年12月河南省人民医院收治的PD患者107例，分析其一般资料、吞咽困难与流涎发生情况、疾病分期与严重程度、焦虑与抑郁程度、认知功能、尿酸与同型半胱氨酸水平。PD患者发生吞咽困难的危险因素分析采用多因素Logistic回归分析；绘制受试者工作特征（ROC）曲线以分析多因素Logistic回归分析筛选出的危险因素对PD患者发生吞咽困难的预测价值。

107例PD患者中45例发生吞咽困难（观察组），62例未发生吞咽困难（对照组），吞咽困难发生率为42.1%（45/107）。两组患者年龄、Hoehn-Yahr分级（H-Y分级）、统一帕金森病评分量表（UPDRS） Ⅰ评分、UPDRS Ⅱ评分、UPDRS Ⅲ评分、流涎发生率、汉密尔顿焦虑量表14项版（HAMA-14）评分、汉密尔顿抑郁量表24项版（HAMD-24）评分、简易智能精神状态检查量表（MMSE）评分及尿酸水平比较，差异有统计学意义（P≤0.05）。多因素Logistic回归分析结果显示，UPDRSⅢ评分≥35分〔OR=7.639，95%CI（2.750，21.219）〕、流涎〔OR=3.336，95%CI（1.178，9.447）〕、HAMA-14评分≥13分〔OR=2.847，95%CI（1.027，7.894）〕、尿酸<251 μmol/L〔OR=0.354，95%CI（0.129，0.971）〕是PD患者发生吞咽困难的独立危险因素（P<0.05）。ROC曲线分析结果显示，UPDRS Ⅲ评分、流涎、HAMA-14评分、尿酸预测PD患者发生吞咽困难曲线下面积分别为0.750、0.682、0.638、0.670，灵敏度分别为69.4%、56.5%、59.7%、64.5%，特异度分别为80.0%、80.0%、71.1%、66.7%，约登指数分别为0.494、0.365、0.308、0.312。

UPDRSⅢ评分≥35分、流涎、HAMA-14评分≥13分、尿酸<251 μmol/L是PD患者发生吞咽困难的独立危险因素，且以上4项指标对PD患者吞咽困难的发生均具有一定预测价值。