早期帕金森病与非典型帕金森综合征患者嗓音参数的临床研究

Clinical Study of Voice Parameters in Early Parkinson’s Disease and Atypical Parkinsonism

摘要: 目的：探索早期帕金森病(Parkinson’s disease, PD)和非典型帕金森综合征(Atypical Parkinsonism, APS)之间有鉴别意义的元音及嗓音质量相关的嗓音参数，并分析可能的临床相关因素。方法：纳入早期PD患者38例、APS患者35例。收集人口学资料及临床资料，采用统一帕金森病评定量表第三部分(Unified Parkinson’s Disease Rating Scale, UPDRS III)、嗓音障碍评定量表(Voice Handicap Index, VHI)、汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)、汉密尔顿抑郁量表(Hamilton Depression Scale, HAMD)、蒙特利尔认知评估量表(Montreal Cognitive Assessment, MOCA)、简易精神状态检查量表(Mini-mental State Examination, MMSE)、帕金森病疲劳量表(Parkinson Fatigue Scale, PFS)。收集患者核心元音的嗓音参数资料：/i/、/u/、/v/、/o/、/e/、/a/、/s/、/zh/、/er/，使用Praat分析软件提取各元音的嗓音参数：基频(F0)、音强(Loudness)、基频微扰(Jitter)、振幅微扰(Shimmer)及谐噪比(Harmonics-to-Noise ratio, HNR)。人口学资料和临床资料采用卡方检验或Mann-Whitney U检验，不同组别的元音嗓音参数比较采用Mann-Whitney U检验，组间差异性嗓音参数与临床特征进行Spearman相关性分析。结果：临床资料分析显示，PD患者与APS患者在UPDRS III得分、MOCA得分、MMSE得分、HAMA得分、HAMD得分及尿频率方面的差异有统计学意义(P < 0.05)。以下元音的嗓音参数值水平在PD和APS间差异有统计学差异(P < 0.05)：/i/、/u/、/v/、/s/、/zh/的F0值，/u/、/v/、/o/、/e/、/s/、/zh/、/er/的Jitter值，/i/、/u/、/v/、/o/、/e/、/s/、/zh/的Shimmer值，/er/的HNR值。音强大小在两组间无统计学差异(P > 0.05)。PD患者嗓音参数变化与认知功能、运动功能、疲劳状态有相关性，APS患者嗓音参数变化与认知功能、焦虑情绪、自主神经功能有相关性。结论：部分元音的F0、Jitter、Shimmer、HNR值在PD和APS的鉴别中有重要意义，PD和APS嗓音参数变化与部分非运动症状有一定相关性。

Abstract: Aim: The objective of this study was to explore the Voice Acoustic parameters related to vowel and voice quality that are discriminatory between early primary Parkinson’s disease (PD) and Atypical Parkinsonism syndrome (APS), and to analyze the possible clinical correlates of the phase. Methods: A total of 38 patients with early primary PD and 35 patients with APS were included. Demographic and clinical data were collected, including the Unified Parkinson’s Disease Rating Scale Part III (UPDRS III), Voice Handicap Index (VHI), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Montreal Cognitive Assessment (MOCA), Mini mental State Examination (MMSE), and Parkinson Fatigue scale (PFS). Voice parameters of the core vowels were collected, such as /i/, /u/, /v/, /o/, /e/, /a/, /s/, /zh/, /er/, and extracted Fundamental frequency (F0), Intensity, Jitter, Shimmer and Harmonic to noise ratio (HNR) by using Praat analysis software. The demographic and clinical data were analyzed by Chi-square test or Mann-Whitney U test, and the vowel voice parameters were compared between groups by Mann-Whitney U test, and Spielman correlation analysis was performed between the differential voice acoustic parameters and clinical characteristics. Results: The analysis of clinical data revealed statistically significant differences between PD patients and APS patients in UPDRS III score, MOCA score, MMSE score, HAMA score, HAMD score and presence of urinary frequency (P < 0.05). The following vowel voice parameters were found to be statistically different between PD and APS (P < 0.05): F0 values for /i/, /u/, /v/, /s/, /zh/, Jitter values for /u/, /v/, /o/, /e/, /s/, /zh/, /er/, /i/, /u/, /v/, /o/, /e/, /s/, /zh/ Shimmer, and HNR values of /er/. There was no statistical difference in voice intensity between groups (P > 0.05). Changes in voice parameters were correlated with cognitive function, motor function, and fatigue status in APS patients and with cognitive function, anxiety, and autonomic function in APS patients. Conclusion: F0, Jitter, Shimmer, and HNR values of some vowels are im-portant in the differentiation of PD and APS, and changes of voice parameters in PD and APS are correlated with some non-motor symptoms.