조기발병형 파킨슨병환자와 정상인의 호흡 및 발성 특성 비교 = Characteristics of Respiration and Phonation in Patients with Young-Onset Parkinson’s Disease Compared to Normal Adults

국문 초록 (Abstract)

배경 및 목적: 파킨슨병은 호흡과 발성에 영향을 준다. 49세 이전에 발병하는 조기발병형 파킨슨병(young-onset parkinson’s disease: YOPD, 이하 YOPD)도 호흡과 발성에 문제가 있는지 보기 위해 정상군과 비교하여 살펴보고자 하였다. 또한 파킨슨병 환자의 음성에 관한 연구는 있었지만 YOPD 환자의 음성특성에 대한 호흡과 발성 기능에 대해서 연구된 선행연구는 찾아보기 어렵다. 방법: YOPD 환자군 6명과 빈도대응 시킨 정상군 6명을 대상으로 호흡기능 평가를 위하여 MicroQuarkⓇ를 이용하여 노력성 폐활량(forced vital capacity: FVC, 이하 FVC), 1초간 노력성 호기량(forced expiratory volume at one second: FEV1, 이하 FEV1)과 1초간 노력성 호기량의 노력성 폐활량에 대한 비(이하 FEV1/FVC)를, 음향학적인 평가를 위하여 Multi-Dimentional Voice Program(이하 MDVP)를 이용하여 주기간 주파수 변동률 (이하 jitter)과 주기간 진폭 변동률(이하 shimmer)을, 공기역학적인 평가를 위하여 Phonatory Aerodynamic System(이하 PAS)를 이용하여 평균호기류율(mean airflow rate: MFR, 이하 MFR)과 성문하압(subglottal pressure: Psub, 이하 Psub)을, MDVP를 이용하여 최대발성지속시간(maximum phonation time: MPT, 이하 MPT)을 측정하고 분석하였다. 이비인후과 전문의사가 후두 스트로보스코피(stroboscopy)를 통해 후두의 병리 유무를 평가하였다. 두 집단의 호흡기능, 발성기능의 차이는 맨-휘트니 U검정(Mann-Whitney U-test)을 실시했다. 결과: MPT는 YOPD 환자군에 비하여 정상군이 통계적으로 유의하게 길었고, jitter와 shimmer는 정상군에 비하여 YOPD 환자군이 통계적으로 유의하게 컸다. 그러나 두 군간의 FVC, FEV1, FEV1/FVC, MFR, Psub은 통계적으로 유의한 차이가 없었다. 논의 및 결론: 두 집단 간의 호흡기능에서 차이가 없고 YOPD의 MPT, jitter, shimmer가 정상범주를 벗어나 차이가 있다. 이들 변수들이 YOPD의 음성적 진단, 치료계획과 예후를 판단하는데 도움이 될 것이다. 따라서 본 연구는 ‘연령’이라는 혼란변수를 배제하고 파킨슨병의 음성 특성을 규명 하는데 의의가 있다고 할 수 있다.

다국어 초록 (Multilingual Abstract)

Background & Objectives: Parkinson’s disease affects respiration as well as phonation. Young-onset Parkinson’s disease (YOPD) can occur even before the age of 49 years. The present study selected YOPD patients in such a manner as to exclude the confounding variable of ‘age’ and thus examine the vocal characteristics of Parkinson’s disease solely. We aimed to compare the respiration function and phonation characteristics of these YOPD patients with a normal group. Methods: The present study’s subjects included a YOPD group comprised of 6 patients whose chronological ages were between 38 and 49 years and onset ages were prior to 49 years, and a normal group comprised of 6 subjects selected by frequency-matching. For testing respiration function, FVC, FEV1 and FEV1/FVC were measured using Cosmed’s MicroQuarkⓇ as a basic test for the ventilation function of the lung. For vocal sampling, the Multi-Dimensional Voice Program (MDVP) and the Advanced Model 5105 of KayPENTAX’s Computerized Speech Lab (CSL) Model 4400 were used to analyze maximum phonation time (MPT), jitter, and shimmer. Additionally, KayPENTAX’s Phonatory Aerodynamic System (PAS) 4500 was utilized to analyze mean air flow rate (MFR) and subglottal pressure (Psub). Otolaryngologists and neurologists participated in the research cooperatively, and the otolaryngologists assessed the presence of laryngeal disease directly through larynx stroboscopy in the all subject. Mann-Whitney’s U test was used to analyze the difference between the 2 groups’ respiration and phonation function. Results: The MPT was longer in the normal group than YOPD patient group, and both jitter and shimmer were larger in the YOPD patient group than the normal group; both of these differences were statistically significant. However, there was no statistically significant difference in FVC, FEV1, FEV1/FVC, MFR, and Psub. Discussion & Conclusion: The 2 groups’ respiration function did not differ, and YOPD patients’ MPT, jitter, and shimmer differed beyond the normal range. Thus, these variables will help in YOPD patients’ phonation diagnosis and therapeutic plans or prognosis. Although there have been studies on the phonation of Parkinson’s disease patients, limited advanced research can be found on the respiration and phonation function of YOPD patients’ vocal characteristics. The results of this study are meaningful and provide a better understanding of Parkinson’s disease because the subjects were selected such that confounding by age was avoided.

목차 (Table of Contents)

• Ⅰ. 서 론
• Ⅱ. 연구 방법
• Ⅲ. 연구 결과
• Ⅳ. 논의 및 결론

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