Data_Sheet_1_The Role of the Diaphragm in Postural Stability and Visceral Function in Parkinson’s Disease.docx

Background: In normal subjects, the diaphragm plays a key functional role in postural stability, articulation, respiration, defecation, and urination.
Objectives: The aim of this study was to investigate the role of the diaphragm in postural stability and visceral function in patients with Parkinson’s disease (PD) and to compare the diaphragm function by gender, Hoehn and Yahr (H&Y) staging, and motor subtypes.
Methods: In total, 79 patients were enrolled in this cross-sectional study. The severity of the disease was assessed by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale III and by H&Y staging. Postural stability was quantitatively recorded, and respiratory function was evaluated by spirometry. Several scales were used to evaluate visceral function in patients with PD. In addition, diaphragm ultrasound was used to measure the excursion, contraction velocity, and thickness of the diaphragm during quiet breathing, deep breathing, and the sniff test. Significant features were selected by the least absolute shrinkage and selection operator (LASSO) regression and fitted in the multivariate linear regression and Pearson’s correlation analysis.
Results: Diaphragm thickness and excursion during quiet breathing were significantly different between men and women and between H&Y stage 1–2 and stage 2.5–3, whereas the diaphragm function was not influenced by motor subtypes. It was shown that the diaphragmatic function was significantly correlated with postural stability, voice function, respiratory function, constipation, and urological function to varying degrees in patients with PD.
Conclusion: The diaphragmatic function is associated with dysfunction in PD although it remains unclear as to whether the observed changes in the diaphragm are primary or secondary.

研究背景：在健康受试者中，膈肌在姿势稳定性、发音功能、呼吸、排便及排尿等生理过程中发挥关键作用。
研究目的：本研究旨在探讨膈肌在帕金森病（PD）患者姿势稳定性与内脏功能中的作用，并按性别、霍恩-亚尔（H&Y）分期及运动亚型对膈肌功能进行比较分析。
研究方法：本横断面研究共纳入79例帕金森病患者。采用运动障碍学会统一帕金森病评定量表第三部分（Movement Disorder Society-Unified Parkinson’s Disease Rating Scale III）及霍恩-亚尔（H&Y）分期评估疾病严重程度。通过定量记录姿势稳定性，并采用肺量测定法评估呼吸功能；采用多维度量表评估PD患者的内脏功能。此外，通过膈肌超声测量受试者在静息呼吸、深呼吸及吸气试验时的膈肌活动度、收缩速度与厚度。采用最小绝对收缩和选择算子（LASSO）回归筛选特征变量，并将其纳入多元线性回归与皮尔逊相关分析。
研究结果：静息呼吸状态下的膈肌厚度与活动度在性别间、H&Y分期1~2期与2.5~3期患者间均存在显著差异，但膈肌功能不受运动亚型影响。研究显示，PD患者的膈肌功能与姿势稳定性、发音功能、呼吸功能、便秘症状及泌尿功能均存在不同程度的显著相关性。
研究结论：尽管目前尚不清楚所观察到的膈肌改变为原发性还是继发性，但膈肌功能与帕金森病患者的功能障碍存在关联。