中国特定人群吞咽功能障碍的流行病学调查报告

Prevalence of dysphagia in China： an epidemiology survey of 6102 participants

目的了解中国脑卒中、神经退行性疾病、头颈部肿瘤患者和老年人群的吞咽功能障碍流行病学现状。方法选取3种最常见的与吞咽障碍相关的疾病人群（包括脑卒中、神经退行性疾病和头颈部肿瘤）以及年龄≥65岁的老年人群（包括一般社区和养护机构），采用Ohkuma和Sydney吞咽问卷调查、洼田饮水测试和吞咽造影检查评估吞咽功能，观察该3种疾病和老年人群吞咽障碍的患病率，并比较我国三大主要经济区之间以及不同性别、年龄的吞咽障碍的患病率差异。结果总调查人数为7000例，其中有效调查人数为6102例，吞咽障碍阳性人数2363例，吞咽障碍的患病率为38．7％。各种疾病吞咽障碍的患病率分别为脑卒中（急性期46．3％、恢复期56．9％）、神经退行性疾病（阿尔兹海默症40．8％、帕金森病46．2％、多发性硬化12．5％、脊髓侧索硬化50．0％）、头颈肿瘤（鼻咽癌36．6％、喉癌58．4％）。老年人群的吞咽障碍患病率分别为一般社区13．9％、养护机构26．4％。三大经济地区吞咽障碍患病率分别为中部地区最高55．0％、东部沿海地区次之38．6％、西部地区最低32．5％，且差异有统计学意义（X2=116．2，P〈0．001）。不同性别吞咽障碍患病率比较，男性患病率40．0％、女性36．3％，男性患病率高于女性（X2=8．757，P=0．003）；年龄分组显示患病率随年龄增长而增加（X2=20．993，P〈0．001）。结论吞咽障碍在我国脑卒中、神经退行性疾病、头颈部肿瘤和老年人群中患病率处于较高水平，其中男性高于女性，与年龄增长正相关，且存在经济区域间的差异。

Objective To determine the prevalence of dysphagia among elderly population and patients with stroke, head and neck cancer or neurodegenerative diseases in China. Methods Patients with stroke, head and neck cancer and neurodegenerative diseases, as well as elderly people older than 65 were selected. They were sur- veyed using the Sydney or Ohkuma swallowing questionnaire and evaluated using the Kubota＇s water swallow test and videofluoroscopie swallowing study （VFSS）. The incidence of dysphagia among patients with the three diseases and elderly population was recorded, and its relationship with age, gender and economic status was also observed. Results For 7000 people surveyed, 6102 met the inclusion criteria. Of all the included participants, 2363 （ 38.7% ） were identified as having swallowing abnormalities. Dysphagia was found in 46.3% of stroke patients at the acute phase, 56.9% of stroke patients at the chronic phase, 40.8% of Alzheimer＇s disease patients, 46.2% of Parkinson＇s disease patients, 12.5% of multiple sclerosis patients, 50.0% of amyotrophic lateral sclerosis patients, 36.6% of nasopharyngeal cancer sufferers, 58.4% of laryngeal cancer sufferers. The prevalence of oropharyngeal dysphagia was 26.4% and 13.9% in nursing home- and community-dwelling elderly people. The average prevalence rate of deglutition disorder in the midland （55.0%） was significantly higher than the east coast （38.6%）, still significantly higher than the western areas （32.5%） of China （X2= 116.2, P〈0.001 ） , representing 3 different economic development status. This study demonstrated that the prevalence of the male （40.0%） was higher than the female （36.3%）. Moreover, the prevalence increased with age. Conclusion Dysphagia is of high prevalence among patients with stroke, head and neck cancers or neurodegenerative diseases, as well as the elderly in China. Its prevalence has significant correlations with age, gender and economic status.