不同起病方式肌萎缩侧索硬化患者吞咽功能特点的比较

Clininal research of deglutition function in patients with amyotrophic lateral sclerosis

目的比较不同起病方式的肌萎缩侧索硬化(ALS)患者吞咽功能的特点。方法根据起病方式将70例有吞咽障碍ALS患者分为肢体起病组(42例)及球部起病组(28例)。采用吞咽造影(VFSS)检查患者的吞咽功能,分析吞咽功能与一般临床资料的关系。结果与肢体起病组比较,球部起病组的VFSS检查口中漏出和向咽部移送障碍比率显著升高(Z=-2.699,P=0.007;Z=-2.102,P=0.036)。两组患者VFSS评分结果均异常。与肢体起病组比较,球部起病组VFSS口腔期评分显著降低,洼田饮水试验等级显著升高(t=2.027,P=0.048;t=-2.387,P=0.020)。肢体起病组球部受累持续时间与VFSS总分、误咽程度评分呈负相关(r=-0.354,P=0.022;r=-0.313,P=0.044)。VFSS总分和口腔期评分在不同病程分组的差异有统计学意义(F=2.961,P=0.032;F=2.796,P=0.040)。不同球部受累持续时间患者的VFSS总分和误咽程度评分差异有统计学意义(F=5.027,P=0.002;F=5.632,P=0.001)。球部起病组VFSS总分、咽期和误咽程度评分与发病年龄呈显著相关性(r=-0.490,P=0.008;r=-0.414,P=0.029;r=-0.532,P=0.004)。不同发病年龄患者的VFSS总分、咽期和误咽程度评分差异有统计学意义(F=5.909,P=0.008;F=3.502,P=0.046;F=8.982,P=0.001)。男性误咽程度评分显著低于女性(t=2.644,P=0.018),误咽程度评分与性别呈负相关(r=-0.485,P=0.009)。结论球部起病、男性、发病年龄较大的ALS患者吞咽功能更严重;对肢体起病ALS,球部受累持续时间越长,误咽风险越大,洼田饮水试验可一定程度评估其误咽风险。

Objective To observe the characteristics of deglutition function in amyotrophic lateral sclerosis（ALS） patients with different onset forms. Methods According to onset form,seventy consecutive dysphagic ALS patients were divided into spinal onset group（42 cases） and bulbar onset group（28 cases）. The patient’s swallowing function was examined by videofluoroscopic swallowing study（VFSS）. Relationship between swallowing function and general clinical data was analyzed. Result In the bulbar onset group,the abnormality rate of the parameters of premature spillage and transit to the oropharynx were higher（Z =-2. 699,P = 0. 007; Z =-2. 102,P = 0. 036）compared with the spinal onset group. VFSS score results were abnormal in both groups. In the bulbar onset group,the VFSS oral subscore was lower,and the level of Kubota drinking test was higher（t = 2. 027,P = 0. 048; t =-2. 387,P = 0. 020） compared with the spinal onset group. In the spinal onset group,the VFSS total score and aspiration subscore both had a significant negative correlation with time from bulbar onset to diagnosis（r =-0. 354,P = 0. 022; r =-0. 313,P = 0. 044）. Among subgroups of disease duration,differences of the VFSS total score and oral subscore were both statistically significant（F = 2. 961,P = 0. 032; F = 2. 796,P = 0. 040）. Among subgroups of time from bulbar onset to diagnosis,differences of the VFSS total score and aspiration subscore were both statistically significant（F = 5. 027,P = 0. 002; F = 5. 632,P = 0. 001）. In the bulbar onset group,the VFSS total score,pharyngeal subscore and aspiration subscore all have a significant correlation with age of onset（r =-0. 490,P =0. 008; r =-0. 414,P = 0. 029; r =-0. 532,P = 0. 004）. Among subgroups of age of onset,differences of the VFSS total score,pharyngeal subscore and aspiration subscore were all statistically significant（F = 5. 9 0 9,P =0. 008; F = 3. 502,P = 0. 046; F = 8. 982,P = 0. 001）. Aspiration subscore was lower in male patients than female（t = 2. 644,P = 0. 018）. Aspiration subscore has a significant correlation with gender（r =-0. 485,P = 0. 009）.Conclusion Swallowing dysfunction severity in ALS patients is associated with bulbar onset form of disease,male gender and older age of onset. For spinal onset ALS,aspiration risk gets higher over time from bulbar onset to diagnosis. Kubota drinking test helps to find out the aspiratin risk to some extent.