Nozaki Sonoko, Umaki Yoshifumi, Sugishita Shuhei, Tatara Katsunori, Adachi Katsuhito, Shinno Susumu
Clinical Research Division, Department of Neurology, Tokushima National Hospital, National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima 776-8585 Japan.
Rinsho Shinkeigaku. 2007 Jul;47(7):407-12.
To identify the characteristics of swallowing function in patients with Duchenne muscular dystrophy (DMD).
Swallowing function was evaluated using videofluorography (VF) in a cross-sectional observational study of 102 DMD patients (mean age 21.5 years) who had dysphagia or in whom dysphagia was suspected based on clinical signs. Reduced tongue movement, impaired bolus transport to the pharynx, decreased pharyngeal contraction, bolus delivery into the airway, and bolus residue at the epiglottic vallecula and at the piriform recess were qualitatively evaluated for test swallows of jelly and juice. During VF, the length of time of both the oral and pharyngeal phases of swallowing was measured in 59 patients.
Patients started to show oral phase abnormalities in their mid-teens and pharyngeal phase abnormalities such as pharyngeal residue around age 20. Oral phase abnormalities was higher with juice than with jelly. Total oral/pharyngeal transit duration was longer with age, and total duration of hyoid maximum elevation was shorter with age.
The weak positive correlation of total oral/pharyngeal transit duration and age was presumably due to gradual onset of functional abnormalities associated with deteriorated swallowing muscles starting in the teenage years. Reduced tongue movement and impaired bolus transport to the pharynx was more common in teenage DMD patients because they have limited tongue movements associated with structural abnormalities such as macroglossia and open bite. VF showed that the swallowing difficulties were more severe during the oral phase than in the pharyngeal phase in the teenage patients. The pharyngeal phase disorders such as pharyngeal residue and decreased pharyngeal contraction were seen more often in the patients in their 20s, presumably due to deterioration of swallowing muscles that becomes more apparent in the older age group.
确定杜氏肌营养不良症（DMD）患者吞咽功能的特征。
在一项横断面观察性研究中，对102例DMD患者（平均年龄21.5岁）进行吞咽功能评估，这些患者有吞咽困难或根据临床体征怀疑有吞咽困难。基于果冻和果汁的测试吞咽，对舌运动减少、食团向咽部输送受损、咽部收缩减弱、食团进入气道以及会厌谷和梨状窝处的食团残留进行定性评估。在视频荧光造影检查期间，测量了59例患者吞咽的口腔期和咽部期的时长。
患者在十几岁中期开始出现口腔期异常，在20岁左右开始出现咽部期异常，如咽部残留。果汁引起的口腔期异常高于果冻。口腔/咽部总通过时间随年龄增长而延长，舌骨最大抬高的总时长随年龄增长而缩短。
口腔/咽部总通过时间与年龄的弱正相关可能是由于从青少年时期开始，与吞咽肌肉退化相关的功能异常逐渐出现。青少年DMD患者中舌运动减少和食团向咽部输送受损更为常见，因为他们的舌运动受限，与巨舌症和开咬等结构异常有关。视频荧光造影检查显示，青少年患者的吞咽困难在口腔期比咽部期更严重。咽部期障碍，如咽部残留和咽部收缩减弱，在20多岁的患者中更常见，这可能是由于吞咽肌肉退化在老年组中更为明显。
