Hanayama Kozo, Liu Meigen, Higuchi Yoshiko, Fujiwara Toshiyuki, Tsuji Testuya, Hase Kimitaka, Ishihara Tadayuki
Department of Rehabilitation Medicine, Tokai University School of Medicine, Kanagawa, Japan.
Disabil Rehabil. 2008;30(7):517-22. doi: 10.1080/09638280701355595.
To investigate swallowing problems in patients with Duchenne muscular dystrophy (DMD) using a questionnaire and videofluorography (VF).
A questionnaire survey was performed of swallowing-related symptoms and VF in 31 male patients with DMD (mean age 19.9 years, range 9 - 26 years). The relationships among age, frequency of symptoms and VF abnormalities were analysed using Spearman's rank correlation. The differences in VF abnormalities among different food textures were analysed with the Kruskal - Wallis test.
Symptoms related to pharyngeal phase dysfunction were more frequent than those related to oral and oesophageal phases. Coughing while eating was seen in 71% of the patients, choking while eating in 32% and the need to clear the throat in 26%. VF abnormalities were observed in 30 patients (96.8%). Common VF abnormalities included pooling in the valleculae (90.3%) and in the pyriform sinus (90.3%). Pharyngo-oral regurgitation was seen in 35.5% of the patients. Pooling in the pyriform sinus after repeated swallowing seen in VF correlated significantly with symptoms related to the pharyngeal phase (Spearman's rho 0.356 - 0.544).
Because oropharyngeal dysphagia in DMD was evident in teenage patients as well as those without clinical symptoms, VF is recommended in patients with DMD.
使用问卷调查和视频荧光吞咽造影（VF）研究杜氏肌营养不良症（DMD）患者的吞咽问题。
对31例男性DMD患者（平均年龄19.9岁，范围9 - 26岁）进行了与吞咽相关症状及VF的问卷调查。采用Spearman等级相关分析年龄、症状频率与VF异常之间的关系。用Kruskal - Wallis检验分析不同食物质地时VF异常的差异。
与咽期功能障碍相关的症状比与口腔期和食管期相关的症状更常见。71%的患者进食时咳嗽，32%的患者进食时呛噎，26%的患者需要清嗓。30例患者（96.8%）观察到VF异常。常见的VF异常包括会厌谷积液（90.3%）和梨状窦积液（90.3%）。35.5%的患者出现咽口反流。VF中反复吞咽后梨状窦积液与咽期相关症状显著相关（Spearman相关系数0.356 - 0.544）。
由于DMD患者的口咽吞咽困难在青少年患者以及无临床症状的患者中均很明显，因此建议对DMD患者进行VF检查。
