From the Department of Neurology (T.M., M.K., H.B., K.S., N.S., A.H., A.A., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; and Department of Speech Pathology and Audiology (S.T., M.Y.), Aichi-Gakuin University School of Health Science, Nagoya, Japan.
Neurology. 2014 Jan 21;82(3):255-62. doi: 10.1212/WNL.0000000000000041. Epub 2013 Dec 18.
This study aimed to explore the reliability and validity of tongue pressure measurement as a quantitative evaluation of swallowing function in patients with spinal and bulbar muscular atrophy (SBMA).
This study enrolled 47 genetically confirmed patients with SBMA and 38 age- and sex-matched healthy controls. In both groups we measured tongue pressure using an intraoral pressure probe and assessed questionnaires that evaluated swallowing functions. We then analyzed the relationship between tongue pressure, functional scales, and the muscle weakness of other regions.
Levels of tongue pressure were decreased in patients with SBMA within 3 years from the onset of the disease compared to healthy controls (SBMA 15.3 ± 6.4 kPa; healthy controls 37.3 ± 9.6 kPa; p < 0.001). Test-retest analysis showed a high reliability in patients with SBMA (intraclass correlation coefficient = 0.986). Tongue pressure showed a strong correlation with bulbar-related functional scales. Decrease of tongue pressure was detected in patients who reported no subjective dysphagia, and repetition of swallowing compensated for tongue weakness in such subjects. In patients with SBMA, tongue pressure more strongly correlates with the strength of pharyngeal, neck, and upper limb musculatures than with that of the lower limbs.
Tongue pressure measurement is reliable and reflects swallowing function in patients with SBMA. The muscle strength of the tongue appears to decrease in SBMA before the awareness of subjective dysphagia, suggesting that tongue pressure measurement is a novel biomarker of SBMA and is applicable to early-stage detection.
本研究旨在探讨舌压测量作为脊髓延髓肌萎缩症（SBMA）患者吞咽功能定量评估的可靠性和有效性。
本研究纳入了 47 名经基因确诊的 SBMA 患者和 38 名年龄和性别匹配的健康对照者。在两组中，我们均使用口腔内压力探头测量舌压，并评估了评估吞咽功能的问卷。然后，我们分析了舌压与功能量表以及其他区域肌肉无力之间的关系。
与健康对照组相比，发病 3 年内的 SBMA 患者的舌压水平降低（SBMA 15.3 ± 6.4 kPa；健康对照组 37.3 ± 9.6 kPa；p < 0.001）。SBMA 患者的测试-重测分析显示出较高的可靠性（组内相关系数 = 0.986）。舌压与延髓相关功能量表具有很强的相关性。在报告无主观吞咽困难的患者中发现了舌压降低，并且这些患者通过重复吞咽来代偿舌肌无力。在 SBMA 患者中，舌压与咽、颈部和上肢肌肉力量的相关性比与下肢肌肉力量的相关性更强。
舌压测量可靠，反映了 SBMA 患者的吞咽功能。在出现主观吞咽困难之前，SBMA 患者的舌肌力量似乎就已经下降，这表明舌压测量是 SBMA 的一种新型生物标志物，适用于早期检测。
