Park Chul-Hyun, Kim Don-Kyu, Lee Yong-Taek, Yi Youbin, Lee Jung-Sang, Kim Kunwoo, Park Jung Ho, Yoon Kyung Jae
Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Physical and Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Ann Rehabil Med. 2017 Oct;41(5):776-785. doi: 10.5535/arm.2017.41.5.776. Epub 2017 Oct 31.
To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia.
Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined.
VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia.
We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.
使用高分辨率测压法（HRM）比较健康受试者与咽吞咽困难患者的吞咽功能，并评估HRM在检测咽吞咽困难方面的实用性。
本研究纳入了75例吞咽困难患者和28例健康受试者。吞咽困难的诊断通过电视荧光吞咽造影检查得以确认。进行HRM以测量腭咽（VP）、舌根（TB）和食管上括约肌（UES）处的压力及时间信息。比较吞咽困难组与健康组之间的HRM参数。确定吞咽困难的显著HRM参数的最佳阈值。
吞咽困难组的VP最大压力、TB最大压力、UES松弛持续时间和UES静息压力均低于健康组。吞咽困难组的UES最小压力高于健康组。进行了受试者操作特征（ROC）分析以验证显著HRM参数的最佳阈值，以识别咽吞咽困难患者。当VP最大压力阈值为144.0 mmHg时，识别吞咽困难的灵敏度为96.4%，特异度为74.7%。当TB最大压力阈值为158.0 mmHg时，识别吞咽困难的灵敏度为96.4%，特异度为77.3%。当UES最小压力阈值为2.0 mmHg时，诊断吞咽困难的灵敏度为74.7%，特异度为60.7%。最后，UES松弛持续时间<0.58秒识别吞咽困难的灵敏度为85.7%，特异度为65.3%，UES静息压力<75.0 mmHg识别吞咽困难的灵敏度为89.3%，特异度为90.7%。
我们提供的证据表明，HRM可能是检测咽吞咽困难的一种有用的评估工具。
