Park Donghwi, Woo Seung Beom, Lee Dae Hee, Yu Kwang Jae, Cho Ju Young, Kim Jong Min, Lee Zeeihn
Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea.
Ann Rehabil Med. 2017 Dec;41(6):915-923. doi: 10.5535/arm.2017.41.6.915. Epub 2017 Dec 28.
To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions.
The medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed.
Eleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625-0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689-0.953; p<0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%).
In patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.
评估脑损伤吞咽困难患者放射性核素唾液造影结果与临床特征之间的相关性。
回顾性分析35例同时接受视频荧光吞咽造影（VFSS）和放射性核素唾液造影的脑损伤吞咽困难患者的病历。根据唾液造影中是否存在误吸将受试者分为两组（A组，唾液造影有误吸的患者；B组，唾液造影无误吸的患者）。分析两组之间临床特征和VFSS结果（渗透-误吸量表[PAS]）的差异。
35例患者中有11例在放射性核素唾液造影中出现唾液误吸。两组在年龄、性别、病程、VFSS上的PAS和喂养方式方面无显著差异（p≥0.05）。A组吸入性肺炎的发生率显著更高。在采用向前逐步法的多因素逻辑回归分析中，简易精神状态检查表（MMSE）评分是预测唾液造影阳性结果的唯一显著参数（比值比=0.760；95%置信区间[CI]，0.625 - 0.923；p = 0.006）。MMSE评分用于唾液造影阳性检测的受试者操作特征曲线（AUC）下面积为0.855（95%CI，0.689 - 0.953；p < 0.0001）。MMSE评分的最佳截断值为7（敏感性72.73%，特异性100%）。
在主诉吞咽困难的脑损伤患者中，MMSE评分与唾液误吸相关。如果患者MMSE评分为7分或更低，进行放射性核素唾液造影可能有助于早期检测出因唾液误吸导致吸入性肺炎的高危患者。
