Hidetaka Wakabayashi, Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama City, Japan 232-0024, E-mail:
J Nutr Health Aging. 2019;23(1):84-88. doi: 10.1007/s12603-018-1117-2.
The purpose of this study was to assess the prevalence and prognosis of sarcopenic dysphagia in patients who require dysphagia rehabilitation.
Prospective cohort study.
Tertiary-care acute general hospital.
One hundred and eight patients referred to the Department of Rehabilitation Medicine for dysphagia rehabilitation.
The Food Intake Level Scale (FILS), a 5-step diagnostic algorithm for sarcopenic dysphagia.
The study included 72 males and 36 females (mean age, 76±7 years). Comorbid diseases included brain and nervous system disease (36%), cardiovascular disease (25%), respiratory disease (14%), and cancer (11%). Median energy intake was 1159 kcal (interquartile range: 648, 1502). Median FILS at admission and discharge was 4 (interquartile range: 2, 7) and 8 (interquartile range: 5, 8), respectively. Sarcopenic dysphagia was observed in 35 patients (32%). Sarcopenic dysphagia was associated with lower FILS at referral and discharge, lower calf circumference, lower handgrip strength, lower body mass index, lower serum albumin, and higher C-reactive protein at referral. Tongue pressure, energy intake, and Barthel index did not differ significantly between patients with or without sarcopenic dysphagia. Ordered logistic regression analysis of the FILS at discharge adjusted for presence of sarcopenic dysphagia, age, sex, and the FILS at admission revealed that presence of sarcopenic dysphagia (β=-1.603, 95% confidence intervals= -2.609, -0.597, p=0.002), sex, and the FILS at admission were independently associated with the FILS at discharge.
The prevalence of sarcopenic dysphagia in patients who require dysphagia rehabilitation was quite high. Sarcopenic dysphagia was independently associated with poor swallowing function at discharge.
本研究旨在评估需要吞咽障碍康复的患者中肌少性吞咽困难的患病率和预后。
前瞻性队列研究。
三级保健急性综合医院。
108 例因吞咽障碍到康复医学科就诊的患者。
采用 5 步肌少性吞咽困难诊断算法——食物摄入水平量表（FILS）。
研究纳入 72 名男性和 36 名女性（平均年龄 76±7 岁）。合并症包括脑部和神经系统疾病（36%）、心血管疾病（25%）、呼吸系统疾病（14%）和癌症（11%）。中位能量摄入量为 1159 千卡（四分位距：648，1502）。入院和出院时的中位 FILS 分别为 4（四分位距：2，7）和 8（四分位距：5，8）。35 例（32%）患者存在肌少性吞咽困难。肌少性吞咽困难与转诊和出院时较低的 FILS、较小的小腿围、较低的握力、较低的体重指数、较低的血清白蛋白和较高的 C 反应蛋白有关。转诊时的舌压、能量摄入和 Barthel 指数在有无肌少性吞咽困难的患者之间无显著差异。对调整了肌少性吞咽困难、年龄、性别和入院 FILS 的出院 FILS 的有序逻辑回归分析显示，肌少性吞咽困难（β=-1.603，95%置信区间：-2.609，-0.597，p=0.002）、性别和入院 FILS 与出院 FILS 独立相关。
需要吞咽障碍康复的患者中肌少性吞咽困难的患病率相当高。肌少性吞咽困难与出院时吞咽功能较差独立相关。
