挥鞭样损伤相关性吞咽困难:潜在发病率及机制的考量

Whiplash-Associated Dysphagia: Considerations of Potential Incidence and Mechanisms.

作者信息

Stone D, Bogaardt H, Linnstaedt S D, Martin-Harris B, Smith A C, Walton D M, Ward E, Elliott J M

机构信息

Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.

Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.

出版信息

Dysphagia. 2020 Jun;35(3):403-413. doi: 10.1007/s00455-019-10039-4. Epub 2019 Aug 3.

Abstract

Non-specific self-reports of dysphagia have been described in people with whiplash-associated disorders (WAD) following motor vehicle collision (MVC); however, incidence and mechanistic drivers remain poorly understood. Alterations in oropharyngeal dimensions on magnetic resonance imaging (MRI), along with heightened levels of stress, pain, and changes in stress-dependent microRNA expression (e.g., miR-320a) have been also associated with WAD, suggesting multi-factorial issues may underpin any potential swallowing changes. In this exploratory paper, we examine key biopsychosocial parameters in three patients with persistent WAD reporting swallowing change and three nominating full recovery after whiplash with no reported swallowing change. Parameters included (1) oropharyngeal volume with 3D MRI, (2) peritraumatic miR-320a expression, and (3) psychological distress. These factors were explored to highlight the complexity of patient presentation and propose future considerations in relation to a potential deglutition disorder following WAD. The three participants reporting changes in swallowing all had smaller oropharyngeal volumes at < 1 week and at 3 months post injury and lower levels of peritraumatic miR-320a. At 3 months post MVC, oropharyngeal volumes between groups indicated a large effect size (Hedge's g = 0.96). Higher levels of distress were reported at both time points for those with persistent symptomatology, including self-reported dysphagia, however, this was not featured in those nominating recovery. This paper considers current evidence for dysphagia as a potentially under-recognized feature of WAD and highlights the need for future, larger-scaled, multidimensional investigation into the incidence and mechanisms of whiplash-associated dysphagia.

摘要

在机动车碰撞(MVC)后患有挥鞭样损伤相关疾病(WAD)的人群中,已出现吞咽困难的非特异性自我报告;然而,其发病率和机制驱动因素仍知之甚少。磁共振成像(MRI)显示口咽尺寸改变,以及压力水平升高、疼痛和应激相关微小RNA表达变化(如miR-320a)也与WAD有关,这表明多因素问题可能是任何潜在吞咽变化的基础。在这篇探索性论文中,我们研究了三名持续存在WAD且报告有吞咽变化的患者以及三名挥鞭样损伤后完全康复且未报告有吞咽变化的患者的关键生物心理社会参数。参数包括:(1)通过三维MRI测量的口咽体积;(2)创伤周围miR-320a表达;(3)心理困扰。对这些因素进行探索,以突出患者表现的复杂性,并就WAD后潜在的吞咽障碍提出未来的考虑因素。三名报告吞咽有变化的参与者在受伤后<1周和3个月时口咽体积均较小,创伤周围miR-320a水平较低。在MVC后3个月,两组之间的口咽体积显示出较大的效应量(Hedge's g = 0.96)。有持续症状(包括自我报告的吞咽困难)的患者在两个时间点报告的困扰水平较高,然而,在报告康复的患者中未出现这种情况。本文认为目前有证据表明吞咽困难是WAD一种可能未被充分认识的特征,并强调未来需要对挥鞭样损伤相关吞咽困难的发病率和机制进行更大规模的多维研究。

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