Department of Neurology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu-City, Gifu, 501-1194, Japan.
Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan.
Dysphagia. 2021 Feb;36(1):33-40. doi: 10.1007/s00455-020-10095-1. Epub 2020 Mar 5.
Tongue pressure is often used to evaluate swallowing muscle strength in dysphagia patients with sarcopenia. However, the amount of tongue pressure that reflects pharyngeal swallowing function is unclear. The aims of this descriptive study were (1) to assess the association between tongue pressure and swallowing function using high-resolution manometry (HRM), (2) to evaluate whether manometric parameters were related to maximum tongue pressure (MTP) and other sarcopenia-related factors, and (3) to evaluate the manometric characteristics of pharyngeal swallowing in sarcopenic dysphagia. Sixteen patients with dysphagia (13 men; mean age 85.0 ± 6.6) who were diagnosed with sarcopenia and sixteen healthy subjects (10 men; mean age 33.6 ± 7.2) were included. Evaluation of HRM parameters including velopharyngeal contractile integral (VPCI), mesohypopharyngeal contractile integral (MHPCI), upper esophageal sphincter (UES) relaxation duration, and UES nadir pressure was performed. HRM parameters of patients were compared with MTP, sarcopenia factors, and manometric parameters of healthy subjects. The VPCI showed no statistically significant differences between patient and healthy groups. In the patient group, the MHPCI was significantly lower (126.1 ± 76.6 vs 193.2 ± 34.1 mmHg cm s; p = 0.003), UES nadir pressure was significantly higher (10.5 ± 27.5 vs - 11.2 ± 6.7 mmHg; p < 0.001), and UES relaxation duration (318.0 ± 152.4 vs 520.6 ± 60.0 ms; p = 0.007) was significantly shorter than those in the healthy group. HRM parameters were not significantly correlated with MTP and sarcopenia factors. Older dysphagia patients with sarcopenia had weaker pharyngeal contractility and UES dysfunction. Manometric evaluation of pharyngeal function may not be significantly associated with MTP and sarcopenia-related factors. Further study is needed to clinically apply tongue pressure for evaluating sarcopenic dysphagia.
舌压常用于评估肌少症吞咽困难患者的吞咽肌肉力量。然而，反映咽吞咽功能的舌压量尚不清楚。本描述性研究的目的是：(1) 使用高分辨率测压法（HRM）评估舌压与吞咽功能之间的关系；(2) 评估测压参数是否与最大舌压（MTP）和其他肌少症相关因素相关；(3) 评估肌少症吞咽困难患者的咽吞咽测压特征。纳入 16 例吞咽困难患者（13 名男性；平均年龄 85.0±6.6）和 16 名健康受试者（10 名男性；平均年龄 33.6±7.2）。评估包括软腭收缩积分（VPCI）、中咽收缩积分（MHPCI）、食管上括约肌（UES）松弛持续时间和 UES 最低点压力等 HRM 参数。将患者的 HRM 参数与 MTP、肌少症因素和健康受试者的测压参数进行比较。患者组和健康组之间的 VPCI 无统计学差异。在患者组中，MHPCI 显著降低（126.1±76.6 对 193.2±34.1mmHg·cm·s；p=0.003），UES 最低点压力显著升高（10.5±27.5 对-11.2±6.7mmHg；p<0.001），UES 松弛持续时间（318.0±152.4 对 520.6±60.0ms；p=0.007）显著缩短。HRM 参数与 MTP 和肌少症因素无显著相关性。患有肌少症的老年吞咽困难患者的咽收缩力和 UES 功能较弱。咽功能的测压评估可能与 MTP 和肌少症相关因素无显著相关性。需要进一步的研究来将舌压临床应用于评估肌少症吞咽困难。
