评估康复环境中肌少症患者的吞咽困难：恶性循环的启示。

Evaluation of dysphagia in patients with sarcopenia in a rehabilitation setting: insights from the vicious cycle.

机构信息

Department of Physical Medicine and Rehabilitation, Ege University Medical School, Bornova, 35100, İzmir, Turkey.

出版信息

Eur Geriatr Med. 2020 Apr;11(2):333-340. doi: 10.1007/s41999-020-00302-5. Epub 2020 Mar 14.

DOI:10.1007/s41999-020-00302-5

PMID:32297201

Abstract

PURPOSE

Nutritional deficits are known to cause sarcopenia. There is also evidence that sarcopenia itself may cause dysphagia, and swallowing problems are among the reasons for patients to have nutritional deficits. This study aims to evaluate the prevalence of nutritional deficits and dysphagia in patients with or without sarcopenia.

METHODS

128 patients residing in a rehabilitation clinic are evaluated with EAT-10, MD Anderson Dysphagia Inventory, Functional Oral Intake Status scale, Mini Nutritional Assessment (MNA) and Beck Depression Index. All patients were then classified according to the latest sarcopenia classification proposed by the European Working Group on Sarcopenia in Older People in 2018. Muscle strength and mass were assessed using a hand dynamometer and measuring calf circumference, respectively. Walking velocity was assessed using the 4-m gait speed test. Patients belonging to sarcopenia, probable sarcopenia, and non-sarcopenia groups were then compared using relevant statistical methods to show whether there are differences in outcomes mentioned as well as demographical and clinical status.

RESULTS

The presence of oropharyngeal dysphagia risk was only found between sarcopenic [85 (48-100)] and non-sarcopenic [91 (62-100)] individuals (p = 0.026) while other comparisons were insignificant. EAT-10 scores were found to be worse for probably sarcopenic [0 (0-13)] and sarcopenic [0 (0-35)] individuals compared to non-sarcopenics [0 (0-6)], and it was also shown sarcopenics were worse than probable sarcopenics (p = 0.001). While gait velocity only differed between individuals with sarcopenia and not sarcopenic ones, grip strength was deteriorated for both sarcopenic and probably sarcopenic individuals when compared to non-sarcopenics. MNA scores were still significantly worse for probable sarcopenics [10 (3-14)] and sarcopenics [9 (0-13)], when compared to non-sarcopenics [13 (3-14)] latter being even worse than the other two, respectively) (p = 0.0001).

CONCLUSIONS

Dysphagia and nutritional impairments may be seen in the course of sarcopenia, and this also applies to the condition of probable sarcopenia.

摘要

目的

营养不足已知会导致肌肉减少症。有证据表明，肌肉减少症本身可能导致吞咽困难，而吞咽问题是患者出现营养不足的原因之一。本研究旨在评估有或无肌肉减少症的患者中营养不足和吞咽困难的患病率。

方法

对居住在康复诊所的 128 名患者进行 EAT-10、MD 安德森吞咽障碍量表、功能性口腔摄入状态量表、迷你营养评估量表（MNA）和贝克抑郁指数评估。然后根据欧洲老年人肌肉减少症工作组在 2018 年提出的最新肌肉减少症分类标准对所有患者进行分类。使用手部测力计评估肌肉力量和质量，分别测量小腿围。使用 4 米步行速度测试评估步行速度。然后使用相关统计方法比较属于肌肉减少症、可能肌肉减少症和非肌肉减少症组的患者，以显示结果以及人口统计学和临床状况是否存在差异。

结果

仅发现有口咽性吞咽困难风险的患者[85（48-100）]与无口咽性吞咽困难风险的患者[91（62-100）]之间存在差异（p=0.026），而其他比较则无显著差异。EAT-10 评分显示，可能肌肉减少症[0（0-13）]和肌肉减少症[0（0-35）]患者的评分均比非肌肉减少症患者[0（0-6）]差，而且肌肉减少症患者比可能肌肉减少症患者差（p=0.001）。虽然只有在有肌肉减少症和无肌肉减少症的患者之间，步行速度才会有所不同，但与非肌肉减少症患者相比，肌肉减少症和可能肌肉减少症患者的握力均有所下降。与非肌肉减少症患者[13（3-14）]相比，可能肌肉减少症患者[10（3-14）]和肌肉减少症患者[9（0-13）]的 MNA 评分仍然明显更差，后者比其他两者都差（p=0.0001）。