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多发性硬化症患者吞咽困难的患病率及危险因素。

Prevalence and Risk Factors of Dysphagia in Patients with Multiple Sclerosis.

机构信息

Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Dysphagia. 2022 Feb;37(1):21-27. doi: 10.1007/s00455-021-10245-z. Epub 2021 Feb 12.

Abstract

Dysphagia is one of the most common symptoms in multiple sclerosis (MS) patients. It can reduce the quality of life and increase the risk of mortality by developing complications such as aspiration pneumonia. The present study was conducted to estimate the prevalence of dysphagia in MS patients and investigate the associations between dysphagia and disease characteristics. The Persian version of the DYMUS questionnaire was used to assess dysphagia in 865 patients with MS, including 738 (85.3%) relapsing-remitting MS (RRMS), 106 (12.3%) secondary progressive MS (SPMS), and 21 (2.4%) primary progressive MS (PPMS). Also, demographic and clinical data, including age, sex, smoking status, Expanded Disability Status Scale (EDSS) score, disease duration, disease-modifying therapies exposure, initial symptoms of MS, were recorded. The mean (SD) age was 37.95(9.25) years, and 83.1% of the participants were female. The prevalence of dysphagia was estimated to be 25.4% among all patients. According to the DYMUS questionnaire results, the prevalence of dysphagia in RRMS, SPMS, and PPMS patients was 22.2%, 44.3%, and 42.9%, respectively. After multivariate analysis the current EDSS score (OR = 1.197, CI: 1.062, 1.350, p = 0.003), cerebellar impairment (OR = 1.335, CI: 1.450, 4.716, p = 0.004) and motor dysfunction (OR = 1.651, CI: 1.004, 2.715, p = 0.048) emerged as the risk factors for dysphagia. Since dysphagia, as previously mentioned, is a common symptom in multiple sclerosis, particularly in SPMS and PPMS courses, active screening for this condition is recommended in all patients, particularly those with identified risk factors.

摘要

吞咽困难是多发性硬化症(MS)患者最常见的症状之一。它会降低生活质量,并通过发展吸入性肺炎等并发症增加死亡率。本研究旨在评估 MS 患者吞咽困难的患病率,并研究吞咽困难与疾病特征之间的关系。使用波斯语版 DYMUS 问卷评估了 865 名 MS 患者的吞咽困难情况,其中包括 738 名(85.3%)复发缓解型 MS(RRMS)、106 名(12.3%)继发进展型 MS(SPMS)和 21 名(2.4%)原发进展型 MS(PPMS)。还记录了人口统计学和临床数据,包括年龄、性别、吸烟状况、扩展残疾状况量表(EDSS)评分、疾病持续时间、疾病修饰疗法暴露、MS 初始症状等。参与者的平均(SD)年龄为 37.95(9.25)岁,83.1%为女性。所有患者吞咽困难的患病率估计为 25.4%。根据 DYMUS 问卷结果,RRMS、SPMS 和 PPMS 患者吞咽困难的患病率分别为 22.2%、44.3%和 42.9%。多变量分析后,目前的 EDSS 评分(OR=1.197,CI:1.062,1.350,p=0.003)、小脑损伤(OR=1.335,CI:1.450,4.716,p=0.004)和运动功能障碍(OR=1.651,CI:1.004,2.715,p=0.048)是吞咽困难的危险因素。由于如前所述,吞咽困难是多发性硬化症的常见症状,特别是在 SPMS 和 PPMS 病程中,建议对所有患者,特别是有明确危险因素的患者积极筛查吞咽困难。

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