Shijo Tomomi, Ikeda Ryoukichi, Suzuki Naoki, Ohta Jun, Suzuki Jun, Hirano-Kawamoto Ai, Kato Kengo, Ikeda Kensuke, Izumi Rumiko, Mitsuzawa Shio, Warita Hitoshi, Kato Masaaki, Aoki Masashi, Katori Yukio
Department of Neurology, Tohoku University Graduate School of Medicine.
Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine.
Tohoku J Exp Med. 2023 Mar 24;259(4):293-300. doi: 10.1620/tjem.2023.J005. Epub 2023 Jan 26.
Pseudobulbar palsy and bulbar palsy cause dysphagia in patients with amyotrophic lateral sclerosis (ALS). Dysphagia in patients with ALS not only increases the risk of aspiration and pneumonia but also leads to malnutrition and weight loss, which are poor prognostic factors. Gastrostomy is the preferred route of feeding and nutritional support in patients with dysphagia. However, there are no established standards to determine the ideal timing of gastrostomy for patients with ALS. Therefore, we used the videofluoroscopic dysphagia scale (VDS), which objectively quantifies swallowing function, in videofluoroscopic swallowing study (VFSS) to investigate whether this scale at diagnosis can be a useful predictor for the timing of gastrostomy. We retrospectively evaluated 22 patients with ALS who were diagnosed at our hospital. We assessed the VDS scores in all patients within 3 months of diagnosis. A decline in the ALS functional rating scale revised (ALSFRS-R) scores was used as an indicator of disease progression. As a result, we found that the VDS score of the pharyngeal phase and the total VDS score were significantly correlated with the ΔALSFRS-R scores. These scores were also associated with the existing indicators for the timing of gastrostomy, i.e., decreased body weight and percent-predicted forced vital capacity. We demonstrated the noninferiority of the VDS scores relative to the existing indicators. In addition, the VDS score of the pharyngeal phase was significantly correlated with the time from diagnosis to gastrostomy. The VDS score could estimate the timing of gastrostomy in patients with ALS with dysphagia at diagnosis.
假性延髓麻痹和延髓麻痹可导致肌萎缩侧索硬化症（ALS）患者出现吞咽困难。ALS患者的吞咽困难不仅会增加误吸和肺炎的风险，还会导致营养不良和体重减轻，而这些都是不良预后因素。胃造口术是吞咽困难患者首选的喂养和营养支持途径。然而，对于ALS患者，尚无确定胃造口术理想时机的既定标准。因此，我们在视频荧光吞咽造影研究（VFSS）中使用了能客观量化吞咽功能的视频荧光吞咽造影量表（VDS），以研究诊断时的该量表是否可作为胃造口术时机的有用预测指标。我们回顾性评估了在我院确诊的22例ALS患者。我们在诊断后3个月内评估了所有患者的VDS评分。ALS功能评定量表修订版（ALSFRS-R）评分的下降被用作疾病进展的指标。结果，我们发现咽期VDS评分和总VDS评分与ΔALSFRS-R评分显著相关。这些评分还与胃造口术时机的现有指标相关，即体重下降和预测用力肺活量百分比。我们证明了VDS评分相对于现有指标的非劣效性。此外，咽期VDS评分与从诊断到胃造口术的时间显著相关。VDS评分可以估计诊断时伴有吞咽困难的ALS患者的胃造口术时机。
