Pinho João, Meyer Tareq, Schumann-Werner Beate, Becker Johanna, Tauber Simone, Nikoubashman Omid, Wiesmann Martin, Schulz Jörg B, Werner Cornelius J, Reich Arno
Department of Neurology, University Hospital RWTH, Aachen, Germany.
Department of Neurology and Geriatrics, Johanniter Hospital Stendal GmbH, Stendal, Germany.
J Cachexia Sarcopenia Muscle. 2024 Aug;15(4):1539-1548. doi: 10.1002/jcsm.13512. Epub 2024 Jun 18.
Neurogenic dysphagia is a frequent complication of stroke and is associated with aspiration pneumonia and poor outcomes. Although ischaemic lesion location and size are major determinants of the presence and severity of post-stroke dysphagia, little is known about the contribution of other acute stroke-unrelated factors. We aimed to analyse the impact of swallowing and non-swallowing muscles measurements on swallowing function after large vessel occlusion stroke.
This retrospective study was based on a prospective registry of consecutive ischaemic stroke patients. Patients who underwent mechanical thrombectomy between July 2021 and June 2022 and received a flexible endoscopic evaluation of swallowing (FEES) within 5 days after admission were included. Demographic, anthropometric, clinical, and imaging data were collected from the registry. The cross-sectional areas (CSA) of selected swallowing muscles (as a surrogate marker for swallowing muscle mass) and of cervical non-swallowing muscles were measured in computed tomography. Skeletal muscle index (SMI) was calculated and used as a surrogate marker for whole body muscle mass. FEES parameters, namely, Functional Oral Intake Scale (FOIS, as a surrogate marker for dysphagia presence and severity), penetration aspiration scale, and the presence of moderate-to-severe pharyngeal residues were collected from the clinical records. Univariate and multivariate ordinal and logistic regression analyses were performed to analyse if total CSA of swallowing muscles and SMI were associated with FEES parameters.
The final study population consisted of 137 patients, 59 were female (43.1%), median age was 74 years (interquartile range 62-83), median baseline National Institutes of Health Stroke Scale score was 12 (interquartile range 7-16), 16 patients had a vertebrobasilar occlusion (11.7%), and successful recanalization was achieved in 127 patients (92.7%). Both total CSA of swallowing muscles and SMI were significantly correlated with age (rho = -0.391, P < 0.001 and rho = -0.525, P < 0.001, respectively). Total CSA of the swallowing muscles was independently associated with FOIS (common adjusted odds ratio = 1.08, 95% confidence interval = 1.01-1.16, P = 0.029), and with the presence of moderate-to-severe pharyngeal residues for puree consistencies (adjusted odds ratio = 0.90, 95% confidence interval = 0.81-0.99, P = 0.036). We found no independent association of SMI with any of the FEES parameters.
Baseline swallowing muscle mass contributes to the pathophysiology of post-stroke dysphagia. Decreasing swallowing muscle mass is independently associated with increasing severity of early post-stroke dysphagia and with increased likelihood of moderate-to-severe pharyngeal residues.
神经源性吞咽困难是中风常见的并发症，与吸入性肺炎及不良预后相关。虽然缺血性病变的位置和大小是中风后吞咽困难存在及严重程度的主要决定因素，但对于其他与急性中风无关的因素的作用却知之甚少。我们旨在分析大血管闭塞性中风后吞咽和非吞咽肌肉测量对吞咽功能的影响。
本回顾性研究基于连续缺血性中风患者的前瞻性登记。纳入2021年7月至2022年6月期间接受机械取栓并在入院后5天内接受吞咽功能的软性内镜评估（FEES）的患者。从登记处收集人口统计学、人体测量学、临床和影像学数据。在计算机断层扫描中测量选定吞咽肌肉的横截面积（CSA，作为吞咽肌肉质量的替代指标）和颈部非吞咽肌肉的横截面积。计算骨骼肌指数（SMI）并将其用作全身肌肉质量的替代指标。从临床记录中收集FEES参数，即功能性经口摄入量表（FOIS，作为吞咽困难存在及严重程度的替代指标）、渗透误吸量表以及中重度咽部残留的情况。进行单变量和多变量有序及逻辑回归分析，以分析吞咽肌肉的总CSA和SMI是否与FEES参数相关。
最终研究人群包括137例患者，59例为女性（43.1%），中位年龄为74岁（四分位间距62 - 83岁），基线美国国立卫生研究院卒中量表评分中位数为12分（四分位间距7 - 16分），16例患者为椎基底动脉闭塞（11.7%），127例患者实现了成功再通（92.7%）。吞咽肌肉的总CSA和SMI均与年龄显著相关（rho分别为 - 0.391，P < 0.001和rho为 - 0.525，P < 0.001）。吞咽肌肉的总CSA与FOIS独立相关（共同调整优势比 = 1.08，95%置信区间 = 1.01 - 1.16，P = 0.029），并且与泥状食物质地存在中重度咽部残留独立相关（调整优势比 = 0.90，95%置信区间 = 0.81 - 0.99，P = 0.036）。我们未发现SMI与任何FEES参数存在独立关联。
基线吞咽肌肉质量对中风后吞咽困难的病理生理学有影响。吞咽肌肉质量下降与中风后早期吞咽困难严重程度增加以及中重度咽部残留可能性增加独立相关。
