肌萎缩侧索硬化患者隐性误吸的危险因素及ALSFRS-R对其预测价值

doi:10.11958/20230473

天津医药 ›› 2023, Vol. 51 ›› Issue (7): 677-680.doi: 10.11958/20230473

所属专题：专题研究

• 专题研究·肌萎缩侧索硬化 • 上一篇下一篇

肌萎缩侧索硬化患者隐性误吸的危险因素及ALSFRS-R对其预测价值

夏小茜¹(), 张炜², 畅雪丽², 郭军红²^,^△()

1 山西医科大学第一临床医学院（邮编030000）
2 山西医科大学第一医院神经内科

收稿日期:2023-03-31 修回日期:2023-04-12 出版日期:2023-07-15 发布日期:2023-06-20
通讯作者: ^△郭军红 E-mail:neuroguo@163.com
作者简介:夏小茜（1997），女，硕士在读，主要从事神经肌肉病与运动神经元病方面研究。E-mail：estherrrxx@163.com
基金资助:
国家自然科学基金资助项目(82001222)

Risk factors of silent aspiration in patients with amyotrophic lateral sclerosis and the predictive value of ALSFRS-R scale

XIA Xiaoqian¹(), ZHANG Wei², CHANG Xueli², GUO Junhong²^,^△()

1 The First Hospital of Shanxi Medical University, Taiyuan 030000, China
2 Department of Neurology, the First Hospital of Shanxi Medical University

Received:2023-03-31 Revised:2023-04-12 Published:2023-07-15 Online:2023-06-20
Contact: ^△GUO Junhong E-mail:neuroguo@163.com

夏小茜, 张炜, 畅雪丽, 郭军红. 肌萎缩侧索硬化患者隐性误吸的危险因素及ALSFRS-R对其预测价值[J]. 天津医药, 2023, 51(7): 677-680.

XIA Xiaoqian, ZHANG Wei, CHANG Xueli, GUO Junhong. Risk factors of silent aspiration in patients with amyotrophic lateral sclerosis and the predictive value of ALSFRS-R scale[J]. Tianjin Medical Journal, 2023, 51(7): 677-680.

摘要/Abstract

摘要：

目的探索肌萎缩侧索硬化（ALS）患者隐性误吸的危险因素及修订版ALS功能评定量表（ALSFRS-R）对其诊断价值。方法纳入68例ALS患者，根据电视透视吞咽功能检查（VFSS）结果分为隐性误吸组（9例）和无隐性误吸组（59例）。使用医学研究理事会（MRC）评分评估颈部和四肢肌力，使用Logistic回归分析评估隐性误吸的独立影响因素。以VFSS结果为金标准，使用受试者工作特征（ROC）曲线分析ALSFRS-R球部亚评分及吞咽亚评分对隐性误吸的诊断价值。结果单因素分析结果显示，与无隐性误吸组相比，隐性误吸组患者颈屈肌肌力和右上肢近端肌力降低（P<0.05），球部起病患者比例升高（P<0.05）；多因素Logistic回归分析显示，肢体起病的患者发生隐性误吸的风险较球部起病者降低（OR=0.001，95%CI：0.000~0.222，P=0.014）；颈屈肌肌力越高，隐性误吸风险越小（OR=0.089，95%CI：0.010~0.814，P=0.032）。ROC曲线结果显示，ALSFRS-R球部亚评分及吞咽亚评分对ALS患者的隐性误吸的临床诊断价值有限，曲线下面积（AUC）分别为0.774（95%CI：0.741~0.924）和0.781（95%CI：0.757~0.934）。ALSFRS-R球部亚评分最佳分界值为11分，诊断隐性误吸的敏感度和特异度分别为88.89%和57.63%；ALSFRS-R吞咽亚评分的最佳分界值为3分，诊断隐性误吸的敏感度和特异度分别为77.78%和67.80%。结论对于球部起病及颈屈肌肌力差的ALS患者，应重视吞咽障碍的筛查，及早进行临床干预。ALSFRS-R球部亚评分及吞咽亚评分对隐性误吸的诊断价值有限，需要开发新的量表评估ALS患者隐性误吸的风险。

关键词: 肌萎缩侧索硬化, 隐性误吸, 颈屈肌, ALSFRS-R

Abstract:

Objective To detect risk factors of silent aspiration in patients with amyotrophic lateral sclerosis (ALS) and the diagnostic value of ALSFRS-R scale. Methods A total of 68 patients with ALS were recruited in our study. According to the results of Videofluoroscopic Swallowing Study (VFSS), patients were divided into the silent aspiration group (9 cases) and the non-silent aspiration group (59 cases). The muscle strength of neck and limb was assessed using the Medical Research Council score (MRC) scale, and the independent influencing factors of silent aspiration were assessed using Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of ALSFRS-R bulbar subscales and swallowing items for silent aspiration. Results The results of univariate analysis showed that compared with the non-silent aspiration group, cervical flexor muscle strength and right proximal upper limb muscle strength were decreased in the silent aspiration group (P<0.05), and the proportion of patients with bulbar onset was higher in the silent aspiration group (P<0.05). Multivariate Logistic regression analysis showed that patients with limb onset were less likely to have occult aspiration than those of bulbar onset (OR=0.001, 95%CI: 0.000-0.222, P=0.014). The higher the cervical flexor muscle strength was, the less the risk of occult aspiration was (OR=0.089, 95%CI: 0.010-0.814, P=0.032). The results of ROC curve showed that the ALSFRS-R bulbar subscales and swallowing items had limit clinical diagnostic value for ALS patients with silent aspiration, and the areas under the curve (AUC) were 0.774 (95%CI：0.741-0.924) and 0.781 (95%CI： 0.757-0.934), respectively (P<0.05). When the Youden index was the maximum, the optimal cut-off value of ALSFRS-R bulbar subscales was 11, and the sensitivity and specificity for the diagnosis of silent aspiration were 88.89% and 57.63%, respectively. The optimal cut-off value of ALSFRS-R swallowing items was 3, and the sensitivity and specificity for the diagnosis of silent aspiration were 77.78% and 67.80%, respectively. Conclusion For ALS patients with bulbar onset and poor cervical flexor muscle strength, attention should be paid to the screening of dysphagia and early clinical intervention. ALSFRS-R bulbar subscales and swallowing items have limited diagnostic value for silent aspiration, and new scales need to be developed to assess the risk of silent aspiration in ALS patients.

Key words: amyotrophic lateral sclerosis, silent aspiration, cervical flexor muscle, ALSFRS-R

中图分类号:

R746.4

图/表 4

参考文献 21

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组别	n		性别/ （男/女）		起病部位				BMI/（kg/m²）		年龄/岁		病程/月		颈屈肌肌力/分
组别	n		性别/ （男/女）		肢体起病		球部起病		BMI/（kg/m²）		年龄/岁		病程/月		颈屈肌肌力/分
无隐性误吸组	59		30/29		52（88.2）		7（11.8）		23.71±3.50		57.30±10.16		11（5，18）		4.39±0.72
隐性误吸组	9		3/6		3（33.3）		6（66.7）		22.44±4.45		60.44±13.74		9（4，21）		3.00±0.87
χ²或t或Z			0.386		11.830^＊＊				0.979		0.819		0.584		5.256^＊＊
组别		近端肌力/分								远端肌力/分
组别		左上肢		右上肢		左下肢		右下肢		左上肢		右上肢		左下肢		右下肢
无隐性误吸组		4.31±0.68		4.22±0.77		4.33±0.87		4.40±0.70		4.05±0.91		4.03±0.85		4.42±1.14		4.17±0.75
隐性误吸组		3.85±0.56		3.59±0.60		4.04±1.30		4.07±1.30		4.41±0.56		3.64±0.88		4.33±1.12		4.08±0.82
t		1.890		2.337^＊		0.889		1.119		1.173		1.282		0.222		0.333

组别	n		性别/ （男/女）		起病部位				BMI/（kg/m²）		年龄/岁		病程/月		颈屈肌肌力/分
组别	n		性别/ （男/女）		肢体起病		球部起病		BMI/（kg/m²）		年龄/岁		病程/月		颈屈肌肌力/分
无隐性误吸组	59		30/29		52（88.2）		7（11.8）		23.71±3.50		57.30±10.16		11（5，18）		4.39±0.72
隐性误吸组	9		3/6		3（33.3）		6（66.7）		22.44±4.45		60.44±13.74		9（4，21）		3.00±0.87
χ²或t或Z			0.386		11.830^＊＊				0.979		0.819		0.584		5.256^＊＊
组别		近端肌力/分								远端肌力/分
组别		左上肢		右上肢		左下肢		右下肢		左上肢		右上肢		左下肢		右下肢
无隐性误吸组		4.31±0.68		4.22±0.77		4.33±0.87		4.40±0.70		4.05±0.91		4.03±0.85		4.42±1.14		4.17±0.75
隐性误吸组		3.85±0.56		3.59±0.60		4.04±1.30		4.07±1.30		4.41±0.56		3.64±0.88		4.33±1.12		4.08±0.82
t		1.890		2.337^＊		0.889		1.119		1.173		1.282		0.222		0.333

影响因素	β	SE	Wald χ²	P	OR	OR 95%CI
起病部位	-7.464	3.040	6.027	0.014	0.001	0.000~0.222
颈屈肌肌力	-2.414	1.127	4.589	0.032	0.089	0.010~0.814
右上肢近端肌力	-2.707	1.413	3.673	0.055	0.067	0.004~1.603

影响因素	β	SE	Wald χ²	P	OR	OR 95%CI
起病部位	-7.464	3.040	6.027	0.014	0.001	0.000~0.222
颈屈肌肌力	-2.414	1.127	4.589	0.032	0.089	0.010~0.814
右上肢近端肌力	-2.707	1.413	3.673	0.055	0.067	0.004~1.603

组别	n	球部亚评分	吞咽亚评分
无隐性误吸组	59	11.07±1.62	3.71±0.53
隐性误吸组	9	7.00±3.74	2.33±1.23
t		3.216^＊	3.330^＊

肌萎缩侧索硬化患者隐性误吸的危险因素及ALSFRS-R对其预测价值

Risk factors of silent aspiration in patients with amyotrophic lateral sclerosis and the predictive value of ALSFRS-R scale

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