动态喉镜下肌萎缩侧索硬化患者的咽喉改变及与球麻痹的关系  

Clinical characteristics of the throat in patients with amyotrophic lateral sclerosis under laryngostroboscope and its relationship with bulbar palsy

作　　者：杨碧莹[1] 郑瑜[1] 侯晓妹[1] 杜宝新[1] YANG Biying;ZHENG Yu;HOU Xiaomei;DU Baoxin(Department of Neurology,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510006,Guangdong,China)

机构地区：[1]广东省中医院脑病四科,广东广州510120

出　　处：《暨南大学学报（自然科学与医学版）》2022年第1期67-72,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省中医药局科研项目(A2019114,20203002,20211188)。

摘　　要：目的:回顾性分析肌萎缩侧索硬化(ALS)患者的动态喉镜下咽喉改变的特点及其与球麻痹的关系,探讨动态喉镜对ALS的球麻痹症状(构音障碍和吞咽困难)评估的临床应用价值。方法:收集32例患者的临床资料,所有患者均行肌电图、动态喉镜检查和量表评估。根据咽喉反流检查积分量表(RFS)对喉部检查的情况进行描述并打分。量表评估包括ALSSS量表(构音和吞咽部分)、改良的ALS功能评分量表(ALSFRS-R)、ALS自我评估问卷(ALSAQ-40)和Frenehay构音障碍评定法。结果:32例患者中,RFS评分异常有13例(40.63%)。异常集中于声门下水肿和喉室消失。RFS评分与ALS患者ALSFRS-R言语评分、ALSSS-SP(构音)评分、Frenchay评分呈正相关(P<0.05),与性别、发病年龄、病程、起病部位、诊断级别、吸烟史、胃病史、ALSFRS-R流涎、ALSFRS-R吞咽、ALSAQ-40饮食能力、ALSAQ-40社交能力、肌电图有无延髓段病变无相关性。喉镜与肌电图相比,对球麻痹的检出率无提高(P>0.05)。构音障碍组与无构音障碍组比较,RFS评分的总分和喉室消失的评分较高(P<0.05)。吞咽困难与无吞咽困难组比较,RFS评分中的声门下水肿评分较高(P<0.05)。RFS评分异常(>7分)与Frenchay中的舌功能评分异常存在正相关(P<0.05)。结论:动态喉镜异常与ALS患者的球麻痹症状严重程度存在一定程度的正相关,尤其是构音障碍方面。动态喉镜可用于评估ALS患者的球麻痹症状。Objective:To analyse the characteristics of throat changes under laryngostroboscope in patients with amyotrophic lateral sclerosis(ALS)and its relationship with bulbar paralysis retrospectively and discuss the clinical application value of laryngostroboscope in evaluating bulbar paralysis symptoms(dysarthria and dysphagia)of ALS.Methods:Clinical data of 32 patients were collected including electromyogram,laryngostroboscope and assessment scales.Characteristics of the throat were described and scored according to the reflux finding score(RFS).Assessment scales include ALS severity scale(ALSSS scale),revised amyotrophic lateral sclerosis functional rating scale(ALSFRS-R),the forty item ALS assessment questionnaire(ALSAQ-40)and Frenchay dysarthria assessment.Results:Among the 32 patients,13(40.63%)had abnormal RFS scores.Abnormalities exhibited in subglottic edema and disappearance of laryngeal chamber.RFS score was positively correlated with ALSFRS-R speech score,ALSSS-SP articulation score and Frenchay score(P<0.05),independent of sex,age of onset,course of disease,onset site,diagnosis level,smoking history,gastropathy history,salivation of ALSFRS-R,swallowing of ALSFRS-R,eating ability of ALSAQ-40,social ability of ALSAQ-40,and medullary segment lesions in EMG.The detection rate of bulbar paralysis by laryngostroboscope did not increase compared with electromyography(P>0.05).Compared with the group without dysarthria,the total score of RFS and the score of laryngeal chamber disappearance were higher in the dysarthria group(P<0.05).Compared with the group without dysphagia,the score of subglottic edema was higher in the dysphagia group(P<0.05).The abnormal RFS score(>7)is positively correlated with the abnormal tongue function score in Frenchay dysarthria assessment(P<0.05).Conclusion:There is a positive correlation between the abnormality of laryngostroboscope and the severity of bulbar paralysis in ALS patients especially with dysarthria.Laryngostroboscope can be used to evaluate the symptoms of bulbar paralysis

关 键 词：肌萎缩侧索硬化 动态喉镜 构音障碍 吞咽困难 

分 类 号：R741.041[医药卫生—神经病学与精神病学]