目的:吞咽困难是肌萎缩侧索硬化(ALS)的一种常见且严重的临床症状。该研究旨在评估ALS中四种吞咽困难筛查工具的诊断实用性,包括ALS功能评定量表修订(ALSFRS-R)延髓子量表,吞水试验(WST),饮食评估工具-10(EAT-10)和悉尼燕子问卷(SSQ)。
方法:第一医院共68人,山西医科大学,在研究中被招募。ALSFRS-R,WST,进行EAT-10,SSQ和黄金标准视频荧光透视吞咽研究(VFSS)。评估VFSS期间的渗透抽吸量表(PAS)以识别不安全吞咽(PAS≥3)和抽吸(PAS≥6)。进行受试者操作特征曲线(ROC)分析以评估4种工具的准确性。Youden指数用于确定每种工具的理想截止值。
结果:在患者中,20.59%(14/68)出现不安全吞咽,16.18%(11/68)出现误吸。这四种工具可以有效地识别不安全吞咽和误吸的患者。EAT-10在诊断不安全吞咽和吸入的工具中具有最大AUC(分别为0.873和0.963)。为了检测不安全的吞咽和抽吸,EAT-10得分为6分(敏感度:78.6%,特异性:87.0%),EAT-10评分为8分(敏感性:90.9%,特异性:91.2%),是最合适的截止点,分别。
结论:ALSFRS-R球分量表,WST,EAT-10和SSQ可以有效识别ALS患者的不安全吞咽和误吸。在这四种工具中,EAT-10相对准确,安全,和方便。应进行包括更多患者在内的进一步研究以验证结论。
OBJECTIVE: Dysphagia is a common and serious clinical symptom of amyotrophic lateral sclerosis (ALS). The study aimed to evaluate the diagnostic utility of four dysphagia screening tools in ALS, including the ALS Functional Rating Scale-Revised (ALSFRS-R) bulbar subscale, water-swallowing test (WST), Eating Assessment Tool-10 (EAT-10) and Sydney Swallow Questionnaire (SSQ).
METHODS: A total of 68 individuals from First Hospital, Shanxi medical university, were recruited in the study. The ALSFRS-R, WST, EAT-10, SSQ and the gold standard video fluoroscopic swallowing study (VFSS) were performed. The Penetration Aspiration Scale (PAS) during VFSS was assessed to identify unsafe swallowing (PAS ≥ 3) and aspiration (PAS ≥ 6). Receiver operator characteristic curve (ROC) analyses were performed to evaluate the accuracy of the 4 tools. Youden index was used to determine the ideal cut-off value for each tool.
RESULTS: Of the patients, 20.59% (14/68) presented unsafety swallowing and 16.18% (11/68) had aspiration. The four tools could effectively identify patients with unsafe swallowing and aspiration. The EAT-10 had the maximum AUC (0.873 and 0.963, respectively) among the tools in the diagnosis of unsafe swallowing and aspiration. To detect unsafe swallowing and aspiration, an EAT-10 score of 6 (sensitivity: 78.6%, specificity: 87.0%) and an EAT-10 score of 8 (sensitivity: 90.9%, specificity: 91.2%), were the most appropriate cut-off points, respectively.
CONCLUSIONS: The ALSFRS-R bulbar subscale, WST, EAT-10, and SSQ could effectively identify unsafe swallowing and aspiration in patients with ALS. Of the four tools, the EAT-10 was relatively accurate, safe, and convenient. Further studies including more patients should be conducted to verify the conclusions.