陈兆聪，曹君妍，喻勇，王纯，谢纯青，张耀文，戴萌，丘卫红，窦祖林.鼻咽癌放疗后吞咽困难患者肌肉纤维化与舌骨位移的相关性研究[J].中华物理医学与康复杂志,2017,39(12):903-907
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| 鼻咽癌放疗后吞咽困难患者肌肉纤维化与舌骨位移的相关性研究 |
| The relationship between muscle fibrosis and the hyoid displacement in dysphagic patients with nasopharyngeal carcinoma after radiation therapy |
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| DOI： |
| 中文关键词: 肌肉纤维化 舌骨位移 鼻咽癌 吞咽困难 |
| 英文关键词: Muscle fibrosis Hyoid bone displacement Nasopharyngeal Carcinoma Dysphagia |
| 基金项目:国家自然科学青年基金项目资助（81401869） |
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| 中文摘要: |
| 目的 探讨鼻咽癌放疗后吞咽困难患者肌肉纤维化与舌骨位移的相关关系。 方法 选取鼻咽癌放疗后吞咽困难患者26例，采用剪切波弹性成像测量下颌舌骨肌的弹性模量，同时对患者的吞咽造影行渗漏-误吸评分（PAS）及运动学参数分析，测量舌骨的水平和垂直位移，将弹性模量与舌骨位移作相关性分析，以PAS＞5级为吞咽障碍程度的判断标准构建下颌舌骨肌弹性模量的ROC曲线。 结果 PAS＞5级的患者下颌舌骨肌弹性模量与舌骨位移呈负相关，PAS≤5级的患者下颌舌骨肌弹性模量与舌骨位移不存在相关性，下颌舌骨肌弹性模量判断吞咽障碍程度的ROC曲线，诊断阈值为14.37kPa，敏感度为80%，特异度为81.8%。 结论 鼻咽癌放疗后严重吞咽困难患者肌肉纤维化与舌骨位移存在较大的相关性，肌肉弹性模量可作为评价患者吞咽功能的辅助监测手段。 |
| 英文摘要: |
| Objective To evaluate the relationship between muscle fibrosis and the displacement of the hyoid bone while swallowing among patients with nasopharyngeal carcinoma (NPC) after radiation therapy. Methods Twenty-six NPC patients with dysphagia were recruited. Shear wave elastography was performed to assess the fibrosis of the mylohyoid muscle. The horizontal and vertical displacement of the hyoid bone were measured based on the videofluoroscopic swallowing study, and the severity of dysphagia was determined using the penetration-aspiration scale (PAS). The correlation between the modulus value of the mylohyoid muscle and the horizontal and vertical displacement of the hyoid bone were analyzed, respectively. Receiver-operating characteristic (ROC) curve were constructed to assess the diagnostic ability of modulus value for the severity of dysphagia above grade 5 of PAS. Results For patients whose PAS was higher than grade 5, the modulus value of mylohyoid muscle was negatively correlated with the displacement of hyoid bone, while such correlation was absent for patients whose PAS grading were less than or equal to 5. Sensitivity and specificity by modulus value to detect dysphagia were 80% and 81.8%, respectively, with the best cut-off value of 14.37 kPa. Conclusion The reduction of hyoid bone displacement can be partially attributed to muscle fibrosis for post-radiation NPC patients with severe dysphagia. The modulus value measured by Shear wave elastography could be used as a supplementary way to monitor the development of dysphagia. |
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