唾液在吞咽中的作用：一项系统综述。

文献信息

中文摘要

背景： 唾液通过润滑组织并帮助形成和运送食团，在吞咽中发挥关键作用。虽然唾液分泌减少（唾液分泌不足）与吞咽困难有关，但新出现的证据表明，唾液物理和化学性质的变化也可能影响吞咽。然而，这些关系背后的机制仍知之甚少。目的：本系统综述旨在通过回顾同时提供唾液分泌和吞咽生物力学客观测量的研究，探讨唾液与吞咽之间的关系。方法：对Medline（Ovid和PubMed）、CINAHL、Web of Science和Scopus进行了全面检索，涵盖从数据库建库至2025年8月22日的所有记录。我们纳入了报告唾液客观测量指标（如流速、体积、黏稠度、pH值和生物标志物）以及吞咽生物力学的研究。三名独立评审员进行了两个阶段的筛选，审阅了全文，提取了数据，并使用改良的牛津循证医学中心（OCEBM）量表评估了方法学质量。结果：大多数研究采用横断面研究设计，根据OCEBM量表被评为“4”级。在许多研究中，较高的唾液流速与健康成人自发性吞咽频率增加有关。然而，唾液流速与特定吞咽生物力学测量指标之间的关联并不一致。在几个患者群体中，神经肽P物质水平较低与吞咽困难相关，但各研究结果不一。结论：已确定的证据表明，唾液流速和神经肽可能影响吞咽功能，尤其是感觉功能和自发性吞咽频率。然而，这些关系并不一致。患者人群、唾液采集方法和吞咽评估的差异使得研究间的数据合成变得困难。需要更多标准化的长期研究来阐明唾液在吞咽中的作用，并改善对唾液功能障碍和吞咽困难患者的临床评估。

英文摘要

Saliva plays a critical role in swallowing by lubricating tissues and helping form and transport the food bolus. While low saliva production (hyposalivation) is linked to difficulty swallowing, emerging evidence shows that changes in saliva's physical and chemical properties may also affect swallowing. However, the mechanisms underlying these relationships remain poorly understood. The aim of this systematic review was to explore relationships between saliva and swallowing by reviewing studies that provided objective measurements of both saliva production and swallowing biomechanics. A comprehensive search of Medline (Ovid and PubMed), CINAHL, Web of Science, and Scopus was conducted, covering all records from database inception through August 22, 2025. We included studies that reported objective measures of saliva-such as flow rate, volume, thickness, pH, and biomarkers-and swallowing biomechanics. Three independent reviewers carried out two stages of screening, reviewed full texts, extracted data, and evaluated the quality of the methods using a modified Oxford Centre for Evidence-Based Medicine (OCEBM) scale. Most studies used a cross-sectional study design and were rated a "4" according to the OCEBM scale. In many studies, higher salivary flow rates were linked to increased spontaneous swallowing frequency in healthy adults. However, associations between saliva flow and specific swallowing biomechanical measures were not consistent. Lower levels of the neuropeptide substance p were associated with swallowing difficulties in several patient groups, but results varied across studies. The identified evidence suggests that salivary flow and neuropeptides may impact swallowing function, especially sensory function and spontaneous swallowing frequency. However, these relationships were inconsistent. Differences in the patient populations, saliva collection methods, and swallowing assessments made data synthesis between studies difficult. More standardized, long-term research is necessary to elucidate saliva's role in swallowing and improve clinical assessments for people with salivary dysfunction and dysphagia.