超越急性期：门诊卒中幸存者中未报告吞咽障碍的患病率及临床特征
Beyond the Acute Phase: Prevalence and Clinical Characteristics of Unreported Swallowing Impairments in Ambulatory Outpatient Stroke Survivors.
文献信息
| PMID | 42841781 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Brittany N Krekeler |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, OH. |
| 期刊 | American journal of speech-language pathology |
| SCI 分区 | Q1 |
| IF | 3.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 未报告的吞咽困难，即影像学发现吞咽障碍但患者未报告症状，在卒中急性期之后仍特征不明。本研究旨在（a）量化门诊卒中幸存者中未报告吞咽困难的时点患病率，（b）探讨与这一现象表现相关的人口学和临床因素，以及（c）评估患者报告症状与影像学衍生障碍之间的一致性。
方法： 这项回顾性二次分析纳入了45名缺血性卒中后≥3个月的门诊成人，他们接受了视频荧光吞咽检查并完成了进食评估工具-10（EAT-10）。吞咽障碍定义为动态影像吞咽毒性分级（DIGEST分级≥1），生理特征采用改良钡餐吞咽障碍剖面（MBSImP）进行描述。参与者被分类为无吞咽困难（DIGEST=0）、显性吞咽困难（DIGEST≥1且EAT-10>3）或未报告吞咽困难（DIGEST≥1且EAT-10≤3）。组间差异采用方差分析、Fisher精确检验和非参数分析进行检验。
结果： 16%（7/45）的参与者表现出未报告吞咽困难，而44%（20/45）存在某种程度的吞咽障碍。未报告吞咽困难组和显性吞咽困难组的DIGEST分级相似，但未报告吞咽困难组报告的症状负担极小（EAT-10：中位数=2），而显性组为（EAT-10：中位数=9）。EAT-10与MBSImP口腔总分之间存在显著相关性（r=0.510，p<0.008），但与DIGEST无显著相关性（r=0.21，p=0.163）。年龄、病灶特征、卒中后时间及入院卒中严重程度与未报告吞咽困难无显著关联。
结论： 相当比例的门诊社区居住卒中幸存者表现出持续性吞咽障碍但未报告症状，具有临床意义。依赖基于症状的转诊路径可能无法发现持续存在的安全性或效率缺陷。这些发现支持在卒中恢复急性期之后考虑基于影像学的监测策略。
英文摘要
PURPOSE: Unreported dysphagia, imaging-identified swallowing impairment without symptom reporting, remains poorly characterized beyond the acute phase of stroke. This study aimed to (a) quantify the point prevalence of unreported dysphagia in ambulatory stroke survivors, (b) examine demographic and clinical factors associated with the presentation of this phenomenon, and (c) evaluate concordance between patient-reported symptoms and imaging-derived impairments.
METHOD: This retrospective secondary analysis included 45 ambulatory adults ≥ 3 months post-ischemic stroke who underwent videofluoroscopic swallow study and completed the Eating Assessment Tool-10 (EAT-10). Swallowing impairment was defined using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST Grade ≥ 1), and physiology was characterized using the Modified Barium Swallow Impairment Profile (MBSImP). Participants were classified as having no dysphagia (DIGEST = 0), overt dysphagia (DIGEST ≥ 1 and EAT-10 > 3), or unreported dysphagia (DIGEST ≥ 1 and EAT-10 ≤ 3). Group differences were examined using analysis of variance, Fisher's exact tests, and nonparametric analyses.
RESULTS: Sixteen percent (7/45) of participants demonstrated unreported dysphagia, while 44% (20/45) exhibited some degree of swallowing impairment. Unreported and overt dysphagia groups had similar DIGEST grades, yet the unreported dysphagia group reported minimal symptom burden (EAT-10: Mdn = 2) compared to the overt group (EAT-10: Mdn = 9). Significant correlations were observed between the EAT-10 and the MBSImP oral total (r = .510, p < .008), but not DIGEST (r = .21, p = .163). Age, lesion characteristics, time since stroke, and admission stroke severity were not significantly associated with unreported dysphagia.
CONCLUSIONS: A clinically meaningful proportion of ambulatory, community-dwelling stroke survivors demonstrated persistent swallowing impairment without symptom reporting. Reliance on symptom-based referral pathways may fail to detect ongoing safety or efficiency deficits. These findings support the consideration of imaging-based surveillance strategies beyond the acute phase of stroke recovery.