喉抬高速度作为放疗后吞咽困难中吞咽安全性的候选动态标志物：一项初步探索性研究
Laryngeal Elevation Velocity as a Candidate Dynamic Marker of Swallowing Safety in Postradiotherapy Dysphagia: A Preliminary Exploratory Study.
文献信息
| PMID | 42881986 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Kai-Hsiang Hu |
| 作者单位 | Department of Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan. |
| 期刊 | Journal of clinical medicine |
| SCI 分区 | Q1 |
| IF | 3.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景/目的： 为探讨喉抬高速度（LEV）作为放疗后吞咽困难合并环咽肌功能障碍（CPMD）患者吞咽安全性的候选生理标志物，我们检验了其与气道安全性的关联，以及LEV-上食管括约肌（UES）开放关系在肉毒毒素注射前后是否存在差异，此处肉毒毒素注射被用作受试者内的生理性扰动。
方法： 本回顾性队列研究纳入18例接受环咽肌肉毒毒素注射（中位总剂量30 U；范围20-40 U）并完成干预前后电视透视吞咽检查（VFSS）的放疗后鼻咽癌（NPC）合并CPMD患者。主要结局为穿透-误吸量表（PAS）和UES开放直径；次要结局包括功能性经口摄食量表（FOIS）、喉抬高（LE）和LEV。采用广义估计方程（GEE）并纳入LEV×治疗交互项评估关联在注射前后状态间是否存在差异。
结果： 肉毒毒素注射后，FOIS评分显著改善（中位4至5；p < 0.001），同时LEV（中位149.86至201.12 C2-4%/s；p = 0.027）和UES直径（中位21.10至23.30 C2-4%；p = 0.039）增加；PAS评分和喉抬高位移无显著变化。单变量分析中，较高的LEV与较低的不安全气道侵入（PAS 5-8）几率相关（每增加100单位的比值比0.38；95%置信区间[CI] 0.17-0.86；p = 0.021）。观察到LEV×治疗对UES直径的显著交互作用（p = 0.021）。
结论： 在放疗后NPC合并CPMD患者中，较高的LEV与气道安全性相关，且LEV-UES关系在注射前后状态间存在差异。尽管研究设计不允许得出关于治疗疗效的结论，LEV可能代表一种候选的负荷敏感性吞咽安全性标志物，值得进一步研究。
英文摘要
Background/Objectives: To investigate laryngeal elevation velocity (LEV) as a candidate physiological marker of swallowing safety in post-radiotherapy dysphagia patients with cricopharyngeal muscle dysfunction (CPMD), we examined its association with airway safety and whether the LEV-upper esophageal sphincter (UES) opening relationship differed before versus after botulinum toxin injection, used here as a within-subject physiological perturbation. Methods: This retrospective cohort study included 18 post-radiotherapy patients with nasopharyngeal carcinoma (NPC) and CPMD who underwent botulinum toxin injection into the cricopharyngeal muscle (median total dose, 30 U; range, 20-40 U) and completed videofluoroscopic swallowing studies (VFSSs) before and after intervention. Primary outcomes were the Penetration-Aspiration Scale (PAS) and UES opening diameter; secondary outcomes included the Functional Oral Intake Scale (FOIS), laryngeal elevation (LE) and LEV. Associations were evaluated using generalized estimating equations (GEEs) with LEV × treatment interaction terms to assess whether they differed across pre- and post-injection states. Results: Following botulinum toxin injection, FOIS scores improved significantly (median, 4 to 5; p < 0.001), with concurrent increases in LEV (median, 149.86 to 201.12 C2-4%/s; p = 0.027) and UES diameter (median, 21.10 to 23.30 C2-4%; p = 0.039); PAS scores and laryngeal elevation displacement did not change significantly. Higher LEV was associated with lower odds of unsafe airway invasion (PAS 5-8) in univariate analysis (odds ratio per 100-unit increase, 0.38; 95% confidence interval [CI], 0.17-0.86; p = 0.021). A significant LEV × treatment interaction was observed for UES diameter (p = 0.021). Conclusions: In post-radiotherapy NPC patients with CPMD, higher LEV was associated with airway safety, and the LEV-UES relationship differed across pre- and post-injection states. Although the study design does not permit conclusions about treatment efficacy, LEV may represent a candidate load-sensitive marker of swallowing safety, warranting further investigation.