筋萎縮性側索硬化症例における舌萎縮と嚥下時の食塊移送との関係  [in Japanese] Relationship between muscular atrophy of the tongue and impairment of bolus transport during swallowing in patients with amyotrophic lateral sclerosis  [in Japanese]

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Author(s)

    • 谷口 裕重 Taniguchi Hiroshige
    • 新潟大学大学院医歯学総合研究科摂食・嚥下リハビリテーション学分野 Division of Dysphagia Rehabilitation, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences
    • 大瀧 祥子 Ootaki Sachiko
    • 新潟大学医歯学総合病院摂食・嚥下機能回復部 Unit of Dysphagia Rehabilitation, Niigata University Medical and Dental Hospital
    • 梶井 友佳 Kajii Yuka
    • 新潟大学医歯学総合病院摂食・嚥下機能回復部 Unit of Dysphagia Rehabilitation, Niigata University Medical and Dental Hospital
    • 井上 誠 Inoue Makoto
    • 新潟大学大学院医歯学総合研究科摂食・嚥下リハビリテーション学分野 Division of Dysphagia Rehabilitation, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences

Abstract

本研究は筋萎縮性側索硬化症 (Amyotrophic Lateral Sclerosis, ALS) 患者の主症状のひとつである舌萎縮に注目し, 嚥下造影検査 (Videofluorography, VF) を用いて嚥下時の食塊動態を調べることにより, 舌萎縮の進行が嚥下機能に及ぼす影響を検討した.<BR>被験者としてALS患者19名, 対照として健常高齢成人11名に対してVFを行った.検査時の被験試料として40wt/vol%硫酸バリウム溶液3mlを用いた.得られたデータより誤嚥の有無, 誤嚥・喉頭侵入のタイプ, 嚥下後の咽頭内食塊残留量, 舌骨挙上を嚥下開始の指標とした食塊移送時刻, 食塊通過時間を計測した.<BR>VF画像より誤嚥の有無を評価した結果, ALS患者の中で誤嚥がみられたすべての症例において舌萎縮像が観察された.さらにALS患者の舌萎縮無群に対して, 舌萎縮有群では嚥下後の咽頭内残留量が多かった.誤嚥が認められなかったALS患者の舌萎縮有群と舌萎縮無群, さらに対照群を合わせた3群間で食塊動態を比較したところ, 舌萎縮有群ではクリアランスタイム, 食道入口部通過時間が有意に延長し, また嚥下反射開始前に食塊先端が咽頭最下端部に到達していた.舌の形態異常および運動不良などにより口腔内保持が困難および嚥下惹起遅延となった結果, 嚥下前に食塊が下咽頭まで流入していたことが原因と考えられた.以上より, ALS患者において舌萎縮がみられた場合, 嚥下関連運動機能の低下とともに咽頭内残留量が増加しさらに液体の咽頭内停滞時間が延長するために食塊の誤嚥もしくは喉頭侵入を起こす可能性が高いことが示された.

The present study was focused on the tongue atrophy which is one of the common symptom in patients with amyotrophic lateral sclerosis (ALS) and investigated the effects of tongue atrophy on impairment of swallowing function by using videofluorographic assessment.<BR>The subjects included 19 patients diagnosed ALS and 11 age-matched normal adults. Each subject was asked to swallow 3 ml water with 40 vt/wt% barium sulfate. Whether aspiration and/or penetration of bolus before, during and after swallowing was observed or not and amount of bolus residues in the pharynx were evaluated. Furthermore, in case of no aspiration observed, bolus transit times were measured and compared among the groups.<BR>All the cases in which the patient had an episode of aspiration were related to the muscular atrophy of tongue. The patient group showing tongue atrophy exhibited higher scores of pharyngeal residue than the other groups, meaning that the amount of pharyngeal residues after the swallow in the former group was much more than that of patients with no atrophy of the tongue or normal adults.<BR>Comparing the bolus transit time among the atrophic tongue in patients without aspiration, normal tongue in patients and normal adults, Clearance Time, i.e., the time of the bolus invading the pharynx and Upper Esophageal Segment Transit Time were delayed and the bolus head reached at the bottom of hypopharynx before onset of swallowing in the first group. It may be possible that abnormal structure and motility and/or extension of pharyngeal duct due to the atrophy of tongue may cause the difficulty in the bolus handling in the oral cavity and delay of triggering reflex swallowing.<BR>All the results obtained in the present study suggested that the muscular atrophy of tongue in patients with ALS may be a critical sign for the risk of severe problem with swallowing function.

Journal

  • The Journal of Japanese Society of Stomatognathic Function

    The Journal of Japanese Society of Stomatognathic Function 15(1), 30-37, 2008

    Japanese Society of Stomatognathic Function

Codes

  • NII Article ID (NAID)
    130003820285
  • Text Lang
    JPN
  • ISSN
    1340-9085
  • Data Source
    J-STAGE 
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