鼻咽癌放/化疗后吞咽障碍的临床评估

Clinical evaluation of dysphagia after radiotherapy and chemotherapy for nasopharyngeal carcinoma

摘要:

目的 遴选出安全、有效、便捷的鼻咽癌放/化疗后吞咽障碍的评估方法。方法 选取在邵阳市中心医院就诊的鼻咽癌患者37例，应用吞咽X线荧光透视检查（VFSS）、进食评估问卷调查量表（EAT-10）、安德森吞咽障碍量表（MDADI）、反复唾液吞咽试验（RSST）和洼田饮水试验（WST）对入组患者进行吞咽功能的评估，筛选适合鼻咽癌放/化疗后吞咽障碍评估的方法。结果 以VFSS为金标准，进食评估EAT-10的灵敏度为83.33%，MDADI灵敏度为72.22%，RSST特异度为84.21%，但这些方法与金标准的Kappa值都小于0.2，其一致性较低。WST特异度为78.95%，Kappa值大于0.2，具有相对较好的一致性。结论 WST与VFSS的一致性相对较好，可以作为鼻咽癌放/化疗后吞咽障碍的筛查工具，其他方法也可辅助评估。

Abstract:

Objective To select some safe, effective and convenient methods for the evaluation of dysphagia after radiotherapy/chemotherapy for nasopharyngeal carcinoma(NPC).Methods A total of 37 patients with NPC in the Central Hospital of Shaoyang were selected. Video fluoroscopic swallowing study (VFSS), eating assessment tool (EAT-10), M.D.Anderson dysphagia inventory (MDADI), repeated saliva swallowing test (RSST) and water swallowing test (WST)were used to evaluate the swallowing function of the patients. Its purpose is to screen some suitable methods for the evaluation of dysphagia after radiotherapy/chemotherapy for NPC.Results Taking VFSS as the gold standard, the sensitivity of EAT-10 was 83.33%, the sensitivity of MDADI was 72.22%, and the specificity of RSST was 84.21%. However, the Kappa values of these methods compared with gold standard were all less than 0.2, which meant a low consistency. The specificity of WST was 78.95%, and the Kappa value was more than 0.2, which revealed a well consistency.Conclusion The consistency between WST and VFSS is relatively good, which can be used as a screening tool for dysphagia after radiotherapy/chemotherapy for NPC, and other methods can also assist in the evaluation.