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当前位置：国际医学与数据杂志 > 2025年 9卷 (2)期

Open Access Article

International Journal of Medicine and Data. 2025; 9: (2) ; 113-122 ; DOI: 10.12208/j.ijmd.20250045.

Tongue thickness in older adults with sarcopenia and visual impairment: a pilot study
先导研究肌少症与视力缺失老年患者的舌头厚度

作者： 赵达燊¹ *, 黄颕思² *, 黄家强⁴, 叶志刚³, 伍可怡², 陈绰彤⁴, 陈心妍⁴, 张君仪⁴, 舒妍卉⁴, 谭舜馨⁴, 谢佩珊⁴, 叶智斌³

1 中国香港盲人辅导会院舍职业治疗香港

2 中国香港理工大学中文及双语学系言语治疗所香港

3 中国香港东华学院医疗及健康科学学院（职业治疗）香港

4 中国香港理工大学康复治疗科学系（职业治疗）香港

*通讯作者：赵达燊,单位：中国香港盲人辅导会院舍职业治疗香港；黄颕思,单位：中国香港理工大学中文及双语学系言语治疗所香港；

发布时间: 2025-05-27 总浏览量: 143

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摘要

肌少症是一种进行性肌肉疾病，其特征是骨骼肌质量（Skeletal Muscle Mass）和功能的渐进性、广泛性丧失，并且与身体功能障碍和机能衰退密切相关。当肌少症表现为舌肌萎缩（进一步体现为舌体厚度减少）时，舌骨上肌群肌力的减弱可能导致吞咽困难，并增加误吸风险，这种情况可能危及生命。目前，肌少症的常用筛查方法包括问卷评估、诊断量表（diagnostic grids）或预测公式（prediction equations），这些工具通常采用"排除法"测试——即通过比对多项参数来筛除无肌少症风险的人群。骨骼肌质量（SMM）和体重被视为最可靠且常用的评估参数，可通过生物电阻抗分析（BIA）仪获取。由于肌少症对吞咽功能的不良影响，亟需采用一种更具成本效益且普适性的舌体厚度测量方法用于肌少症筛查。本研究采用横断面设计，使用3.5MHz凸面探头测量颏舌骨肌至舌背距离（三次测量均值作为舌厚值），发现舌厚每减少0.1cm，误吸风险显著增加15%（Nakamorietal.， 2020）。本研究旨在通过超声波测量舌体厚度，探究肌少症与舌体厚度的相关性，并探索推广超声波技术在肌少症筛查中的应用。研究目的本研究旨在比较健康受试者与罹患肌少症的老年患者之间的舌体厚度差异。研究方法本研究采用便利抽样法招募35名男女受试者。受试者符合入选标准，包括肌少症组（n=15，来自香港港盲人辅导会）和健康对照组（n=25，来自香港社区）。使用MIRUKO®便携式超声波设备（日本东京Nippon Sigmax公司）测量受试者舌体厚度，以颏舌骨肌下端中点至舌背的三次测量平均值作为舌体厚度值。另外采用InBodyS10（韩国首尔InBody公司）进行生物电阻抗分析（BIA）测定肌肉质量、骨骼肌质量及骨骼肌质量指数（SMI）。本研究采用欧洲老年肌少症工作组（EWGS）制定的骨骼肌质量指数（SMI）和握力标准为7.4kg/m²和22kg（Bahat G等，2016）。研究结果在肌少症患者（N=15）中，舌体厚度与骨骼肌质量（r=0.643，p=0.01）及骨骼肌指数（r=0.564，p=0.028）三者呈显着正相关。舌体厚度的接受者操作特征曲线显示，4.145cm的舌体厚度对肌少症的筛查敏感度为80%，特异度为70%，曲线下面积为0.737（p=0.018）。基于舌体厚度预测骨骼肌质量的回归模型分析显示舌体厚度可解释35.7%的骨骼肌质量变异（F=7.223，df=1，p=0.019）。合并身高、体重、舌体厚度、舌肌力量及唇肌力量的回归模型可解释95.1%的骨骼肌质量变异（F=19.367，df=7，p<0.001）但仅身高与体重的系数在模型中具有统计学意义。结论与展望本研究表明，在肌少症患者當中，舌体厚度与骨骼肌质量及体重呈显着正相关，展现出舌体厚度可能可作为肌少症的筛查指标，超声波技术或可应用于肌少症筛查。早期筛查有助于减少可避免的吞咽困难与误吸所致健康损害，并缓解肌少症对医疗系统造成的经济负担。此外，超声波测量舌体厚度技术有望用于监测肌少症老年患者的口腔运动训练及康复进程。

关键词： 肌少症；吞咽困难；超声波

Abstract

Sarcopenia is a progressive muscle disorder characterized by progressive and generalized loss of skeletal muscle mass and functions and it is strictly correlated with physical disability and functional decline. When sarcopenia presents itself as the atrophy of tongue muscles which is further manifested by a reduction of tongue thickness, the reduction of suprahyoid muscle strength may result in difficulties in swallowing and increased risks of aspiration, which can be fatal. Common screening approaches at sarcopenia include questionnaires, diagnostic grids, or prediction equations which comprise of “rule-out” tests that identify those who are not at risk of sarcopenia by comparing different parameters. SMM and bodyweight are regarded as the most reliable and common parameters and could be obtained by a bioelectrical impedance analysis (BIA) machine. The Iowa Oral Performance Instrument (IOPI) used as an intervention tool in measuring strength and endurance of tongue in healthy populations or disordered populations. Owing to the adverse impacts of sarcopenia on swallowing, there is a need for using a more cost-effective and universal method to measure tongue thickness for the screening of sarcopenia. This study aimed at measuring the tongue thickness using ultrasound, examining the correlation between sarcopenia and tongue thickness and generalizing the use of ultrasound in the screening of sarcopenia. Objectives The study aimed at comparing the tongue thickness between healthy subjects and older individuals with sarcopenia.
Methods A population-based sample of 35 male and female were recruited by convenience sampling. The sample met the selection criteria and was comprised of the sarcopenia group (n=15) who were recruited from the Kowloon Home for the Aged Blind and the healthy subject group (n=25) who were recruited in the community. The tongue thickness of the subjects was examined by the MIRUKO ® Portable Ultrasound (Nippon Sigmax Co. Ltd, Tokyo, Japan). The mean value of the distance between the midpoint of the lower end of the geniohyoid muscle to the tongue dorsum obtained from the three trials was considered to be the tongue thickness. Muscle mass, Skeletal Muscle Mass(SMM) and skeletal muscle index (SMI) were measured by bioelectrical impedance analysis (BIA) using InBody S10 (InBody Co. Ltd, Seoul, Korea). This study adopted the EWGS cut-off thresholds for skeletal muscle index (SMI) hand grip strength was 7.4 kg/m2 and 22 kg for females with sarcopenia. (Bahat G et al., 2016).
Results Receiver operating characteristic curve on the tongue thickness revealed that the tongue thickness at 4.145cm displayed the sensitivity and specificity to classify the sarcopenia at 80% and 70% respectively. The area under the curve at 0.737 with p = 0.018. In people with sarcopenia (N= 15), there were significant correlation between tongue thickness, the skeletal muscle mass (r = 0.643, p = 0.01) and skeletal muscle index (r = 0.564, p = 0.028). Regression model on the prediction of the SMM by the tongue thickness showed that the tongue thickness explained 35.7% of the SMM (F = 7.223, df =1, p = 0.019). We incorporated Height, Weight, Tongue thickness, Tongue strength and Lip strength into the regression model, which explained 95.1% of the SMM (F=19.367, df = 7, p<0.001). However, only the coefficient of height and weight were significant in the model.
Conclusion and Future Implications Our findings suggested that tongue thickness had a positive and significant correlation with skeletal muscle mass and body weight. The results revealed that tongue thickness might be an indicator of sarcopenia, and hence ultrasound could be used in the screening of sarcopenia. Early screening may help to minimize the health consequences of dysphagia and aspiration that could otherwise be avoided and the economic burden sarcopenia has exerted on the healthcare system. In addition, the use of ultrasound in measuring tongue thickness has the potential to monitor the progress of oral-motor training and rehabilitation process of older individuals with sarcopenia.

Key words： Sarcopenia; Dysphagia; Ultrasound

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引用本文

赵达燊, 黄颕思, 黄家强, 叶志刚, 伍可怡, 陈绰彤, 陈心妍, 张君仪, 舒妍卉, 谭舜馨, 谢佩珊, 叶智斌, 先导研究肌少症与视力缺失老年患者的舌头厚度[J]. 国际医学与数据杂志, 2025; 9: (2) : 113-122.

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