Abstract: Background　Dysphag ia is common in stroke patients.Accurate assessment of swallowing function is of great significance in rehabilitation treatment of such patients.The use of traditional evaluation methods is limit due to low accuracy and specificity，radiation and complicated operation.As a non-invasive，convenient and highly reproducible method，ultrasound can measure the hyoid-larynx approximation（HLA）accurately，providing a new way to evaluate swallowing function.Objective　To explore the value of utrasonographic measurement of HLA in the evaluation of dysphagia after stroke.Methods　A total of 42 patients with dysphagia after stroke hospitalized in Guigang City People's Hospital from January to December 2018 were enrolled as the study group，and 40 healthy volunteers were selected as the control group.All the subjects in the study group were confirmed to have swallowing dysfunction by videofluoroscopic swallowing study（VFSS）.Two ultrasound physicians separately examined the maximum hyoid-larynx approximation（MHLA） and minimum hyoid-larynx approximation（NHLA） of 5 controls to evaluate the reliability of ultrasound examination.Both groups were examined by pharyngeal ultrasound.The MHLA，NHLA，hyoid-larynx shortening approximation（HLAS） and approximation shortening rate（ASR） were measured or calculated.The differences of ultrasonic values between the two groups were compared，and the correlations between the measured values and the VFSS scores were also calculated.ROC curves were drawn to evaluate the diagnosis ability of NHLA，HLAS and ASR.And the AUC，the optimal cutoff value，sensitivity，specificity and Youden index were determined.Results　The ICC values of MHLA measured by the same operator were 0.975，and 0.949，respectively，and those of NHLA measured by the same operator were 0.924，and 0.957 respectively.The mean NHLA in the study group was significantly larger than that of the control group，while the mean HLAS and ASR were significantly smaller than those of the control group（P<0.05）.VFSS score was correlated negatively with NHLA
（rs=-0.581，P<0.001），while correlated positively with HLAS and ASR（rs=0.575 and 0.778，P<0.001）.The AUC of NHLA，HLAS and ASR in the diagnosis of dysphagia was 0.907〔95%CI（0.822，0.960）〕，0.852〔95%CI（0.757，0.921）〕，and 0.972〔95%CI（0.910，0.996）〕，respectively.ASR had a larger AUC than NHLA（Z=2.012，P=0.044），and HLAS（Z=3.421，P<0.001）.The optimal ASR cutoff value was 40.63%，leading to a sensitivity of 85.71%，a specificity of 100.00%，and a Youden index of 0.857，respectively.Conclusion　The AUC of ASR is larger than that of NHLA and HLAS in diagnosing dysphagia after stroke with high sensitivity and specificity，indicating that ultrasonic measurement of HLA can be used to evaluate the dysphagia after stroke，and ASR is a satisfactory diagnostic indicator.

Key words: Stroke, Deglutition disorders, Utrasonography, Hyoid bone, Thyroid cartilage, Hyoid-larynx approximation

摘要： 背景　吞咽功能障碍是脑卒中患者常见的并发症，准确地评估吞咽功能在此类患者的康复治疗中具有重大意义。传统的评估方法正确率和特异度较低，且兼具辐射性以及操作复杂等特点，不能在临床上广泛应用。超声作为一项无创、便捷、可重复性高的检查手段，可准确地测量舌骨-甲状软骨间距（HLA），为评估吞咽功能提供了新思路。目的　探讨HLA评估脑卒中后吞咽功能障碍的价值。方法　选取2018年1—12月在贵港市人民医院住院治疗的脑卒中后吞咽功能障碍患者共42例为研究组，同期另选取本院40例健康体检者为对照组。研究组均经吞咽荧光透视检查（VFSS）证实存在吞咽功能障碍。两名超声科医生（检查者Ⅰ、Ⅱ）分别对5例健康受检者进行检查，评估超声检查的可靠性。两组受检者均进行咽部超声检查，测量或计算舌骨-甲状软骨间最大距离（MHLA）、最小距离（NHLA）和舌骨-甲状软骨缩短距离（HLAS）以及舌骨-甲状软骨间距离缩短率（ASR），比较两组间各超声测值的差异，并将各超声测值与VFSS评分进行相关性分析；绘制NHLA、HLAS及ASR诊断吞咽功能障碍的受试者工作特征曲线（ROC曲线），并计算ROC曲线下面积（AUC）及最佳截断值、灵敏度、特异度、约登指数。结果　检查者Ⅰ、Ⅱ测量MHLA的组内相关系数（ICC）分别为0.975和0.949，测量NHLA的ICC分别为0.924和0.957。研究组NHLA大于对照组，HLAS、ASR小于对照组（P<0.05）。VFSS评分与NHLA呈负相关（rs=-0.581，P<0.001），而与HLAS及ASR呈正相关（rs值分别为0.575、0.778，P值均<0.001）。NHLA、HLAS及ASR诊断吞咽功能障碍的AUC分别为0.907〔95%CI（0.822，0.960）〕、0.852〔95%CI（0.757，0.921）〕和0.972〔95%CI（0.910，0.996）〕。ASR诊断吞咽功能障碍的AUC大于NHLA和HLAS（Z=2.012、3.421，P=0.044、<0.001）。ASR诊断吞咽功能障碍的最佳截断值为40.63%，灵敏度、特异度及约登指数分别为85.71%、100.00%、0.857。结论　ASR诊断吞咽功能障碍的AUC大于NHLA和HLAS，灵敏度、特异度较高，提示超声测量HLA能够用于脑卒中后吞咽功能障碍的评估。其中ASR是诊断脑卒中后吞咽功能障碍的最佳指标。

关键词: 卒中, 吞咽功能障碍, 超声测量, 舌骨, 甲状软骨, 舌骨-甲状软骨间距