神经系统自身免疫性疾病相关吞咽障碍研究进展

doi:10.3877/cma.j.issn.2095-123X.2026.02.007

近年来，神经系统自身免疫性疾病的流行病学、临床表现、诊断和治疗逐渐受到临床重视。吞咽障碍是部分神经系统自身免疫性疾病的主要甚至唯一的临床表现，其病因复杂，常见原因为脑血管病、口腔、食管等占位性病变。当神经系统自身免疫性疾病导致吞咽相关组织结构和功能损伤时即可出现吞咽障碍的临床表现。本文综述可能导致吞咽障碍的神经系统自身免疫性疾病的研究进展，旨在为早期诊断、临床评估、辅助检查及治疗策略提供参考，为拓展吞咽障碍的病因学认识与诊疗分析思路提供依据。

关键词: 神经系统, 自身免疫性疾病, 吞咽障碍, 脑神经病变

In recent years, the epidemiology, clinical manifestations, diagnosis and treatment of autoimmune diseases of the nervous system have gradually attracted clinical attention. Dysphagia is the main or sole clinical manifestation of some autoimmune diseases of the nervous system. The etiology of dysphagia is complex. The common causes are cerebrovascular diseases, oral cavity, esophagus and other space occupying lesions. When autoimmune diseases of the nervous system cause damage to the structural and functional components related to swallowing, the clinical manifestation of dysphagia will occur. This article reviews the research progress of autoimmune diseases of nervous system that may cause dysphagia, aiming to provide references for early diagnosis, clinical assessment, auxiliary examinations and treatment strategies, and to provide a basis for expanding the etiological understanding and diagnostic analysis approaches of dysphagia.

Key words: Nervous system, Autoimmune disease, Dysphagia, Cranial neuropathy

表1 常见吞咽障碍相关神经系统自身免疫性疾病临床特征汇总

Tab.1 Summary of clinical characteristics of common autoimmune diseases of nervous system related to dysphagia

疾病种类	病理机制	受累分期	吞咽障碍表现	评估量表	检查方法	治疗		发病率
疾病种类	病理机制	受累分期	吞咽障碍表现	评估量表	检查方法	药物	非药物	发病率
DM	血管及肌肉周围炎性细胞浸润	口腔期、咽期、食管期	口咽部收缩力受损、环咽功能障碍、喉部抬高减弱和食管运动减弱	常规筛查	VFSS、FEES	糖皮质激素联合免疫抑制剂	康复治疗如球囊扩张训练等,肉毒毒素注射、环咽肌切开术等	18%~58%
IBM	肌质或肌核内有管状细丝包涵体	口腔期、咽期、食管期	口咽期吞咽肌群力量下降、环咽肌功能障碍、喉上抬减少和食管运动异常	常规筛查	VFSS、FEES	药物治疗效果差	调整食物形状、改变进食姿势,肠内营养途径如鼻饲管、胃造瘘、空肠造口管等,肉毒毒素注射、环咽肌切开术等	40%~80%
MG	神经肌肉接头乙酰胆碱被消耗	口腔期、咽期、食管期	口腔、咽喉部肌肉无力及疲劳、食团推进力减弱	无	HRM、FTT、sEMG	溴吡斯的明、类固醇、免疫抑制剂	不推荐	60%
GBS	球麻痹	口腔期、咽期	口腔运送延缓、咽部感觉减退、咽部分泌物残留	常规筛查	VFSS、FEES	激素、IVIG、血浆置换、手术治疗	康复训练如PES、球囊扩张等	41.0%~53.5%
MS	皮质延髓束、小脑及脑干等多部位受累	口腔期、咽期、食管期	食团形成困难、咽部吞咽启动延迟、咽部收缩减弱、环咽肌功能障碍	TWST、DYMUS、SDQ	VFSS、FEES、sEMG等	无	康复训练如PES、rTMS、tDCS等	21%~56%
NMOSD	延髓部疑核、孤束核、迷走神经背核和其间的神经纤维联络受损	咽期、食管期为主	渗漏、误吸、食团过早溢入梨状窝、咽部残留	常规筛查	VFSS、FEES	激素、血浆置换、IVIG、利妥昔单抗等生物制剂	传统康复训练、环咽肌肉毒毒素注射、球囊扩张等	29.50%~61.54%

表1 常见吞咽障碍相关神经系统自身免疫性疾病临床特征汇总

Tab.1 Summary of clinical characteristics of common autoimmune diseases of nervous system related to dysphagia

疾病种类	病理机制	受累分期	吞咽障碍表现	评估量表	检查方法	治疗		发病率
疾病种类	病理机制	受累分期	吞咽障碍表现	评估量表	检查方法	药物	非药物	发病率
DM	血管及肌肉周围炎性细胞浸润	口腔期、咽期、食管期	口咽部收缩力受损、环咽功能障碍、喉部抬高减弱和食管运动减弱	常规筛查	VFSS、FEES	糖皮质激素联合免疫抑制剂	康复治疗如球囊扩张训练等,肉毒毒素注射、环咽肌切开术等	18%~58%
IBM	肌质或肌核内有管状细丝包涵体	口腔期、咽期、食管期	口咽期吞咽肌群力量下降、环咽肌功能障碍、喉上抬减少和食管运动异常	常规筛查	VFSS、FEES	药物治疗效果差	调整食物形状、改变进食姿势,肠内营养途径如鼻饲管、胃造瘘、空肠造口管等,肉毒毒素注射、环咽肌切开术等	40%~80%
MG	神经肌肉接头乙酰胆碱被消耗	口腔期、咽期、食管期	口腔、咽喉部肌肉无力及疲劳、食团推进力减弱	无	HRM、FTT、sEMG	溴吡斯的明、类固醇、免疫抑制剂	不推荐	60%
GBS	球麻痹	口腔期、咽期	口腔运送延缓、咽部感觉减退、咽部分泌物残留	常规筛查	VFSS、FEES	激素、IVIG、血浆置换、手术治疗	康复训练如PES、球囊扩张等	41.0%~53.5%
MS	皮质延髓束、小脑及脑干等多部位受累	口腔期、咽期、食管期	食团形成困难、咽部吞咽启动延迟、咽部收缩减弱、环咽肌功能障碍	TWST、DYMUS、SDQ	VFSS、FEES、sEMG等	无	康复训练如PES、rTMS、tDCS等	21%~56%
NMOSD	延髓部疑核、孤束核、迷走神经背核和其间的神经纤维联络受损	咽期、食管期为主	渗漏、误吸、食团过早溢入梨状窝、咽部残留	常规筛查	VFSS、FEES	激素、血浆置换、IVIG、利妥昔单抗等生物制剂	传统康复训练、环咽肌肉毒毒素注射、球囊扩张等	29.50%~61.54%

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Research progress in dysphagia associated with autoimmune diseases of nervous system

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Research progress in dysphagia associated with autoimmune diseases of nervous system