要介護高齢者における舌圧と唾液腺細菌との関係

Relationship between Tongue Pressure and Salivary Bacteria in the Older Adults Requiring Long-Term Care.

抄録

はじめに:

高齢者における誤嚥性肺炎は、唾液中の病原性微生物の増加、誤嚥、宿主の免疫力低下などが原因となり、重要な問題である。近年，舌圧の低下が嚥下障害と関連することが報告されている．本研究では、要介護高齢者の舌圧低下と唾液中の細菌数との関係を検討することを目的とした。

INTRODUCTION: Aspiration pneumonia, an important issue for the older adults, is caused by an increase in pathogenic microorganisms in the saliva, aspiration, and weakened host immunity. Recently, decreased tongue pressure has been reported to be associated with dysphagia. This study aimed to investigate the relationship between decreased tongue pressure and the number of bacteria in the saliva of the older adults requiring long-term care.

方法:

本研究は、施設または在宅で介護を必要とし、経口で食事をし、舌圧測定の指示を理解できる高齢者95名を対象とした横断的研究である。性別，年齢，緩慢さ，脱力感，萎縮，疲労感，低活性，歯数，機能的歯単位，義歯使用，口腔衛生，舌コーティング指数，ドライマウス，舌圧，唾液中の細菌数について検討した．細菌数は，総菌数，総連鎖球菌数，メチシリン耐性黄色ブドウ球菌，肺炎球菌，緑膿菌，Porphyromonas gingivalis，およびCandida albicansについてリアルタイムPCR法により解析した．

METHODS: This cross-sectional study involved 95 older adults requiring long-term care in a facility or at home, eating orally, and who could understand the instructions for measuring tongue pressure. Sex, age, slowness, weakness, shrinking, exhaustion, low activity, number of teeth, functional teeth unit, denture use, oral hygiene, tongue coating index, dry mouth, tongue pressure, and number of bacteria in the saliva were examined. Bacterial counts were analyzed by real-time PCR for total bacteria, total streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans.

結果:

重回帰分析により、口腔衛生状態の悪化と舌圧の低下が、唾液中の細菌増加の独立した危険因子であることが示された。舌圧の低下は、総細菌数の増加および P. gingivalis の存在と有意な相関が認められた。

RESULTS: Multiple regression analysis showed that poor oral hygiene and decreased tongue pressure were independent risk factors for increased bacteria in the saliva. Decreased tongue pressure is significantly correlated with an increased number of total bacteria and the presence of P. gingivalis.

考察／結論:

舌圧は嚥下機能を維持するだけでなく、要介護高齢者の唾液中の細菌の増加を防ぐことが示唆された。

DISCUSSION/CONCLUSION: Our results suggest that tongue pressure not only maintains the swallowing function but also prevents the increase of bacteria in the saliva of older adults requiring long-term care.