Study on Tongue Coating Patterns of the Xerostomia in the Elderly Patients

Transcription

1 17 3 ( ) The Journal of the Society of Korean Medicine Diagnostics 2013; 17(3): * 1) Abstract Study on Tongue Coating Patterns of the Xerostomia in the Elderly Patients Gajin Han 1 Jae-Woo Park 1 Seok-Jae Ko 1 Juyeon Kim 1 Jiyoung Son 1 Seungwon Jang 1 Seul-Ki Kim 1 Minji Kim 1 Jinsung Kim 1* 1 Department of Gastroenterology College of Korean Medicine Kyung Hee University Objectives The aim of this study is to analyze the characteristics of the tongue coating pattern in the elderly patients with xerostomia Methods Ninety-six elderly patients with xerostomia were recruited by advertisement and they visited the oral diseases clinics at Kyung Hee University Korean Medicine Hospital and Kyung Hee University Hospital at Gangdong from November 2011 to August 2013 After signifying the assent the subjects who passed screening were enrolled this study The subjects were evaluated on their clinical characteristics of xerostomia using visual analogue scale for xerostomia dry mouth questionnaire unstimulated salivary flow rate In addition Yin-deficiency questionnaire was used to evaluate the Yin-deficiency state and Winkel tongue coating index and Digital Tongue imagin system were used to measure the tongue coating of patients Results The proportion of women was higher than that of men and there were few smokers in this study population This population had chronic and relatively severe xerostomia symptoms Also thin coating pattern was showed in this elderly patients with xerostomia and this result was regarded to the influence of Yin-deficiency The thin coating patten was observed in the group with higher Yin-deficiency score There was no difference in tongue coating between the hyposalivation and normosalivation group Conclusion In the elderly patients with xerostomia Yin-deficiency is might be considered as one of the main cause of xerostomia Hence it is thought that this patients showed the thin coating pattern This results could be used in diagnosis and treatment for the elderly patients with xerostomia in traditional Korean medicine Key Words Xerostomia Aged Tongue coating Yin-deficiency * / : 3 Tel : / oridoc@khuackr : : :

2 1) 2) 65 30% 3) pilo- carpine 4-5) 6) 1)7) 8-9) 10-11) 12-13) 14-18) 19) 20) 21) ( ) 22) 21) 23) 24) 25-27) (winkel tongue coating index) )

3 ) (pilocarpine cevimeline visual analogue scale(vas) 4 03 ml/min 7) 3 IRB (KOMC-IRB / KHNMC-OH- IRB ) / VAS dry mouth symptom questionnaire (DMSQ) (unstimulated salivary flow rate; USFR) (yin-deficiency questionnaire) WTCI (Winkel tongue coating index) 48 DTIS (digital tongue imaging system) A 2 B VAS (Visual analogue scale for xerostomia) 0-100mm

4 ) E (Residual saliva of bucca; RSB Residual saliva of tongue surface; RST) C Dry mouth symptom questionnaire (DMSQ) 32) mm VAS 4 Likert 32) Moisture Checker for Mucus (MCM: Life Co Ltd Tokyo Japan) % 30% 3 F (Yin-deficiency questionnaire; YDQ) 19) D (Unstimulated salivary flow rate; USFR) 33) 9:00 11:00 10 conical tube (1 ) USFR ml/min mm 0 ( ) 100 ( ) Winkel Tongue Coating Index(WTCI) = A + B + C + D + E + F 0 = NO COATING 1 = LIGHT COATING 2 = HEAVY COATING

5 (Appendix 1) A Winkel Tongue Coating Index (WTCI) 23) '0 = ' '1 = ' '2 = ' (Fig 1) (5500K) (strobe) B DTIS) 24) (Digital Tongue Imaging System; (Fig 2)

6 UI (Fig 3) 6 WTCI (3125%) 66 (6875%) (5521%) (4479%) 1 11 (1146%) (1979%) (1875%) (125%) (625%) 5 30 (3125%) Mean ± SD Number(%) independent t-test P < 005 PASW Statistics 18 (SPSS Inc Chicago IL USA) 96 ( VAS DMSQ USFR RSB RST) Table 1 (Table 1) 96 WTCI 442 ± DTIS 4041 ± 1764 DTIS

7 Variables Mean SD Duration of xerostomia (months) Visual analogue scale for xerostomia Dry mouth symptom questionnaire score Unstimulated salivary flow rate (ml/min) Residual saliva of buccal mucosa (%) Residual saliva of tongue surface (%) Group with YD * score under the median value (YD < 288) Group with YD * score over the median value (YD 288) Winkel tongue coating index (N = 96) 426 ± ± Digital tongue imaging system measurement (%) (N = 48) 4153 ± ± * Yin-Deficiency ** P-value was calculated from independent t-test Percentage of tongue coating measured by digital tongue imaging system P ** Hyposalivation group (USFR * 01 ml/min) Normosalivation group (USFR * > 01 ml/min) Winkel tongue coating index (N = 96) 436 ± ± Digital tongue imaging system measurement (%) (N = 48) 3914 ± ± * Unstimulated salivary flow rate ** P-value was calculated from independent t-test Percentage of tongue coating measured by digital tongue imaging system P ** 26) % (Table 2) USFR 01 ml/min 7) DTIS WTCI WTCI DTIS (Table 3)

8 Group with WTCI * score under the median value (WTCI < 442) Group with WTCI * score over the median value (WTCI > 442) Duration of xerostomia (months) 5817 ± ± Visual analogue scale for xerostomia 6823 ± ± Dry mouth symptom questionnaire score ± ± Unstimulated salivary flow rate (ml/min) 012 ± ± Residual saliva of buccal mucosa (%) 1513 ± ± ** Residual saliva of tongue surface (%) 1464 ± ± ** Yin-deficiency questionnaire score ± ± Digital tongue imaging system measurement (%) 3385 ± ± ** * Winkel tongue coating index ** Statistically significant P-value calculated from independent t-test Percentage of tongue coating measured by digital tongue imaging system P Group with DTIS * -measured value under the median (< 3883) Group with DTIS * -measured value over the median ( 3883) Duration of xerostomia (days) 7044 ± ± ** Visual analogue scale for xerostomia 6620 ± ± Dry mouth symptom questionnaire score ± ± Unstimulated salivary flow rate (ml/min) 014 ± ± Residual saliva of buccal mucosa (%) 818 ± ± Residual saliva of tongue surface (%) 790 ± ± Yin-deficiency questionnaire score ± ± * Digital tongue imaging system ** Statistically significant P-value calculated from independent t-test P WTCI Table 4 (Table 4) DTIS Table 5 (Table 5)

9 Yin-deficiency Questionnaire Items Mean SD Ive got irritable fever on palms or sole Ive got flushing of the zygomatic area in the afternoon Ive got tidal fever in the body and the face Ive got night sweats Ive lost weight Ive got dried mouth and/or throat Ive got dizziness Ive got constipation The amount of urine has decreased and it is yellowish I suffer from insomnia (Table 6) % % ( %) (97-258%) 6) 8) VAS (stimulated salivary flow rate; SSFR) USFR USFR 013 ml/min USFR 01 ml/min 02 ml/min USFR ml/min 34-36) 7)

10 30 % 1845 % 1774 % 39) 40) WTCI 442 ± 293 WTCI % 48 DTIS 4041 ± 1764 % DTIS 0 % 100 % 50 % DTIS 26) WTCI DTIS DTIS DTIS WTCI 4597 DTIS % WTCI DTIS WTCI (RSB RST) 41) 37) Kojima 38) 42) Hinode 43)

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