山东大学耳鼻喉眼学报 ›› 2024, Vol. 38 ›› Issue (6): 66-70.doi: 10.6040/j.issn.1673-3770.0.2024.073

• 临床研究 • 上一篇    

声带白斑组织中胃蛋白酶的表达分析

牛燕燕,顾伟,金晓峰,霍红,杨大海,崔婷婷,王剑   

  1. 中国医学科学院北京协和医学院北京协和医院 耳鼻喉科, 北京 100730
  • 发布日期:2024-12-13
  • 通讯作者: 王剑. E-mail:wangjianent@126.com

Expression analysis of pepsin in vocal cord leukoplakia tissues

NIU Yanyan, GU Wei, JIN Xiaofeng, HUO Hong, YANG Dahai, CUI Tingting, WANG Jian   

  1. Department of Otolaryngology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Published:2024-12-13

摘要: 目的 研究胃蛋白酶在不同病理类型的声带白斑组织中的表达,探讨声带白斑与咽喉反流的相关性。 方法 回顾性分析71例声带白斑患者的临床资料。采用免疫组织化学染色的方法,分析胃蛋白酶在不同病理类型声带白斑中的表达。采用多因素分析明确咽喉反流与声带白斑的关系。 结果 71例患者中,男63例、女8例;40~75岁,平均(58.6±8.6)岁。声带白斑低级别异型增生组和高级别异型增生组中,胃蛋白酶染色阳性的比例分别为23.4%(11/47)和75%(18/24),具有统计学意义。在调整了患者年龄、性别、吸烟及饮酒高危因素后,胃蛋白酶阳性亦增加了高级别异型增生的风险,其OR值为9.64(95%CI为2.96-31.38)。 结论 作为咽喉反流标志物的胃蛋白酶是声带白斑高级别异型增生的独立危险因素。咽喉反流可能是声带白斑高级别异型增生的潜在危险因素之一。

关键词: 咽喉反流, 声带白斑, 低级别异型增生, 高级别异型增生, 胃蛋白酶

Abstract: Objective To investigate the expression of pepsin in different pathological types of vocal cord leukoplakia tissues and to explore the relationship between vocal cord leukoplakia and laryngopharyngeal reflux(LPR), providing evidence for the prevention and treatment of vocal cord leukoplakia. Methods Clinical data of 71 patients with vocal cord leukoplakia were retrospectively analyzed. Immunohistochemical staining was used to analyze the expression of pepsin in vocal cord leukoplakia tissues. Multivariate analysis was performed to clarify the relationship between laryngopharyngeal reflux and vocal cord leukoplakia. Results Among the 71 patients, there were 63 males and 8 females. The age ranged from 40 to 75 years with a mean age of 58.6±8.6 years. The proportions of positive pepsin staining in the low-grade dysplasia group and the high-grade dysplasia group of vocal cord leukoplakia were 23.4%(11/47)and 75%(18/24), respectively, with statistical significance. After adjustment for possible risk factors such as age, gender, smoking and alcohol consumption, positive pepsin expression also increased the risk of high-grade dysplasia with an odds ratio of 9.64(95%CI:2.96-31.38). Conclusion Pepsin, as a biomarker of LPR, is an independent risk factor for high-grade dysplasia of vocal cord leukoplakia. LPR may be one of the potential risk factors for high-grade dysplasia of vocal cord leukoplakia.

Key words: Laryngopharyngeal reflux, Vocal cord leukoplakia, Low-grade dysplasia, High-grade dysplasia, Pepsin

中图分类号: 

  • R766.5
[1] Lechien J R, Akst L M, Hamdan A L, et al. Evaluation and management of laryngopharyngeal reflux disease: state of the art review[J]. Otolaryngology-Head and Neck Surgery, 2019, 160(5):762-782. doi: 10.1177/0194599819827488
[2] Lechien JR, Bobin F, Muls V, et al. Validity and reliability of the reflux symptom score[J]. Laryngoscope, 2020, 130(3): E98-E107. doi:10.1002/lary.28017
[3] Lechien JR, Saussez S, Nacci A, et al. Association between laryngopharyngeal reflux and benign vocal folds lesions: a systematic review[J]. Laryngoscope, 2019, 129(9): E329-E341. doi:10.1002/lary.27932
[4] Parsel SM, Wu EL, Riley CA, et al. Gastroesophageal and laryngopharyngeal reflux associated with laryngeal malignancy: a systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol, 2019, 17(7): 1253-1264.e5. doi:10.1016/j.cgh.2018.10.028
[5] Han H, Lyu Q, Zhao J. Laryngopharyngeal reflux in hypertrophic laryngeal diseases[J]. Ear Nose Throat J, 2022, 101(4): NP158-NP163. doi:10.1177/0145561320953232
[6] 赵佳宁,崔元馨,王丹,等. 咽喉反流与复发性乳头状瘤病的关系及其机制探讨[J]. 山东大学耳鼻喉眼学报, 2024,38(6):39-45. doi: 10.6040/j.issn.1673-3770.0.2023.010 ZHAO Jianing, CUI Yuanxin, WANG Dan, et al. Exploration of the relationship between laryngopharyngeal reflux and recurrent respiratory papilloma and its mechanism[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024,38(6):39-45. doi: 10.6040/j.issn.1673-3770.0.2023.010
[7] 王磊,王刚,孙喆喆,等. 咽喉反流与声带良性增生性病变、声带白斑、慢性咽喉炎相关性研究[J]. 山东大学耳鼻喉科眼学报, 2024, 38(6): 71-77. doi:10.6040/j.issn.1673-3770.0.2023.028 WANG Lei, WANG Gang, SUN Zhezhe, et al. Correlations between vocal cord hyperplastic lesions, vocal cord leukoplakia, chronic laryngopharyngitis, and laryngopharyngeal reflux[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(6): 71-77. doi:10.6040/j.issn.1673-3770.0.2023.028
[8] Gale N, Poljak M, Zidar N. Update from the 4th edition of the World Health Organization classification of head and neck tumours: what is new in the 2017 WHO blue book for tumours of the hypopharynx, larynx, trachea and parapharyngeal space[J]. Head and Neck Pathology, 2017, 11(1):23-32. doi: 10.1007/s12105-017-0788-z
[9] Jiang A, Liang M, Su Z, et al. Immunohistochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux[J]. Laryngoscope, 2011, 121(7): 1426-1430. doi:10.1002/lary.21809
[10] 高诚凯. 正常人群生理性咽喉反流及相关参数研究[D]. 广州:南方医科大学, 2018 GAO Kaicheng. Physiological laryngopharyngeal reflux and related parameters in normal population[D]. Guangzhou: Southern Medical University, 2018
[11] 高竞逾, 罗仁婧, 阮标, 等. 胃蛋白酶免疫组织化学与胃蛋白酶检测试剂盒在咽喉反流诊断中的一致性分析[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(2): 97-102, 106. doi:10.13201/j.issn.2096-7993.2023.02.004 GAO Jingyu, LUO Renjing, RUAN Biao, et al. Consistency analysis of pepsin immunohistochemistry and pepsin test box in the diagnosis of laryngopharyngeal reflux[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2023, 37(2): 97-102, 106. doi:10.13201/j.issn.2096-7993.2023.02.004
[12] Zhukhovitskaya A, Battaglia D, Khosla SM, et al. Gender and age in benign vocal fold lesions[J]. Laryngoscope, 2015, 125(1): 191-196. doi:10.1002/lary.24911
[13] Parker NP. Vocal fold leukoplakia: incidence, management, and prevention[J]. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(6): 464-468. doi:10.1097/moo.0000000000000406
[14] Isenberg JS, Crozier DL, Dailey SH. Institutional and comprehensive review of laryngeal leukoplakia[J]. Ann Otol Rhinol Laryngol, 2008, 117(1): 74-79. doi:10.1177/000348940811700114
[15] Fang TJ, Lin WN, Lee LY, et al. Classification of vocal fold leukoplakia by clinical scoring[J]. Head Neck, 2016, 38(Suppl 1): E1998-E2003. doi:10.1002/hed.24368
[16] Krause AJ, Walsh EH, Weissbrod PA, et al. An update on current treatment strategies for laryngopharyngeal reflux symptoms[J]. Ann N Y Acad Sci, 2022, 1510(1): 5-17. doi:10.1111/nyas.14728
[17] Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index(RSI)[J]. J Voice, 2002, 16(2): 274-277. doi:10.1016/S0892-1997(02)00097-8
[18] Vance D, Alnouri G, Shah P, et al. The validity and reliability of the reflux finding score[J]. J Voice, 2023, 37(1): 92-96. doi:10.1016/j.jvoice.2020.11.008
[19] Golub JS, Johns MM, Lim JH, et al. Comparison of an oropharyngeal pH probe and a standard dual pH probe for diagnosis of laryngopharyngeal reflux[J]. Ann Otol Rhinol Laryngol, 2009, 118(1): 1-5. doi:10.1177/000348940911800101
[20] Lee JS, Jung AR, Park JM, et al. Comparison of characteristics according to reflux type in patients with laryngopharyngeal reflux[J]. Clin Exp Otorhinolaryngol, 2018, 11(2): 141-145. doi:10.21053/ceo.2017.00577
[21] Becker V, Graf S, Schlag C, et al. First agreement analysis and Day-to-Day comparison of pharyngeal pH monitoring with pH/Impedance monitoring in patients with suspected laryngopharyngeal reflux[J]. J Gastrointest Surg, 2012, 16(6): 1096-1101. doi:10.1007/s11605-012-1866-x
[22] Wang L, Tan JJ, Wu T, et al. Association between laryngeal pepsin levels and the presence of vocal fold polyps[J]. Otolaryngol Head Neck Surg, 2017, 156(1): 144-151. doi:10.1177/0194599816676471
[23] Wang J, Li J, Li X, et al. Is the pepsin immunohistochemical staining of laryngeal lesions an available way for diagnosing laryngopharyngeal reflux[J]. Acta Otolaryngol, 2020, 140(8): 702-705. doi:10.1080/00016489.2020.1758774
[24] Johnston N, Dettmar PW, Bishwokarma B, et al. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease[J]. Laryngoscope, 2007, 117(6): 1036-1039. doi:10.1097/mlg.0b013e31804154c3
[25] Johnston N, Dettmar PW, Strugala V, et al. Laryngopharyngeal reflux and GERD[J]. Ann N Y Acad Sci, 2013, 1300: 71-79. doi:10.1111/nyas.12237
[26] Knight J, Lively MO, Johnston N, et al. Sensitive pepsin immunoassay for detection of laryngopharyngeal reflux[J]. Laryngoscope, 2005, 115(8): 1473-1478. doi:10.1097/01.mlg.0000172043.51871.d9
[27] Gong X, Wang XY, Yang L, et al. Detecting laryngopharyngeal reflux by immunohistochemistry of pepsin in the biopsies of vocal fold leukoplakia[J]. J Voice, 2018, 32(3): 352-355. doi:10.1016/j.jvoice.2017.06.010
[28] Chen YL, Bao YY, Zhou SH, et al. Relationship between pepsin expression and dysplasia grade in patients with vocal cord leukoplakia[J]. Otolaryngol Head Neck Surg, 2021, 164(1): 160-165. doi:10.1177/0194599820938654
[29] Lewin JS, Gillenwater AM, Garrett JD, et al. Characterization of laryngopharyngeal reflux in patients with premalignant or early carcinomas of the larynx[J]. Cancer, 2003, 97(4): 1010-1014. doi:10.1002/cncr.11158
[30] Klimara MJ, Randall DR, Allen J, et al. Proximal reflux: biochemical mediators, markers, therapeutic targets, and clinical correlations[J]. Ann N Y Acad Sci, 2020, 1481(1): 127-138. doi:10.1111/nyas.14366
[31] Johnston N, Yan JC, Hoekzema CR, et al. Pepsin promotes proliferation of laryngeal and pharyngeal epithelial cells[J]. Laryngoscope, 2012, 122(6): 1317-1325. doi:10.1002/lary.23307
[32] Tan JJ, Wang L, Mo TT, et al. Pepsin promotes IL-8 signaling-induced epithelial-mesenchymal transition in laryngeal carcinoma[J]. Cancer Cell Int, 2019, 19: 64. doi:10.1186/s12935-019-0772-7
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