山东大学耳鼻喉眼学报 ›› 2025, Vol. 39 ›› Issue (6): 87-96.doi: 10.6040/j.issn.1673-3770.0.2024.003

• 论著 • 上一篇    

窄带成像内镜联合嗓音声学分析在声带白斑鉴别诊断中的价值

刘梓琪,黄佳丽,汪李琴,陈曦,张立庆,周涵   

  1. 南京医科大学第一附属医院/江苏省人民医院 耳鼻咽喉科, 江苏 南京 210029
  • 发布日期:2025-11-19
  • 基金资助:
    江苏省卫生健康委面上项目(H2019001)

Application of narrow band imaging endoscopy combined with voice acoustic analysis in the differential diagnosis of vocal cord leukoplakia

LIU Ziqi, HUANG Jiali, WANG Liqin, CHEN Xi, ZHANG Liqing, ZHOU Han   

  1. Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu, China
  • Published:2025-11-19

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摘要： 目的 探讨窄带成像(narrow band imaging, NBI)内镜联合计算机嗓音声学分析在声带白斑良恶性鉴别诊断中的应用价值。 方法 收集49例声带白斑患者的相关临床资料,包括年龄、吸烟饮酒史、反流症状指数(reflux symptom index, RSI)及反流体征评分(reflux finding score, RFS),病变的侧别、范围、累及前联合情况,将49例患者分别按照NBI内镜及组织病理学诊断进行良恶性病变分组,统计分析其嗓音声学指标,进一步通过Logistic回归及受试者工作特征曲线(receiver operating characteristic curve, ROC)分析来判断NBI内镜联合嗓音声学分析在良恶性声带白斑鉴别诊断中的价值。 结果 单因素方差分析显示,嗓音声学分析参数中的jitter、shimmer及最长发声时间(maximum phonation time, MPT)在NBI内镜和组织病理学诊断中良恶性病变组比较均具有统计学意义(P<0.05), DSI在组织病理学诊断模式下良恶性组的比较中具有统计学意义(P<0.05);二元Logistic回归分析显示,jitter、shimmer为影响声带白斑良恶性的独立危险因素。基于此构建ROC曲线,NBI、Jitter、Shimmer的ROC曲线下面积(area under ROC curve, AUC)分别为0.836、0.739和0.743,三者对恶性声带白斑都具中度诊断价值(0.70.9;95%CI=0.72~0.96)。 结论 计算机嗓音声学分析中的jitter和shimmer是辅助判断声带白斑性质的敏感指标,在NBI内镜的基础上结合嗓音声学分析可以有效提高声带白斑良恶性病变的诊断效能,降低恶性白斑漏诊率。

关键词: 声带白斑, 窄带成像内镜, 嗓音声学分析, 鉴别诊断

Abstract: Objective To explore the application value of narrow band imaging(NBI)endoscopy combined with computerised voice acoustic analysis in the differential diagnosis of benign and malignant vocal cord leukoplakia. Methods Related clinical data of 49 patients with vocal cord leukoplakia were collected, including age, smoking, alcohol consumption, values of reflux symptom index(RSI)and reflux findings score(RFS), side, range, and anterior commissure involvement of the vocal cord. 49 patients were divided into benign and malignant groups separately according to the endoscopic and histopathological diagnosis of NBI,and then their vocal acoustic indexes were statistically analysed. Logistic regression and receiver operating characteristic curve(ROC)analysis were used to further assess the value of narrow band imaging endoscopy combined with voice acoustic analysis in the differential diagnosis between benign and malignant vocal cord leukoplakia. Results One-way ANOVA showed that jitter, shimmer and MPT in voice acoustic analysis were both statistically significant(P<0.05)in the comparison between benign and malignant groups under NBI endoscopy and histopathological diagnosis separately, and DSI was statistically significant(P<0.05)under histopathological diagnosis. Binary logistic regression analysis revealed that jitter and shimmer were independent risk factors affecting benign and malignant vocal cord leukoplakia whereby the receiver operating characteristic curve was constructed. The area under ROC curve(AUC)of NBI, jitter and shimmer was 0.836, 0.739 and 0.743, respectively, all of which had moderate diagnostic value for malignant vocal cord leukoplakia(0.70.9;95%=0.72-0.96). Conclusion Computerised voice acoustic analysis jitter and shimmer are sensitive indicators to predict the nature of vocal cord leukoplakia. Combining voice acoustic analysis with NBI endoscopy can improve the diagnostic efficiency of benign and malignant vocal cord leukoplakia and reduce the missed diagnosis of malignant vocal cord leukoplakia.

Key words: Vocal cord leukoplakia, Narrow band imaging endoscopy, Voice acoustic analysis, Differential diagnosis

中图分类号: 

  • R767.4
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