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

doi:10.6040/j.issn.1673-3770.0.2023.028

摘要/Abstract

摘要： 目的对比慢性咽喉炎探讨三种声带良性增生性病变、声带白斑与咽喉反流相关性。方法回顾分析声带息肉92例、声带囊肿24例、任克水肿37例、声带白斑53例、慢性咽喉炎106例患者的反流相关量表评分、口咽pH监测结果,比较各组咽喉反流阳性率及反流相关参数差异,并纳入年龄、性别、烟酒嗜好进行多因素Logistic回归分析。结果声带占位病变(良性增生性病变+白斑)较慢性咽喉炎组量表阳性率、口咽pH监测Ryan指数阳性率、W指数阳性率、pH6.0反流百分比时间有统计学差异(P<0.05)。白斑组反流症状指数量表阳性率最低,pH监测相关参数均高于良性增生性病变各组,结果存在统计学差异(P<0.05)。声带囊肿组W指数阳性率及W值仅次于白斑组。多因素分析,除了高龄、男性、吸烟,LPR是声带白斑的独立危险因素;以W指数为标准时,LPR是声带囊肿的危险因素。结论咽喉反流与多种声带病变相关,声带良性增生性病变、声带白斑较非占位性咽喉炎与咽喉反流关系更密切,尤其声带白斑相关性最大。声带囊肿与LPR关系仍需进一步验证。

关键词: 咽喉反流, 声带增生性病变, 声带白斑, 口咽pH监测

Abstract: Objective The purpose of this study was to explore the correlations between vocal cord hyperplastic lesions, vocal cord leukoplakia, chronic laryngopharyngitis, and laryngopharyngeal reflux(LPR). Methods A retrospective analysis of 153 patients with benign vocal cord hyperplastic lesions(including 92 cases of vocal cord polyps, 24 cases of vocal cord cyst, and 37 cases of Reinke’s edema), 53 patients with vocal cord leukoplakia, and 106 patients with chronic laryngopharyngitis was performed. Reflux symptom index(RSI), reflux finding score(RFS), and oropharyngeal pH monitoring results were analyzed. The positive rate of LPR and the reflux-related indexes of each group were compared. Multi-factor logistic regression analysis was performed and included age, sex, smoking, and drinking habits. Results The prevalence of LPR in the vocal cord lesion group(benign vocal cord hyperplastic lesions and leukoplakia)was significantly higher than in the laryngopharyngitis group, according to the RSI, RFS, Ryan score, W score, and other parameters of oropharyngeal pH monitoring(P<0.05). The leukoplakia group had the lowest positive rate of RSI, but the reflux-related parameters of pH monitoring were significantly higher than those in other groups(P<0.05). The positive rate and W score in the vocal cord cyst group were second to those in the leukoplakia group. Multivariate analysis showed that LPR was an independent risk factor for leukoplakia, except for old age, male, and smoking. LPR was also a risk factor for vocal cord cysts when W score was considered as the standard. Conclusions LPR is associated with a variety of laryngeal diseases. Vocal cord hyperplastic lesions and leukoplakia are related to LPR more closely than laryngopharyngitis disease, especially leukoplakia. Further studies to validate the relationship between vocal cord cysts and LPR are necessary.

Key words: Laryngopharyngeal reflux, Vocal cord hyperplastic lesions, Vocal cord leukoplakia, Dx-pH monitoring

中图分类号:

R766.5

王磊,王刚,孙喆喆,刘红丹,韩浩伦,李保卫,张晓丽,吴玮. 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]. 山东大学耳鼻喉眼学报, 2024, 38(6): 71-77.

WANG Lei, WANG Gang, SUN Zhezhe, LIU Hongdan, HAN Haolun, LI Baowei, ZHANG Xiaoli, WU Wei. 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.

参考文献

[1] Lechien JR, Saussez S, Nacci A, et al. Association between laryngopharyngeal reflux and benign vocal folds lesions: a systematic review[J]. The Laryngoscope, 2019, 129(9): E329-E341. doi:10.1002/lary.27932
[2] Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders[J]. Otolaryngology-Head and Neck Surgery, 2000, 123(4): 385-388. doi:10.1067/mhn.2000.109935
[3] Lee YS, Choi SH, Son YI, et al. Prospective, observational study using rabeprazole in 455 patients with laryngopharyngeal reflux disease[J]. European Archives of Oto-Rhino-Laryngology, 2011, 268(6): 863-869. doi:10.1007/s00405-010-1475-9
[4] Naunheim MR, Carroll TL. Benign vocal fold lesions: update on nomenclature, cause, diagnosis, and treatment[J]. Current Opinion in Otolaryngology & Head and Neck Surgery, 2017, 25(6): 453-458. doi:10.1097/MOO.0000000000000408
[5] 郑杰元, 张立红, 李晶兢, 等. 咽喉反流症状指数量表中文版的信度及效度评价[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(11): 894-898. doi:10.3760/cma.j.issn.1673-0860.2012.11.004. ZHENG Jieyuan, ZHANG Lihong, LI Jingjing, et al. Chinese version of the reflux symtom index was evaluated for reliability and validity[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2012, 47(11): 894-898. doi:10.3760/cma.j.issn.1673-0860.2012.11.004
[6] 李进让, Peter C Belafsky, 张立红. 中国喉科医师应用反流体征评分量表的信度研究[J]. 中国耳鼻咽喉头颈外科, 2012, 19(7): 388-390. doi:10.16066/j.1672-7002.2012.07.017 LI Jinrang, Belafsky PC, ZHANG Lihong. Reliability of the reflux finding score used in Chinese laryngologist[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2012, 19(7): 388-390. doi:10.16066/j.1672-7002.2012.07.017
[7] 吴玮, 王刚, 王磊, 等. Ryan指数在诊断咽喉反流性疾病中的探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(12): 885-889. doi:10.3760/cma.j.issn.1673-0860.2017.12.002 WU Wei, WANG Gang, WANG Lei, et al. Ryan index for detection of laryngopharyngeal reflux diseases[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(12): 885-889. doi:10.3760/cma.j.issn.1673-0860.2017.12.002
[8] Guo YZ, Wang G, Li LY, et al. Machine learning aided diagnosis of diseases without clinical gold standard: a new score for laryngopharyngeal reflux disease based on pH monitoring[J]. IEEE Access, 2020, 8: 67005-67014. doi:10.1109/ACCESS.2020.2985494
[9] Ayazi S, Lipham JC, Hagen JA, et al. A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold[J]. Journal of Gastrointestinal Surgery, 2009, 13(8): 1422-1429. doi:10.1007/s11605-009-0915-6
[10] Lechien JR, Saussez S, Schindler A, et al. Clinical outcomes of laryngopharyngeal reflux treatment: a systematic review and meta-analysis[J]. The Laryngoscope, 2019, 129(5): 1174-1187. doi:10.1002/lary.27591
[11] Lechien JR, Rodriguez Ruiz A, Dequanter D, et al. Validity and reliability of the reflux sign assessment[J]. Ann Otol Rhinol Laryngol, 2020, 129(4): 313-325. doi:10.1177/0003489419888947
[12] Wang G, Qu CM, Wang L, et al. Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease[J]. Acta Otolaryngol, 2019, 139(3): 299-303. doi:10.1080/00016489.2019.1571280
[13] Zhang M, Chia C, Stanley C, et al. Diagnostic utility of salivary pepsin as compared with 24-hour dual pH/impedance probe in laryngopharyngeal reflux[J]. Otolaryngol Head Neck Surg, 2021, 164(2): 375-380. doi:10.1177/0194599820951183
[14] Vance D, Park J, Alnouri G, et al. Diagnosing laryngopharyngeal reflux: a comparison between 24-hour pH impedance testing and pharyngeal probe(restech)testing, with introduction of the sataloff score[J]. J Voic, 2023, 37(5): 737-747. doi:10.1016/j.jvoice.2021.04.002
[15] 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
[16] 王嘉森, 吴慕坤, 李进让. 喉癌和声带白斑患者并发咽喉反流的观察研究[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(8): 587-591. doi:10.3760/cma.j.issn.1673-0860.2018.08.006 WANG Jiasen, WU Mukun, LI Jinrang. Observational study on patients with laryngeal cancer and/or vocal leukoplakia concurrent with laryngopharyngeal reflux[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53(8): 587-591. doi:10.3760/cma.j.issn.1673-0860.2018.08.006
[17] Chung JH, Tae K, Lee YS, et al. The significance of laryngopharyngeal reflux in benign vocal mucosal lesions[J]. Otolaryngol Head Neck Surg, 2009, 141(3): 369-373. doi:10.1016/j.otohns.2009.05.033
[18] 严森, 徐文, 李赟, 等. 咽喉反流与嗓音疾病的相关分析[J]. 听力学及言语疾病杂志, 2014, 22(1): 34-38. doi:10.3969/j.issn.1006-7299.2014.01.010 YAN Sen, XU Wen, LI Yun, et al. Correlation of laryngopharyngeal reflux and voice disorders[J]. Journal of Audiology and Speech Pathology, 2014, 22(1): 34-38. doi:10.3969/j.issn.1006-7299.2014.01.010
[19] Lechien JR, Schindler A, Robotti C, et al. Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2019, 136(3): 39-43. doi:10.1016/j.anorl.2018.08.008
[20] 胡鸿敏, 余林, 傅然, 等. 咽喉反流与声带息肉相关性的病例对照研究[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(8): 774-778. doi:10.3760/cma.j.cn115330-20200515-00415 HU Hongmin, YU Lin, FU Ran, et al. Case-control survey on relationship between laryngopharyngeal reflux and vocal fold polyps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(8): 774-778. doi:10.3760/cma.j.cn115330-20200515-00415
[21] Tavaluc R, Tan-geller M. Reinke's edema[J]. Otolaryngol Clin North Am, 2019, 52(4): 627-635. doi:10.1016/j.otc.2019.03.006
[22] Nacci A, Baracca G, Romeo SO, et al. Endoscopic and phoniatric evaluation in singing students[J]. J Voice, 2019, 33(2): 135-142. doi:10.1016/j.jvoice.2017.10.006
[23] Pérez Fernández CA, Preciado López J. Vocal fold nodules. Risk factors in teachers. A case control study design[J]. Acta Otorrinolaringol Esp, 2003, 54(4): 253-260. doi:10.1016/s0001-6519(03)78412-x
[24] Han HL, Lyu QP, Zhao JH. Laryngopharyngeal reflux in hypertrophic laryngeal diseases[J]. Ear Nose Throat J, 2022, 101(4): 158-163. doi:10.1177/0145561320953232
[25] Beltsis A, Katsinelos P, Kountouras J, et al. Double probe pH-monitoring findings in patients with benign lesions of the true vocal folds: comparison with typical GERD and the effect of smoking[J]. Eur Arch Otorhino laryngol, 2011, 268(8): 1169-1174. doi:10.1007/s00405-011-1572-4
[26] 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
[27] Lu GW, Ding X, Xu W. Association between laryngopharyngeal reflux and vocal fold leukoplakia[J]. ORL J Otorhinolaryngol Relat Spec, 2021, 83(3): 159-166. doi:10.1159/000512527
[28] Friedman M, Hamilton C, Samuelson CG, et al. The value of routine pH monitoring in the diagnosis and treatment of laryngopharyngeal reflux[J]. Otolaryngol Head Neck Surg, 2012, 146(6): 952-958. doi:10.1177/0194599812436952
[29] Xiao SF, Li JR, Zheng HL, et al. An epidemiological survey of laryngopharyngeal reflux disease at the otorhinolaryngology-head and neck surgery clinics in China[J]. Eur Arch Otorhinolaryngol, 2020, 277(10): 2829-2838. doi:10.1007/s00405-020-06045-0
[30] Ford CN. Evaluation and management of laryngopharyngeal reflux[J]. JAMA, 2005, 294(12): 1534-1540. doi:10.1001/jama.294.12.1534
[31] Rutt AL, Wang C, LI Z. Clinicopathologic aspects of vocal fold leukoplakia in smokers and nonsmokers[J]. J Voice, 2021, 35(5): 779-784. doi:10.1016/j.jvoice.2020.02.003

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