男性喉局部淀粉样变发生与谷丙转氨酶异常相关性

doi:10.6040/j.issn.1673-3770.0.2025.052

摘要/Abstract

摘要： 目的对喉局部淀粉样变(localized amyloidosis, LA)的临床特征进行回顾性描述分析,寻找与发病可能相关的生化指标。方法对病理学诊断的喉LA患者病案记录的临床症状及血生化测定数据进行描述分析,采用病例-对照研究方法二分类Logistic回归分析男女喉LA患者有关联的危险性因素。结果 46例喉LA患者的总体描述:男31例、女15例,男女比为2.07∶1.00,初诊年龄为45.66岁,主要症状为声嘶。喉LA病变部位,单侧声带18例、双侧声带16例、非声门区12例。确诊前声嘶症状持续时间长,平均(86.57±32.52)个月。37例喉LA接受了喉镜下CO₂激光切除、余者6例为喉镜下常规手术治疗,仅1例在术后10年复发。中位随访期为10.61年,只有1例术后1年半死于脑出血,其它患者都存活,存活率为97.8%。男女喉LA患者的比较分析:男性谷丙转氨酶(alanine aminotransferase, ALT)、谷草转氨酶(aspartate transaminase, AST)和谷氨酰转肽酶(gamma-glutamyl transferase, GGT)高于女性,差异有统计学意义。在互为调整因素的回归分析中,发现谷丙转氨酶水平升高与男性喉LA的危险性有一定关联(OR=1.461, 95%CI=1.021~2.090, P=0.038)。结论喉LA主要症状为声嘶,诊断前持续时间很长,男性罹患多于女性,手术切除效果很好,经过10年随访存活率在95%以上。性别比较提示ALT升高可能与男性喉LA的危险性有关联,但尚需多中心更大样本前瞻性研究证实。

关键词: 喉, 局部淀粉样变, 丙氨酸氨基转移酶(谷丙转氨酶), 谷草转氨酶, 谷氨酰转肽酶

Abstract: Objective To perform a retrospective descriptive analysis of the clinical features of localized amyloidosis(LA)of the larynx and to search for biochemical indicators that may be associated with pathogenesis. Methods Clinical symptoms and blood biochemical measurement data from case records of patients with pathologically diagnosed laryngeal LA were descriptively analyzed, and risk factors associated with laryngeal LA in men and women were analyzed by binary logistic regression using case-control study methodology. Results 1.General description of the 46 patients with laryngeal LA: 31 males and 15 females, male-to-female ratio of 2.07∶1.00, age at first diagnosis of 46 years old, and main symptom of hoarseness. The site of laryngeal LA lesions, unilateral vocal folds in 18 cases, bilateral vocal folds in 16 cases, and non-vocal area in 12 cases. The duration of hoarseness symptoms before diagnosis was long, with a mean of(86.57±32.52)months. 37 cases of laryngeal LA underwent laryngoscopic CO₂ laser resection, and the remaining 6 were treated with conventional laryngoscopic surgery, and only 1 case recurred 10 years after surgery. The median follow-up period was 10.61 years, and only one case died of cerebral hemorrhage 1.5 years after surgery, and all other patients survived, with a survival rate of 97.8%. 2.Comparative analysis of male and female patients with laryngeal LA: males had higher levels of alanine aminotransferase(ALT), aspartate aminotransaminase(AST), and gamma-glutamyl transpeptidase(GGT)than women, and the difference was statistically significant. In the regression analysis with reciprocal adjusting factors, an association was found between elevated ALT levels and the risk of laryngeal LA in men(OR=1.461,95%CI=1.021-2.090, P=0.038). Conclusion Laryngeal LA, whose main symptom is hoarseness and which lasts for a long time before diagnosis, is more frequent in men than in women, and surgical resection is highly effective,with a survival rate of more than 95% after 10 years of follow-up. The gender comparison suggests that elevated ALT may be associated with the risk of laryngeal LA in men, but multicenter prospective studies with larger samples are needed to confirm this.

Key words: Throat, Localized amyloidosis, Alanine aminotransferase, Aspartate transaminase, Gamma-glutamyl transferase

中图分类号:

R767.19

李芃泽,于霜,王加锋. 男性喉局部淀粉样变发生与谷丙转氨酶异常相关性[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 135-140.

LI Pengze, YU Shuang, WANG Jiafeng. Correlation between the occurrence of localized amyloidosis of the larynx and abnormalities of glutathione in men[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(3): 135-140.

参考文献

[1] Ravichandran S, Lachmann HJ, Wechalekar AD. Epidemiologic and survival trends in amyloidosis, 1987-2019[J]. N Engl J Med, 2020, 382(16): 1567-1568. doi:10.1056/NEJMc1917321
[2] Sanchorawala V. Systemic light chain amyloidosis[J]. N Engl J Med, 2024, 390(24): 2295-2307. doi:10.1056/NEJMra2304088
[3] Gertz MA. Immunoglobulin light chain amyloidosis: 2024 update on diagnosis, prognosis, and treatment[J]. Am J Hematol, 2024, 99(2): 309-324. doi:10.1002/ajh.27177
[4] Kyle RA, Larson DR, Kurtin PJ, et al. Incidence of AL amyloidosis in Olmsted County, Minnesota, 1990 through 2015[J]. Mayo Clin Proc, 2019, 94(3): 465-471. doi:10.1016/j.mayocp.2018.08.041
[5] Sepehrvand N, Youngson E, Fine N, et al. The incidence and prevalence of cardiac amyloidosis in a large community-based cohort in Alberta, Canada[J]. J Card Fail, 2022, 28(2): 237-246. doi:10.1016/j.cardfail.2021.08.016
[6] 李航, 李学旺. 33例原发性淀粉样变性病临床分析[J]. 中华内科杂志, 2003, 42(3):195-196.doi: 10.3760/j.issn:0578-1426.2003.03.017
[7] Gertz MA. Immunoglobulin light chain amyloidosis: 2022 update on diagnosis, prognosis, and treatment[J]. Am J Hematol, 2022, 97(6): 818-829. doi:10.1002/ajh.26569
[8] Cho Y, Bae HY, Okun E, et al. Physiology and pharmacology of amyloid precursor protein[J]. Pharmacol Ther, 2022, 235: 108122. doi:10.1016/j.pharmthera.2022.108122
[9] Puig KL, Floden AM, Adhikari R, et al. Amyloid precursor protein and proinflammatory changes are regulated in brain and adipose tissue in a murine model of high fat diet-induced obesity[J]. PLoS One, 2012, 7(1): e30378. doi:10.1371/journal.pone.0030378
[10] Ma C, Hong FF, Yang SL. Amyloidosis in Alzheimer's disease: pathogeny, etiology, and related therapeutic directions[J]. Molecules, 2022, 27(4): 1210. doi:10.3390/molecules27041210
[11] Andjelkovic AV, Situ MY, Citalan-Madrid AF, et al. Blood-brain barrier dysfunction in normal aging and neurodegeneration: mechanisms, impact, and treatments[J]. Stroke, 2023, 54(3): 661-672. doi:10.1161/STROKEAHA.122.040578
[12] 任媛媛, 邵晨, 张明, 等. 11例肝淀粉样变性的临床病理分析[J]. 中华肝脏病杂志, 2022, 30(11): 1207-1210. doi: 10.3760/cma.j.cn501113-20210107-00011 REN Yuanyuan, SHAO Chen, ZHANG Ming, et al. Clinicopathological analysis of 11 cases of hepatic amyloidosis[J].Chinese Journal of Hepatology, 2022, 30(11): 1207-1210. doi: 10.3760/cma.j.cn501113-20210107-00011
[13] Tamber SS, Bansal P, Sharma S, et al. Biomarkers of liver diseases[J]. Mol Biol Rep, 2023, 50(9): 7815-7823. doi:10.1007/s11033-023-08666-0
[14] Wu XF, Zhang J, Wei CS. Risk factors for recurrence of laryngeal amyloidosis treated by microforceps and CO₂ laser[J]. Eur Arch Otorhinolaryngol, 2020, 277(2): 521-525. doi:10.1007/s00405-019-05730-z
[15] Thompson LD, Derringer GA, Wenig BM. Amyloidosis of the larynx: a clinicopathologic study of 11 cases[J]. Mod Pathol, 2000, 13(5): 528-535. doi:10.1038/modpathol.3880092
[16] Lott LA. Approach to small biopsies in the larynx[J]. Semin Diagn Pathol, 2023, 40(5): 333-339. doi:10.1053/j.semdp.2023.06.004
[17] Penner CR, Müller S. Head and neck amyloidosis: a clinicopathologic study of 15 cases[J]. Oral Oncol, 2006, 42(4): 421-429. doi:10.1016/j.oraloncology.2005.09.010
[18] Pai KK, Omiunu AO, Llerena PA, et al. Localized laryngeal amyloidosis: a systematic review[J]. Am J Otolaryngol, 2022, 43(5): 103550. doi:10.1016/j.amjoto.2022.103550
[19] Stachler RJ, Francis DO, Schwartz SR, et al. Clinical practice guideline: hoarseness(dysphonia)(update)[J]. Otolaryngol Head Neck Surg, 2018, 158(1): 1-42. doi:10.1177/0194599817751030
[20] Nakano Y, Kawamoto R, Ito E, et al. A case of cholestatic liver involvement secondary to amyloid light chain amyloidosis with new-onset hypercholesterolemia and elevated gamma-glutamyltransferase level[J]. Cureus, 2023, 15(8): e44001. doi:10.7759/cureus.44001
[21] Fernández A, Ménsua C, Biescas E, et al. Clinicopathological features in ovine AA amyloidosis[J]. Res Vet Sci, 2003, 75(3): 203-208. doi:10.1016/s0034-5288(03)00139-5
[22] Francis DO, Smith LJ. Hoarseness guidelines redux: toward improved treatment of patients with dysphonia[J]. Otolaryngol Clin North Am, 2019, 52(4): 597-605. doi:10.1016/j.otc.2019.03.003

相关文章 15

[1]	肖俊华,潘庆春,晋舒. 基于全球疾病负担数据库分析职业硫酸暴露下喉癌患者的死亡趋势[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 55-61.
[2]	徐娟,崔彪,黄建平,陈以标,施建飞,王燕雯,刘赞华,张剑伟. 电子喉镜评估老年肺部感染患者的吞咽功能[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 74-79.
[3]	章娜娜,黄冠江,卢标清. 联合中医证型分析喉癌变的影响因素及构建预测模型[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 29-37.
[4]	程卓, 梁辉, 邢鲁民. 深度学习技术在咽喉内镜应用中的研究进展及前景分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 112-119.
[5]	刘玉柱,陈尧,苑铁君,李春森,李波. 喉纤维肉瘤1例并相关文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 133-137.
[6]	刘丹凤,潘庆春,李代波,封雪飞,任健. 1990—2021年中国归因于过量饮酒的喉癌疾病负担分析及未来趋势预测[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 61-69.
[7]	刘玉柱,苑铁君,李波. 会厌原发神经内分泌癌1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 97-100.
[8]	胡祎,孔旭辉. 补体在喉鳞状细胞癌发生发展中作用机制的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 148-155.
[9]	沈文浩,陈曦. 双能CT在喉鳞状细胞癌诊疗中的运用[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 156-160.
[10]	石金莲,李建兴,黄幼生,林铭轩,刘灵云,卢永田. 喉部炎性肌纤维母细胞瘤的研究现状与诊疗进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 186-192.
[11]	倪凌达,唐旭兰,孟丽丽,周慧群,苏开明. 电子鼻咽喉镜中I-scan各模式与白光模式的应用比较[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 19-25.
[12]	杨鸣,刘雪霞,张华. m6A识别蛋白IGF2BPs家族在头颈肿瘤中的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 153-161.
[13]	谢枫,许贞菊,吴策,刘杰,臧传善,张龙宵,韩敏. 喉神经内分泌肿瘤26例临床病理特征及生存分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 79-86.
[14]	曲翔宇,朱晗,柳忠禄,牟亚魁,郭文涛,张华. 会厌舌瓣在喉癌声门上缺损修复术中的应用[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 77-84.
[15]	吴玮,王磊,陈升,李连勇,王刚. 胃食管气道反流性疾病多学科研究及进展[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 1-14.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed