咽喉反流与嗓音疾病的相关分析

Correlation of Laryngopharyngeal Reflux and Voice Disorders

严森;徐文;李赟;郑莉;张玉焕;

1:首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈外科学教育部重点实验室

摘要

目的探讨咽喉反流(laryngopharyngeal reflux,LPR)与嗓音疾病的相关关系。方法对103例疑有LPR相关症状的成年患者行反流症状指数量表(reflux symptom index,RSI)、反流体征计分量表(reflux finding score,RFS)、24小时双探头食管pH值监测,其中伴有嗓音疾病患者89例,分别为声带接触性肉芽肿组18例,慢性喉炎组19例,声带息肉组15例,声带白斑组21例,声带任克水肿组16例,余14例无嗓音疾病(对照组)。结果 103例患者中诊断为LPR的阳性率为46.6%(48/103),89例嗓音疾病患者LPR阳性率为48.30%(43/89),其中声带任克水肿组LPR阳性率(75%,12/16)、声带白斑组LPR阳性率(71.4%,15/21)显著高于对照组(35.7%,5/14)(P=0.030,P=0.036)。慢性喉炎组、声带任克水肿组RSI得分(13.5±7.2、13.9±2.3分)显著高于对照组(9.1±2.9分)(P=0.019,P=0.020);声带任克水肿组RFS得分(12.6±2.9分)显著高于对照组(7.6±2.9分)(P=0.009)。声带白斑组立位酸反流次数、卧位酸反流次数、总酸反流次数、立位酸反流时间、总酸反流时间显著高于对照组(P=0.011,P=0.004,P=0.015,P=0.034,P=0.027);声带任克水肿组立位酸反流次数、总酸反流次数、立位酸暴露百分比、总酸暴露百分比、立位酸反流时间、总酸反流时间显著高于对照组(P=0.025,P=0.039,P=0.041,P=0.030,P=0.012,P=0.011)。结论声带白斑、声带任克水肿与LPR相关性较高,两种疾病患者的咽喉部24小时食管pH值监测表现为反流次数多、时间长。

关键词

咽喉反流;嗓音疾病;24小时双探头食管pH值监测;反流症状指数量表;反流体征计分量表

基金项目(Foundation):

北京市卫生系统高层次卫生技术人才骨干基金(2009-3-33)

作者

严森;徐文;李赟;郑莉;张玉焕;

参考文献

1 Koufman JA.The otolaryngologic manifestations of gastroesophageal reflux disease(GERD):a clinical investigation of225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury[J].Laryngoscope,1991,101(4Pt 2Suppl 53):1.

2 Koufman JA,Amin MR,Panetti M.Prevalence of reflux in113 consecutive patients with laryngeal and voice disorders[J].Otolaryngol Head Neck Surg,2000,123:385.

3 Ozturk O,Oz F,Karakullukcu B,et al.Hoarseness and laryngopharyngeal reflux:a cause and effect relationship or coincidence[J]?Eur Arch Otorhinolaryngol,2006,263:935.

4 Chung JH,Tae K,Lee YS,et al.The significance of laryngopharyngeal reflux in benign vocal mucosal lesions[J].Otolaryngol Head Neck Surg,2009,141:369.

5 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 Otorhinolaryngol,2011,268:1169.

6 Havas TE,Priestley J,Lowinger DS.A management strategy for vocal process granulomas[J].Laryngoscope,1999,109:301.

7 倪鑫,王晓哗,张玉焕,等.声带白斑与胃食管咽喉反流的相关分析[J].中华医学杂志,2008,88:1 323.

8 Copper MP,Smit CF,Stanojcic LD,et al.High incidence of laryngopharyngeal reflux in patients with head and neck cancer[J].Laryngoscope,2000,110:1 007.

9 吴修法,徐洁洁,乔明哲,等.反流性咽喉病患者嗓音声学特征分析[J].听力学及言语疾病杂志,2012,20:221.

10 华杜鹃,屈季宁,周涛.反流症状指数量表和反流体征指数量表在喉咽反流性疾病诊断中的应用研究[J].中国耳鼻咽喉头颈外科杂志,2013,20:144.

11 Lewin JS,Gillenwater AM,Garrett JD,et al.Characterization of laryngopharyngeal reflux in patients with premalignant or early carcinoma of the larynx[J].Cancer,2003,97:1 010.

12 Vincent DA Jr,Garrett JD,Radionoff SL,et al.The proximal probe in esophageal pH monitoring:development of a normative database[J].J Voice,2000,14:247.

13 Belafsky PC,Postma GN,Koufman JA.The validity and reliability of the reflux finding score(RFS)[J].Laryngoscope,2001,111:1 313.

14 Belafsky PC,Postma GN,Koufman JA.Validity and reliability of the Reflux Symptom Index(RSI)[J].J Voice,2002,16:274.

15 Reichel O,Hagedorn H,Berghaus A.Diagnosis and treatment of laryngopharyngeal reflux[J].Laryngorhinootologie,2006,85:919.

16 Joniau S,Bradshaw A,Esterman A,et al.Reflux and laryngitis:A systematic review[J].Otolaryngol Head Neck Surg,2007,136:686.

17 Galli J,Frenguelli A,Cal L,et al.Role of gastroesophageal reflux in precancerous conditions and in squamous cell carcinoma of the larynx:our experience[J].Acta Otorhinolaryngol Ital,2001,21:350.

18 Zeitels SM,Hillman RE,Bunting GW,et al.Reinke's edema:phonatory mechanisms and management strategies[J].Ann Otol Rhinol Laryngol,1997,106:533.

19 Cherry J,Margulies SI.Contact ulcer of the larynx[J].Laryngoscope,1968,78:1941.

20 Ward PH,Zwitman D,Hansen D.Contact ulcers and granulomas of the larynx:new insight into their etiology as a basis for more rational treatment[J].Otolaryngol Head Neck Surg,1980,88:262.

本文信息

PDF(124K)

本文关键词相关文章

咽喉反流嗓音疾病 24小时双探头食管pH值监测反流症状指数量表反流体征计分量表

本文作者相关文章

严森徐文李赟郑莉张玉焕