成人声带良性病变发病危险因素的病例对照调查

Case-control survey on risk factors of benign vocal fold lesions

目的探讨与成人声带良性病变发病相关的危险因素。方法采用病例对照研究设计，对168例声带良性病变（包括声带小结、声带息肉、Reinke水肿、慢性喉炎）患者及153例喉部正常者进行问卷调查。Logistic回归分析方法进行统计学分析。结果多因素分析显示职业、工作或居住环境噪声、饮酒、每日用声时间和嗓音滥用5个因素是声带良性病变的危险因素。用声强度大的职业发病的危险性大，以用声强度小的Ⅰ类职业为参照，用声强度中等的Ⅱ类职业的发病危险为其1．934倍（OR=1．934），教师等用声强度大的Ⅲ类职业的发病危险为其2．633倍（OR=2．633）。每日用声时间每增加1h，发病的危险增加1．302倍（OR=1．302）。习惯喊叫等有嗓音滥用行为的OR值为4．744，工作或生活在噪声环境中OR值为2．115，饮酒的OR值为2．177，均会大大增加发病的危险。结论为预防功能不良性声带病变，应戒酒，降低环境噪声，养成良好的用声习惯，避免嗓音滥用，减少用声时间等。在用声强度大的高危人群应加强防护。

Objective To investigate the risk factors that may relate with benign vocal fold lesions including vocal fold nodule, vocal fold polyp, chronic laryngitis and Reinke＇s edema. Methods In present series, 321 cases who were performed laryngoscope were invited to participate the survey. Among them 168 cases with benign vocal fold lesions composed the case group. Another 153 cases with normal larynx composed the control group. Each case were undertook the same questionnaire. Logistic regression analysis was preformed to investigate the possible risk factors. Results The result demonstrated the occurring of benign vocal fold lesions positively correlated to five factors, including occupation, work or residence environment noise, alcohol-consuming, voice-using hours per day and abuse of voice. Occupations with intensive voice - use were more vulnerable to developing these disorders. Occurring risk of occupations type Ⅱ with moderate voice-use was 1. 934 times than that of occupations type Ⅰ with lesser voice-use （ OR = 1. 934）. And risk of occupations type Ⅲ with upper voice-use was 2. 633 times than that of type Ⅰ. Risk raised 1. 302 times with each more hour of voice use per day. OR of the following factors of voice abuse, environment noise, alcohol-consuming was 4. 744, 2. 115 and 2. 177, respectively. Conclusions The result suggested that people should abstain from alcohol, lowering the environment noise, prevent overuse and abuse of voice in order to decrease the prevalence of these disorders, which is especially important for the professional voice users, e.g. teachers or managers. The essential therapy for these disorders is to correct bad phonation habits.