声带白斑诊断和转归的再认识

Diagnosis and prognosis of leukoplakia of vocal cords

目的 再认识声带白斑的病因、诊断和转归.方法 对99例声带白斑患者的临床资料（包括电子喉镜检查结果）进行分析,并检测咽喉深部唾液中胃蛋白酶的浓度,分析比较不同病变程度患者唾液胃蛋白酶阳性率.根据病理类型进行分级,并随访36个月以上,跟踪病变程度进展,按首次病理级别比较声带白斑恶变率.结果 应用电子喉镜诊断声带白斑的灵敏度为94.9%,声带白斑患者唾液中胃蛋白酶浓度为（273.42±14.81）ng/ml,不同病变程度患者唾液胃蛋白酶阳性率的差异有统计学意义（P＜0.01）.首次病理级别一、二、三级为52、30、17例,随访期间癌变率为8.08%,不同病理分级的声带白斑恶变率的差异有统计学意义（P＜0.05）.结论 电子喉镜检查是诊断声带白斑的一种简单易行而且无创手段.声带白斑患者存在咽喉反流,这可能是促使病变程度进展的因素之一.声带白斑病理类型多样化,病程动态化,不同病理级别均存在癌变的风险,首诊时异型程度越高,其恶变的风险越大.

Objective To review the diagnosis and prognosis of leukoplakia of vocal cord. Methods The clinical data of 99 cases with leukoplakia of vocal cords were retrospectively analyzed. Patients underwent electron laryngoscope for diagnosis of leukoplakia of vocal cord; the concentration of gastric pepsin in sputum was measured.. The duration of follow-up was more than 36 months. Results The sensitivity of electron laryngoscope for diagnosis of leukoplakia of the vocal cord was 94.9%. The average concentration of gastric pepsin in sputum was（273.42 ±14.81 ）ng/ ml; and there were significant differences in positive rate of sputum pepsin among different stages of disease （P=0.001）. The initial pathological diagnosis included 52 cases with grade I, 30 cases with grade II and 17 cases with grade III）; and 8 cases （8.1%） had malignant transformation during the follow-up. There were significant differences in malignant transformation rate among different pathological grades （P〈0.01）. Conclusion Electron laryngoscope provides a simple, feasible and non-invasive method for diagnosis of leukoplakia of the vocal cords. The higher extent of atypia is associated with the higher risk of malignant transformation.