咽喉反流对嗓音疾病患者生活质量影响的临床研究

Clinical study of the influence of laryngopharyngeal reflux on quality of life in patients withdysphonia

目的研究咽喉反流（laryngopharyngalreflux，LPR）在嗓音疾病患者中的患病率；探讨咽喉反流对嗓音疾病患者sF-36健康调查（36-itemshortformhealthsurvey，SF-36）量表及嗓音障碍指数（voicehandicapindex，VHI）量表各项指标的影响。方法选取因嗓音疾病来北京大学人民医院耳鼻咽喉科门诊就诊及住院手术的患者127例，填写反流症状指数（refluxsymptomindex，RSI）量表、反流体征评分（refluxfindingscore，RFS）量表、VHI量表及sF-36健康调查量表，并进行24h双探头pH监测。另外，通过体检、门诊、病房及网络微信平台等途径收集RSI资料2643例。结果经24hpH监测的127例嗓音疾病患者中，LPR的患病率为46．4％（59／127）；收集RSI量表2643例中，第一条目“声嘶或发音障碍”得分大于0的有1241例，初步诊断咽喉反流性疾病（1aryngopharyngalrefluxdisease，LPRD）（RSI得分〉13）807例，占“声嘶或发音障碍”患者的65．0％（807／1241）；在127例嗓音疾病患者中，以24h双探头pH监测作为诊断依据，LPR阳性组与LPR阴性组在VHI量表得分中，总分和情感方面得分差异有统计学意义（P〈0．05），而功能和生理方面得分差异无统计学意义（P〉0．05），sF-36健康调查量表的生理职能、总体健康、活力、社会功能、情感职能和精神健康等方面得分差异有统计学意义（P〈0．05），而在生理功能、躯体疼痛等方面差异无统计学意义（P〉0．05）。结论嗓音疾病中LPR患病率较高，治疗同时要关注患者生活质量。

Objective To explore the morbidity of laryngopharyngeal reflux in patients with dysphonic diseases and to investigate the influence of LPR on the patients. Methods One hundred and twenty-seven patients with dysphonic diseases were encountered in Peking University of the People Hospital. Under the agreement, the patients were asked to fill in the scales of RSI, RFS, VHI and SF-36. 24-hour ambulatory double pH monitoring was applied to diagnose LPR definitely. 2 643 volunteers were recruited to fill in the RSI scale through physical examination, outpatient, the ward and web survey. Results 46.46% （59/127） patients were diagnosed with LPR definitely; 1 241 of 2 643 volunteer, who rifled in the RSI, score more than zero in the first entry of hoarseness or dysphonia, 65.0% （807/1 241 ） of them, scoring 13 points or higher, were diagnosed with clinically suspected LPR. Based on the 24-hour ambulatory double pH monitoring, VHI total scores and subscores in the emotional domains were higher in positive group than in negative group. There was no statistical difference （ P 〉 O. 05 ） in functional and physical domains. The SF-36 scale was used to evaluate the quality of life of the patients. The difference of 6 dimensionality, scoreshad statistical significance （ P 〈 0.05 ）, including role-physical, general health, validity, social function, role-emotional and mental health. There was no statistical difference in dimensionalities of role- physical and bodily pain. Conclusions The volunteers who were diagnosed with hoarseness or dysphoniahad the higher morbidity rate of LPR. At the time of treatment, more attention should be paid to the quality of life.