A型肉毒毒素声带注射治疗内收型痉挛性发声障碍的剂量与疗效研究

Dosage of Botulinum Toxin Injection and the Duration of Curative Effect in the Treatment of Adductor Spasmodic Dysphonia

目的探讨A型肉毒毒素声带注射治疗内收型痉挛性发声障碍的剂量和疗效维持时间。方法回顾性分析2003年9月至2017年10月间确诊并进行A型肉毒毒素声带注射治疗的79例内收型痉挛性发声障碍患者的临床资料,男11例,女68例,年龄17~75岁,平均31.56±11.16岁,病程1~16年,平均5.03±4.29年。记录注射日期、剂量、次数及疗效维持时间,对其中连续注射超过10次的12例患者,分析第1~10次注的平均注射剂量变化趋势及疗效维持时间。结果 79例患者首次注射剂量5~10u,平均6.28±1.57u,首次注射后疗效维持时间3~10月,平均4.53±1.62月。12例连续注射超过10次的患者每次注射剂量5~10u,平均5.83~8.54u,第1~10次注射剂量分别为5.83±1.63、8.43±2.20、7.75±1.72、8.12±1.55、8.54±1.28、7.92±1.79、8.02±1.25、7.92±1.79、7.29±1.67、7.19±1.69u;12例患者每次注射后疗效维持3~10月,1~10次平均维持时间分别为4.18±0.83、5.01±1.26、4.49±0.58、4.50±0.84、4.91±0.97、4.66±0.66、4.92±0.68、4.80±0.57、4.87±0.72、5.08±0.38月。结论 A型肉毒毒素单侧或双侧声带注射均能明显改善内收型痉挛性发声障碍患者的症状。本组连续注射10次以上的对象在第7次注射后平均注射剂量稳定于7~8u,平均疗效维持时间为4~6月。

Objective To study the dosage of the botulinum toxin type A injection and the duration of curative effect in the treatment of adductor spasmodic dysphonia.Methods The data of 79 patients received botulinum toxin type A treatmentfor adductor spasmodic dysphonia in Renmin Hospital of Wuhan University during September2003 to October 2017 were retrospectively studied.There were 11 men,68 women,aged from 17 to 75 years old with average of 31.56±11.16 years,the course of disease ranged from 1 to 16 years,and the average duration of disease was 5.03±4.29 years.Clinical data,injection date,dose,times and the duration of curative effectof each injection were all recorded.12 patients received at least 10 continuous injections.The mean dose of injections 1~10 was determined and the time-keeping of normal voice were also determined.Results In the 79 patients group,the injection dose ranged from 5 units（u）to 10 units（u）,and the mean dose was 6.28±1.57 u,the duration of curative effect after the first injection ranged from 3 to 10 months,the average duration was 4.53±1.62 months.For the 12 patients group,the average injection dose from the first injection to 10 thinjection were 5.83±1.63 u、8.43±2.20 u、7.75±1.72 u,8.12±1.55 u,8.54±1.28 u,7.92±1.79 u,8.02±1.25 u,7.92±1.79 u,7.29±1.67 u,7.19±1.69 u,respectively.After the 7 th injection,the dosage declined slowly and steady and it kept between 7 to 8 units.The duration of curative effect of these 12 patients were 3 to 10 months.The average duration of the first injection was4.18±0.83 months which was the shortest.The average duration of the second time was 5.01±1.26 months,and the average duration of the third time was 4.49±0.58 months,which was shorter than the second one.From the fourth,the duration fluctuated between 4 to 6 months and it wassteady thereafter.Conclusion Type A botulinum toxin can improve the voice symptom of adductor spasmodic dysphonia markedly and the average duration of curative effect lasts for about 4 to 6 months.With the increasing of injection number,the mean dose of injection tends to be stable and it ranges from 7 to 8 units.