喉癌和声带白斑患者并发咽喉反流的观察研究

Observational study on patients with laryngeal cancer and/or vocal leukoplakia concurrent with laryngopharyngeal reflux

目的 观察喉癌和声带白斑患者中咽喉反流患病率,并探讨咽喉反流在喉癌和声带白斑发病中的作用.方法 选取2014年1月至2017年6月海军总医院耳鼻咽喉科的喉癌和声带白斑住院患者,填写反流症状指数和反流体征评分量表并行24 h多通道腔内阻抗（multichannel intraluminal impedance,MII）-pH监测,记录喉癌和声带白斑两组患者的一般情况、咽喉反流阳性率和反流相关参数并作对比.正态分布计量资料以x±s表示,非正态分布计量资料以M[P25,P75,P95]表示,计数资料采用卡方检验,计量资料采用t检验或Mann-Whitney U检验.结果 91例喉癌患者中24 h MII-pH监测阳性率为28.6％（26/91）,酸反流次数0[0,3,5]次,酸反流总时间0[0,14,234]s,弱酸反流次数3[0,6,11].54例声带白斑患者中24 h MII-pH监测阳性率为29.6％ （16/54）,酸反流次数0[0,3,4]次,酸反流总时间0[0,13,118]s,弱酸反流次数1.5[0,5,9]次.两组患者间的咽喉反流阳性率差异无统计学意义（x2 =0.018,P =0.892）,各项反流参数差异均无统计学意义（P值均＞0.05）,但均高于文献报道的中国健康人群咽喉反流患病率（0/37）.此外,研究对象中的3例无吸烟饮酒史患者均存在不同程度的酸反流或弱酸反流.结论 咽喉反流在喉癌和声带白斑患者,尤其是无吸烟饮酒史患者中有较高的发病率,提示咽喉反流是喉癌发病的危险因素之一.

Objective To observe the incidence and to determine the significance of laryngopharyngeal reflux （LPR） in laryngeal cancer and vocal leukoplakia.Methods The patients who had been diagnosed as laryngeal cancer or vocal leukoplakia between January 2014 and June 2017 were included in this study.All of them received 24-hour multichannel intraluminal impedance-pH monitoring.The prevalence of LPR and numerous parameters from the 24-hour pH monitoring in laryngeal cancer patient and vocal leukoplakia patient groups were analyzed.The chi-square test was used for counting data,t test and Mann-Whitney U were used for measuring data.Results In the 91 laryngeal cancer patients,the prevalence of pathologic LPR was 28.6% （26/91）,the median number [P25,P75,P95] of acid reflux events was 0[0,3,5],time of acid exposure was 0[0,14,234] s,number of weakly acidic reflux events was 3 [0,6,11].In the 54 vocal leukoplakia patients,the prevalence of pathologic LPR was 29.6% （16/54）,the number of acid reflux events was 0[0,3,4],time of acid exposure was 0 [0,13,118] s,number of weakly acidic reflux events was 1.5 [0,5,9].The incidence of LPR did not vary in the laryngeal cancer patient and vocal leukoplakia patient groups,but were both higher than healthy Chinese volunteers according to a report in the other literature.Furthermore,all the three patients with no history of tobacco or alcohol existed acid or weakly acidic reflux episodes.Conclusions Laryngopharyngeal reflux might play a role as an etiologic factor in laryngeal cancer and vocal leukoplakia.