咽喉反流与声带息肉相关性的病例对照研究

Case-control survey on relationship between laryngopharyngeal reflux and vocal fold polyps

目的分析咽喉反流是否是声带息肉的独立危险因素,并探究咽喉反流可能导致声带息肉发生的潜在机制。方法采用病例对照研究设计,选取2018年9月至2019年12月来重庆医科大学附属第一医院耳鼻咽喉科就诊的152例声带息肉患者(声带息肉组)及176名声带正常者(对照组),进行反流症状指数(RSI)量表与反流体征评分(RFS)量表评分和问卷调查。将RSI>13分和(或)RFS>7分判为咽喉反流。应用χ^2检验、单因素和多因素非条件Logistic回归方法进行统计学分析。结果声带息肉组咽喉反流和清嗓的发生率(47.37%,73.68%)明显高于对照组(27.27%,59.09%),差异有统计学意义(P<0.001,P=0.005)。胸痛胃痛等反酸症状和咳嗽的发生率在两组间差异无统计学意义(P=0.672,P=0.099)。多因素非条件Logistic回归分析显示,咽喉反流(OR=1.815,95%CI:1.061~3.103)、职业暴露(OR=2.655,95%CI:1.397~5.042)、辛辣食物(OR=1.958,95%CI:1.142~3.355)是声带息肉的独立危险因素。结论咽喉反流、职业暴露、辛辣食物是声带息肉的独立危险因素,咽喉反流引起的经常清嗓可能是导致声带息肉的主要原因。为预防声带息肉的发生,应积极治疗咽喉反流。

Objective To investigate whether laryngopharyngeal reflux(LPR)is an independent risk factor for vocal fold polyps and to analyze the potential mechanism.Methods Case control survey was designed.Subjects who came to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from September 2018 to December 2019,including 152 cases with vocal fold polyps and 176 cases with normal vocal folds,were selected.All the subjects filled in a questionnaire and were assessed by the reflux symptom index(RSI)and the reflux finding score(RFS)scale.RSI>13 and(or)RFS>7 were classified as LPR.Chi-square test,univariate and multivariate unconditional logistic regression models were used for statistical analysis.Results The incidence of LPR and throat clearing in vocal fold polyps group(47.37%,73.68%)was significantly higher than that in control group(27.27%,59.09%),with statistically significant difference(P<0.001,P=0.005,respectively).The incidence of troublesome cough,indigestion or stomach acid coming up was no difference between the two groups(P=0.672,P=0.099).Multivariate unconditional logistic regression analysis showed that LPR(OR=1.815,95%CI:1.061-3.103),occupational exposure(OR=2.655,95%CI:1.397-5.042),spicy food(OR=1.958,95%CI:1.142-3.355)were risk factors for vocal fold polyps.Conclusion LPR,occupational exposure,spicy food are independent risk factors for vocal fold polyps.Frequent throat clearing caused by LPR may be the main cause of vocal ford polyps.In order to prevent vocal fold polyps,we need to take action to treat laryngopharyngeal reflux disease actively.