The effect of expression of pepsin in vocal polyps on postoperative curative effect
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摘要: 目的 探讨声带息肉组织胃蛋白酶表达情况对声带息肉术后疗效的影响。方法 回顾性分析2019年6月—2021年3月诊断为声带息肉并进行手术的112例患者资料，根据术后息肉组织免疫组织化学胃蛋白酶表达情况分为阳性组和阴性组，分析两组术前反流症状指数(RSI)和反流体征评分(RFS)，并对比分析两组术后嗓音声学功能及声带形态的恢复情况。结果 112例声带息肉患者的术后标本中胃蛋白酶染色阳性76例(67.9%)，阴性36例(32.1%)；胃蛋白酶阳性组中，48例声带形态恢复正常，20例遗留术区瘢痕或水肿，8例息肉复发；胃蛋白酶阴性组中，32例声带形态恢复正常，4例遗留术区瘢痕或水肿，无息肉复发患者，两组比较，声带形态的恢复差异有统计学意义(χ2=8.689，P=0.013)。术后12周声嘶症状均改善，GRBAS评估的G分级、VHI、MPT、基频微扰和振幅微扰手术前后比较差异均有统计学意义(均P < 0.05)；术后G分级、VHI、MPT、基频微扰和振幅微扰在胃蛋白酶阳性组和胃蛋白酶阴性组之间的差异均有统计学意义(均P < 0.05)。结论 声带息肉组织中胃蛋白酶表达情况是影响术后声带声学效果及形态恢复的有意义的临床指标，术后组织学发现胃蛋白酶表达阳性者应加强抑酸治疗。Abstract: Objective To investigate the effect of tissue pepsin expression of vocal polyps on the postoperative curative effect.Methods Retrospectively analyze the data of 112 patients diagnosed with vocal cord polyps and undergone surgery from June 2019 to March 2021. The cases were divided into positive group and negative group according to the immunohistochemical pepsin expression. The preoperative reflux symptom index (RSI) and the reflux finding score (RFS) were compared, and the recovery of the voice acoustic function and postoperative vocal cord morphology were analyzed.Results Among the postoperative specimens of 112 patients, 76 cases were positive for pepsin staining, accounting for 67.9%, and 36 cases were negative, accounting for 32.1%. In the pepsin-positive group, 48 cases of vocal cord morphology returned to normal, and 20 cases remained scar or edema in the operation area, 8 cases of polyps relapsed; in the pepsin-negative group, a total of 32 cases of vocal cord morphology returned to normal, 4 cases of remained scar or edema in the operation area, no relapsed cases, the difference in vocal cord morphology recovery was significant (χ2=8.689, P=0.013). The symptoms of hoarseness improved after 12 weeks. The differences between pre and post operative of G grade, VHI, MPT, fundamental frequency perturbation and amplitude perturbation assessed by GRBAS were significant (P < 0.05); postoperative G grade, VHI, MPT, fundamental frequency perturbation and amplitude perturbation were compared between the pepsin-positive group and the pepsin-negative group, and the differences were significant (all P < 0.05).Conclusion The expression of pepsin in vocal polyps is a significant clinical indicator that affects the acoustic effect and morphological recovery of vocal cords after surgery. For patients with positive expression, acid suppression treatment should be strengthened after surgery.
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Key words:
- laryngopharyngeal reflux /
- vocal cord polyps /
- reflux symptom index /
- reflux fingding score /
- pepsin
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图 2 胃蛋白酶阴性声带息肉手术前后电子喉镜及免疫组织化学结果 2a: 术前声带息肉位于左侧声带前中1/3, 声带黏膜轻度水肿; 术前RSI=11分, RFS=2分; 2b: 术后12周电子喉镜见声带光滑, 恢复正常形态; 2c: 声带息肉组织免疫组织化学显示胃蛋白酶染色阴性; 图 3 胃蛋白酶弱阳性声带息肉手术前后频闪喉镜及免疫组织化学结果 3a: 术前频闪喉镜下见结节样声带息肉位于左侧声带中份, 喉黏膜水肿, 后连合黏膜明显肥厚; 术前RSI=16分, RFS=6分; 3b: 术后12周频闪喉镜下见左侧声带术区小范围瘢痕; 3c: 声带息肉组织免疫组织化学显示胃蛋白酶染色弱阳性; 图 4 胃蛋白酶阳性声带息肉手术前后电子喉镜及免疫组织化学结果 4a: 术前电子喉镜下见声带息肉位于左侧声带前端, 靠近前连合, 喉室消失, 声带水肿, 弥漫性喉水肿, 后连合黏膜肥厚; 术前RSI=22分, RFS=16分; 4b: 术后12周电子喉镜下见声带光滑, 双侧声带水肿, 喉室消失; 4c: 声带息肉组织免疫组织化学见胃蛋白酶染色阳性; 图 5 胃蛋白酶强阳性声带息肉手术前后电子喉镜及免疫组织化学结果 5a: 术前电子喉镜下见声带息肉位于双侧声带中份, 喉内见黏液性分泌物, 声带水肿肥厚, 后连合黏膜肥厚; 术前RSI=32分, RFS =14分; 5b: 术后12周电子喉镜下见右侧声带术区瘢痕, 左侧术区息肉复发; 5c: 声带息肉组织免疫组织化学见胃蛋白酶染色强阳性。
表 1 以胃蛋白酶阳性作为标准RSI、RFS和RSI与RFS结合的诊断准确度以及术后声带形态恢复情况
组别 RSI RFS RSI+RFS 术后声带形态恢复情况 + - + - + - 恢复正常 瘢痕或水肿 复发 胃蛋白酶(+) 35 39 65 15 24 51 48 20 8 胃蛋白酶(-) 11 27 27 5 10 27 32 4 0 χ2 3.493 0.152 0.290 8.689 P 0.062 0.696 0.590 0.013 
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表 2 胃蛋白酶阳性组与阴性组手术前后嗓音质量比较
x±S 组别 G分级 MPT VHI 基频微扰 振幅微扰 胃蛋白酶阳性组 术前 2.13±0.32 9.62±2.26 47.76±6.46 3.31±0.41 4.90±0.91 术后 1.80±0.52 11.25±2.91 30.28±7.16 2.18±0.66 4.72±0.72 胃蛋白酶阴性组 术前 2.03±0.38 8.19±2.331) 45.92±5.72 3.24±0.40 4.88±0.70 术后 0.83±0.652)3) 13.00±2.692)3) 26.39±5.752)3) 1.81±0.422)3) 4.27±0.942)3) 与胃蛋白酶阳性组术前比较，1)P < 0.05；与胃蛋白酶阳性组术后比较，2)P < 0.05；与胃蛋白酶阴性组术前比较，3)P < 0.05。
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