呼吸压力与持续表现在不同病因类别嗓音障碍中的差异：一项初步研究

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中文摘要

目的： 确定一个反映呼吸压力产生能力和持续压力表现的数据驱动复合因子在不同病因类别嗓音障碍中是否存在差异，并检验其与最长发声时间（MPT）及发声稳定性的倒谱测量指标之间的关联。
研究设计： 前瞻性观察性研究。
方法： 43例嗓音障碍患者接受了嗓音和呼吸功能评估。呼吸变量包括肺活量百分比（%VC）、第一秒用力呼气容积与用力肺活量比值（FEV₁/FVC）、最大吸气压（PImax）、最大呼气压（PEmax）以及吸气和呼气平均持续压力指数（MSPI），采用主成分分析（PCA）进行分析，以得出呼吸肌表现因子（RMPF），这是一个反映最大压力产生能力和持续压力表现的复合因子。使用协方差分析（ANCOVA）控制年龄和性别，检验RMPF在不同病因类别（器质性、神经性和功能性嗓音障碍）之间的差异。在每个病因类别内，使用Spearman秩相关系数分析RMPF与发声测量指标（包括MPT和从持续元音及连续言语中得出的倒谱峰突出度（CPP））之间的关联。
结果： RMPF在不同诊断类别间存在显著差异（P = 0.004），其中器质性嗓音障碍组的数值显著高于功能性嗓音障碍组。未观察到年龄或性别的显著效应。在器质性和神经性嗓音障碍组中，RMPF与MPT呈显著正相关。相反，在功能性嗓音障碍组中，RMPF与从连续言语句子“waɾanojanenoieda”中得出的CPP呈显著正相关。RMPF与其余倒谱测量指标之间未观察到显著关联。
结论： 呼吸肌表现在不同病因类别的嗓音障碍中存在差异，并表现出与发声测量指标之间诊断特异性的关联。功能性嗓音障碍的特征是呼吸功能与连续言语发声稳定性之间的关联，而器质性和神经性嗓音障碍则表现出与发声持续时间的关联。这些发现表明，疾病特异性的呼吸-发声相互作用可能导致不同嗓音障碍人群在发声产生和发声表现方面的差异。

英文摘要

OBJECTIVE: To determine whether a data-driven composite factor reflecting respiratory pressure-generating capacity and sustained pressure performance differs across etiologic categories of voice disorders and to examine its associations with maximum phonation time (MPT) and cepstral measures of phonatory stability.
STUDY DESIGN: Prospective observational study.
METHODS: Forty-three patients with voice disorders underwent voice and respiratory function assessments. Respiratory variables, including percent vital capacity (%VC), forced expiratory volume in one second to forced vital capacity ratio (FEV₁/FVC), maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), and inspiratory and expiratory Mean Sustained Pressure Index (MSPI), were analyzed using principal component analysis (PCA) to derive a Respiratory Muscle Performance Factor (RMPF), a composite factor reflecting maximal pressure-generating capacity and sustained pressure performance. Differences in RMPF across etiologic categories (organic, neurological, and functional voice disorders) were examined using analysis of covariance (ANCOVA) controlling for age and sex. Associations between RMPF and phonatory measures, including MPT and cepstral peak prominence (CPP) derived from sustained vowels and connected speech, were analyzed using Spearman's rank correlation coefficients within each etiologic category.
RESULTS: RMPF differed significantly across diagnostic categories (P = 0.004), with the organic voice disorder group demonstrating significantly higher values than the functional voice disorder group. No significant effects of age or sex were observed. In the organic and neurological voice disorder groups, RMPF showed significant positive correlations with MPT. In contrast, in the functional voice disorder group, RMPF showed a significant positive correlation with CPP derived from the connected-speech sentence "waɾanojanenoieda." No significant associations were observed between RMPF and the remaining cepstral measures.
CONCLUSIONS: Respiratory muscle performance differs across etiologic categories of voice disorders and demonstrates diagnosis-specific associations with phonatory measures. Functional voice disorders were characterized by an association between respiratory function and connected-speech phonatory stability, whereas organic and neurological voice disorders demonstrated associations with phonatory duration. These findings suggest that disease-specific respiratory-phonatory interactions may contribute to differences in voice production and phonatory performance across voice disorder populations.