军人嗓音障碍的患病率：系统综述与荟萃分析

文献信息

中文摘要

背景： 嗓音及相关喉部疾病可能影响军事人群的沟通、职业功能和战备状态，但其患病率仍缺乏充分描述。我们估计了普通军事人群、高嗓音需求人员以及化学暴露军人或退伍军人队列中的患病率。
方法： 本系统综述与荟萃分析遵循PRISMA 2020。于2024年9月检索了PubMed、Embase、Scopus、Web of Science、ClinicalTrials.gov和Google Scholar。符合条件的研究纳入现役人员、新兵、预备役人员或退伍军人，并报告嗓音或相关喉部结局。临床转诊或按症状选择的队列采用叙述性综合。亚组特异性随机效应荟萃分析使用logit转换比例、限制性最大似然估计和Hartung-Knapp校正。计算了预测区间和广义线性混合模型敏感性分析。使用适合研究设计的评价工具和GRADE评估偏倚风险和证据确定性。
结果： 系统综述纳入16项研究，来自9项研究的11个独立数据集纳入荟萃分析。在普通军事人群中，合并患病率为3.3%（95% CI 0.2-37.5%；5个数据集；n = 1,613,921；I2 = 99.8%；95%预测区间0.001-99.1%）。高嗓音需求人员患病率为40.0%（95% CI 0.8-98.2%；3个数据集；n = 3,708；I2 = 99.5%；预测区间0-100%），化学暴露队列为72.8%（95% CI 43.3-90.4%；3个数据集；n = 145；I2 = 57.5%；预测区间0.6-99.9%）。一项探索性荟萃回归发现总体亚组关联（p = 0.0300），但两两比较结果不一致且统计效能有限。三项估计的证据确定性均为极低。
结论： 报告的患病率在不同军事人群和暴露背景之间差异很大。由于异质性高且证据确定性极低，合并估计值应谨慎解读，不应被视为精确的患病率数字或因果证据。需要标准化的前瞻性研究来量化职业健康负担，并评估有针对性的监测、预防和早期转诊方法。
系统综述注册： PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420250640753，标识符：CRD420250640753。

英文摘要

BACKGROUND: Voice and related laryngeal disorders may affect communication, occupational functioning and readiness in military populations, but their prevalence remains poorly characterized. We estimated prevalence across general military populations, high-vocal-demand personnel and chemically exposed military or veteran cohorts.
METHODS: This systematic review and meta-analysis followed PRISMA 2020. PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov and Google Scholar were searched in September 2024. Eligible studies included active-duty personnel, recruits, reservists or veterans and reported voice or related laryngeal outcomes. Clinically referred or symptom-selected cohorts were synthesized narratively. Subgroup-specific random-effects meta-analyses used logit-transformed proportions, restricted maximum likelihood estimation and Hartung-Knapp adjustment. Prediction intervals and generalized linear mixed-model sensitivity analyses were calculated. Risk of bias and certainty of evidence were assessed using design-appropriate appraisal tools and GRADE.
RESULTS: Sixteen studies were included in the systematic review, and 11 independent datasets from nine studies contributed to the meta-analysis. In general military populations, pooled prevalence was 3.3% (95% CI 0.2-37.5%; five datasets; n = 1,613,921; I2 = 99.8%; 95% prediction interval 0.001-99.1%). Prevalence was 40.0% in high-vocal-demand personnel (95% CI 0.8-98.2%; three datasets; n = 3,708; I2 = 99.5%; prediction interval 0-100%) and 72.8% in chemically exposed cohorts (95% CI 43.3-90.4%; three datasets; n = 145; I2 = 57.5%; prediction interval 0.6-99.9%). An exploratory meta-regression identified an overall subgroup association (p = 0.0300), but pairwise findings were inconsistent and statistical power was limited. Certainty of evidence was Very Low for all three estimates.
CONCLUSIONS: Reported prevalence varies substantially across military populations and exposure contexts. Because heterogeneity was high and the certainty of evidence was Very Low, the pooled estimates should be interpreted with caution and should not be considered precise prevalence figures or evidence of causation. Standardized prospective studies are needed to quantify the occupational-health burden and evaluate targeted surveillance, prevention and early-referral approaches.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420250640753, identifier: CRD420250640753.