基于声带萎缩程度对老年性发声障碍的分层治疗评估：半封闭声道训练在不同阶段的疗效与预后差异

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中文摘要

目的： 本研究旨在评估基于声带萎缩程度的半封闭声道（SOVT）训练的分层治疗效果，并探讨反应轨迹。
方法： 在这项单中心前瞻性队列研究中，180例老年性发声障碍患者被分层为轻度、中度和重度组。所有参与者均接受标准化SOVT训练并随访8周。主要结局为VHI-10的变化。次要结局包括GRBAS、最长发声时间（MPT）、倒谱峰值突出（CPP）、声学扰动参数（jitter、shimmer、PPQ、APQ和NHR）以及声门裂隙评分。应用线性混合效应模型和潜在类别增长分析（LCGA）。时间效应指在基线、第4周和第8周获得的重复测量。
结果： 观察到VHI-10、MPT和CPP的显著总体改善（均p < 0.001）。其他声学扰动和噪声相关参数，包括jitter、shimmer、PPQ、APQ和NHR，也随时间显著改善（均p < 0.001）。VHI-10存在显著的时间×严重程度交互作用（p < 0.001），其中中度组表现出最大改善。总体而言，68.9%达到最小临床重要差异（MCID）阈值。LCGA识别出三种反应轨迹，中度病例更可能表现出快速或持续改善。
结论： SOVT训练对老年性发声障碍有效，治疗反应随声带萎缩严重程度而异。倒谱和基于扰动的声学分析均支持干预后逐步改善。中度声带萎缩患者似乎获得最大治疗获益，提示可能存在最佳治疗窗口。分层评估和基于轨迹的分析可能有助于个体化嗓音康复策略。

英文摘要

OBJECTIVE: This study aimed to evaluate the stratified therapeutic effects of semi-occluded vocal tract (SOVT) training based on the degree of vocal fold atrophy and to explore response trajectories.
METHODS: In this single-center prospective cohort study, 180 patients with presbyphonia were stratified into mild, moderate, and severe groups. All participants received standardized SOVT training and were followed for 8 weeks. The primary outcome was change in VHI-10. Secondary outcomes included GRBAS, maximum phonation time (MPT), cepstral peak prominence (CPP), acoustic perturbation parameters (jitter, shimmer, PPQ, APQ, and NHR), and glottal gap score. Linear mixed-effects models and latent class growth analysis (LCGA) were applied. Time effects referred to repeated measurements obtained at baseline, Week 4, and Week 8.
RESULTS: Significant overall improvements were observed in VHI-10, MPT, and CPP (all p < 0.001). Additional acoustic perturbation and noise-related parameters, including jitter, shimmer, PPQ, APQ, and NHR, also improved significantly over time (all p < 0.001). A significant time × severity interaction was found for VHI-10 (p < 0.001), with the moderate group demonstrating the greatest improvement. Overall, 68.9% achieved the minimal clinically important difference (MCID) threshold. LCGA identified three response trajectories, with moderate cases more likely to show rapid or sustained improvement.
CONCLUSIONS: SOVT training is effective for presbyphonia, with therapeutic response varying according to the severity of vocal fold atrophy. Both cepstral and perturbation-based acoustic analyses supported progressive improvement after intervention. Patients with moderate vocal fold atrophy appeared to derive the greatest therapeutic benefit, suggesting a potential optimal therapeutic window for intervention. Stratified assessment and trajectory-based analysis may facilitate individualized voice rehabilitation strategies.