声带麻痹与声带萎缩/沟状声带行去端胶原注射喉成形术后的纵向嗓音结局

文献信息

中文摘要

背景： 去端胶原注射喉成形术是声门闭合不全的一种微创治疗方法，但其疗效的持久性以及纵向反应是否因基础疾病而异仍不清楚。
方法： 我们回顾性分析了来自三家机构的前瞻性收集的临床数据。队列包括92例患者和142次注射事件，其中75例为声带麻痹，17例为声带萎缩/沟状声带。从基线至1年评估声学嗓音质量指数（AVQI）、最长发声时间（MPT）和嗓音障碍指数-10（VHI-10）。采用混合效应模型分析纵向变化，并使用预设标准评估具有临床意义的反应。在具有可用长期数据的声带麻痹患者亚组中，评估了1.5年和≥2年的延长随访。
结果： 在声带麻痹中，AVQI、MPT和VHI-10在至1年的所有随访时间点均显著改善。在声带萎缩/沟状声带中，AVQI和VHI-10主要在1个月和3个月时显示显著改善，而MPT未显示一致改善。时间与疾病分组的交互作用对AVQI显著（p = 0.006），但对MPT（p = 0.239）或VHI-10（p = 0.559）不显著。AVQI应答者轨迹在疾病组间也存在差异（p = 0.023）。在可用的长期亚组中（每个时间点n = 19），所有三项结局在1.5年和≥2年时仍显著改善。在≥2年时，AVQI的应答率为41.9%，VHI-10为48.4%，MPT功能恢复率为31.6%。
结论： 去端胶原注射喉成形术与声带麻痹患者至1年的持续嗓音改善相关，并在一个选定亚组中观察到≥2年的改善。在声带萎缩/沟状声带中的效果持续性较差。

英文摘要

Background: Atelocollagen injection laryngoplasty is a minimally invasive treatment for glottic insufficiency, but the durability of its effects and whether longitudinal responses differ according to the underlying disorder remain unclear. Methods: We retrospectively analyzed prospectively collected clinical data from three institutions. The cohort comprised 92 patients and 142 injection episodes, including 75 patients with vocal fold paralysis and 17 with vocal fold atrophy/sulcus. Acoustic Voice Quality Index (AVQI), maximum phonation time (MPT), and Voice Handicap Index-10 (VHI-10) were evaluated from baseline through 1 year. Longitudinal changes were analyzed using mixed-effects models, and clinically meaningful response was assessed using prespecified criteria. Extended follow-up at 1.5 years and ≥2 years was evaluated in the subset of patients with vocal fold paralysis with available long-term data. Results: In vocal fold paralysis, AVQI, MPT, and VHI-10 improved significantly at all follow-up time points through 1 year. In vocal fold atrophy/sulcus, AVQI and VHI-10 showed significant improvement mainly at 1 and 3 months, whereas MPT did not show consistent improvement. The time-by-disease-group interaction was significant for AVQI (p = 0.006), but not for MPT (p = 0.239) or VHI-10 (p = 0.559). AVQI responder trajectories also differed between disease groups (p = 0.023). In the available long-term subset (n = 19 at each time point), all three outcomes remained significantly improved at 1.5 years and ≥2 years. At ≥2 years, responder rates were 41.9% for AVQI and 48.4% for VHI-10, and MPT functional recovery was 31.6%. Conclusions: Atelocollagen injection laryngoplasty was associated with sustained voice improvement through 1 year in vocal fold paralysis, with improvement also observed at ≥2 years in a selected subset. Effects in vocal fold atrophy/sulcus were less consistently sustained.