动态频谱特征分析对早期痉挛性发音障碍患者疗效及预后评估价值

Evaluation value of the dynamic spectral characteristics in the clinical effect and prognosis of patients with early spasmodic dysphonia

摘要:

目的 分析早期痉挛性发音障碍(SD)动态频谱特征及对临床疗效和预后的评估价值。方法 2022年1月—2024年1月诊断早期SD患者65例为研究对象，接受肉毒素A喉肌注射，根据临床疗效分为有效组58例和无效组7例。比较2组患者治疗前后动态频谱特征、嗓音障碍指数量表(VHI-30)和改良 Frenchay 构音障碍评定(mFDA)的差异。多因素Logistic回归分析与SD患者临床疗效有关的因素。工作特征曲线(ROC)评估预测SD临床疗效的指标价值。结果 与治疗前相比，2组患者治疗后振幅微扰、基频微扰、读标准化段落的总耗时及嗓音中断次数比治疗前显著降低，而嗓音障碍严重程度指数(DSI)、最长发音时间(MPT)和声强范围升高(P<0.05)。与无效组相比，有效组患者中重度比例减少，治疗前振幅微扰和基频微扰降低，DSI、MPT和声强范围增加(P<0.05)。多因素Logistic回归显示，痉挛严重程度、治疗前DSI和声强范围是预测临床疗效的重要指标(P<0.05)。ROC显示，DSI和声强范围预测临床疗效的曲线下面积(AUC)分别为0.853和0.815(P<0.05)。结论 早期SD患者的动态频谱特征及定量参数对疾病诊断和评估临床疗效具有重要的应用价值。

Abstract:

Objective To analyze the dynamic spectral characteristics of patients with early spasmodic dysphonia (SD) and its value in evaluating the clinical effect and prognosis.Methods A total of 65 patients diagnosed with early SD in our hospital from January 2022 to January 2024 were collected. All the patients received botulinum toxin A injedction, and were divided into effective group (n=58) and ineffective group (n=7). The dynamic spectral characteristics, voice handicap index (VHI-30) and modified Frenchay articulation disorder assessment (mFDA) were measured and compared between the two groups before and after treatment. The factors related to clinical outcomes in SD patients were analyzed by multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic values of the indexes.Results Compared with before treatment, the shimmer, jitter, total time spent on reading standardized paragraphs, and the number of voice interruptions were significantly reduced (P<0.05), and the dysphonia severity index (DSI), maximum phonation time (MPT) as well as sound intensity range got increased (P<0.05) in both groups after treatment. Compared with ineffective group, the proportion of moderate to severe cases in the effective group was lower (P<0.05), the shimmer, jitter before treatment were lower, and the ranges of DSI, MPT and sound intensity were higher (P<0.05). Multivariate Logistic regression showed that the severity of spasm, ranges of DSI and sound intensity before treatment were important indicators for predicting clinical efficacy (P<0.05). ROC curve showed that area under curve of range of DSI and sound intensity for predicting clinical efficacy was 0.853 and 0.815, respectively (P<0.05).Conclusion The dynamic spectral characteristics and quantitative parameters of early SD patients have important application value for disease diagnosis and evaluation of clinical efficacy.