Ye Jinny, Nouraie Mehdi, Holguin Fernando, Gillespie Amanda I
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Voice. 2017 May;31(3):382.e1-382.e8. doi: 10.1016/j.jvoice.2016.08.013. Epub 2016 Sep 30.
Goals of the current study were to (1) conduct initial validation of a new Paradoxical Vocal Fold Movement Disorder Screening Questionnaire (PVFMD-SQ); (2) determine if symptom-based questionnaires can discriminate between patients with confirmed PVFMD and those with diagnosed uncontrolled asthma without clinical suspicion for PVFMD; and (3) determine if a new questionnaire with diagnostic specificity could be created from a combination of significant items on previously validated questionnaires.
This is a prospective, case-controlled study of patients with PVFMD only and asthma only, who completed five questionnaires: Dyspnea Index, Reflux Symptom Index, Voice Handicap Index-10, Sino-Nasal Questionnaire, and PVFMD-SQ. Factor analysis was completed on the new PVFMD-SQ, and the discrimination ability of selected factors was assessed by receiver operating characteristics curve. The factor with the greatest discriminatory ability was selected to create one diagnostic questionnaire, and scores for each participant were calculated to estimate how well the factor correlated with a PVFMD or asthma diagnosis. Mean scores on all questionnaires were compared to test their discriminatory ability.
Patients with PVFMD showed greater voice handicap and reflux symptoms than patients with asthma. A 15-item one-factor questionnaire was developed from the original PVFMD-SQ, with a sensitivity of 89% and specificity of 73% for diagnosing asthma versus PVFMD. The combined questionnaires resulted in four factors, none of which showed discriminatory ability between PVFMD and asthma.
This study represents the first time that a patient symptom-based screening tool has shown diagnostic sensitivity to differentiate PVFMD from asthma in a cohort of symptomatic patients.
本研究的目标是：（1）对一种新的矛盾性声带运动障碍筛查问卷（PVFMD-SQ）进行初步验证；（2）确定基于症状的问卷能否区分确诊为PVFMD的患者和被诊断为未控制哮喘且无PVFMD临床怀疑的患者；（3）确定能否通过合并先前验证问卷中的重要项目来创建具有诊断特异性的新问卷。
这是一项前瞻性、病例对照研究，研究对象仅为患有PVFMD的患者和仅患有哮喘的患者，他们完成了五份问卷：呼吸困难指数、反流症状指数、嗓音障碍指数-10、鼻科问卷和PVFMD-SQ。对新的PVFMD-SQ进行了因子分析，并通过受试者工作特征曲线评估所选因子的辨别能力。选择辨别能力最强的因子来创建一份诊断问卷，并计算每位参与者的得分，以评估该因子与PVFMD或哮喘诊断的相关性。比较所有问卷的平均得分以测试其辨别能力。
与哮喘患者相比，PVFMD患者表现出更严重的嗓音障碍和反流症状。从原始的PVFMD-SQ中开发出一份包含15个项目的单因子问卷，在诊断哮喘与PVFMD时，其敏感性为89%，特异性为73%。合并后的问卷产生了四个因子，其中没有一个因子在PVFMD和哮喘之间表现出辨别能力。
本研究首次表明，一种基于患者症状的筛查工具在有症状患者队列中对区分PVFMD和哮喘具有诊断敏感性。
