Sagiroglu Saime, Doganer Adem
Department of Otorhinolaringology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Avsar Campus, 46100, Kahramanmaraş, Turkey.
Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kahramanmaraş Sutcu Imam University, Kahramanmaraş, Turkey.
Eur Arch Otorhinolaryngol. 2018 Nov;275(11):2755-2761. doi: 10.1007/s00405-018-5098-x. Epub 2018 Aug 21.
The aim of the study was to demonstrate the effect of blood electrolytes on the voice in chronic hemodialysis patients.
The study included a total of 59 hemodialysis patients. Pre- and post-dialysis voice recordings were performed. In the analysis of vocal acoustic parameters, fundamental frequency (F0), jitter, shimmer, the noise-to-harmonics ratio (NHR), and F0 minimum and F0 maximum were measured. The Voice Handicap Index-10 (VHI-10), and maximum phonation time (MPT) were evaluated. For perceptual evaluation, the GRBAS scale was used. The duration of dialysis (years) and changes in weight during dialysis were recorded for each patient. From venous blood samples, measurements were taken of hemoglobin (Hb), albumin, Na+, K+, creatinine, uric acid, phosphorus, Ca++, and parathormone.
The difference in the pre and post-dialysis values of F0, shimmer, NHR and MPT were found to be statistically significant (p = 0.001). The only variable determined to have an effect on the change in F0 values was uric acid, and the change in the F0 values was statistically significant (p = 0.009). The only variable determined to have an effect on the change in shimmer values was sodium, and the change was statistically significant (p = 0.034). The only variable determined to have an effect on the change in NHR values was creatinine, and the change in the NHR values was statistically significant (p = 0.028). Hb and the duration of dialysis were determined to have a statistically significant effect on the change in MPT values (p = 0.001).
The results showed that uric acid was the agent creating a reduction in vocal cord vibration, the agent increasing the difference between vibration waves was Na+, and creatinine increased the NHR rate. The effect of these variables can be considered important in the understanding of vocal cord physiology.
本研究旨在证明血液电解质对慢性血液透析患者嗓音的影响。
本研究共纳入59例血液透析患者。在透析前后进行嗓音录音。在分析嗓音声学参数时，测量了基频（F0）、抖动、闪烁、噪声谐波比（NHR）以及F0最小值和F0最大值。评估了嗓音障碍指数-10（VHI-10）和最长发声时间（MPT）。采用GRBAS量表进行主观评估。记录每位患者的透析时长（年）以及透析期间体重的变化。采集静脉血样本，测量血红蛋白（Hb）、白蛋白、Na+、K+、肌酐、尿酸、磷、Ca++和甲状旁腺激素。
发现F0、闪烁、NHR和MPT的透析前后值差异具有统计学意义（p = 0.001）。唯一被确定对F0值变化有影响的变量是尿酸，且F0值的变化具有统计学意义（p = 0.009）。唯一被确定对闪烁值变化有影响的变量是钠，且该变化具有统计学意义（p = 0.034）。唯一被确定对NHR值变化有影响的变量是肌酐，且NHR值的变化具有统计学意义（p = 0.028）。Hb和透析时长被确定对MPT值的变化具有统计学意义（p = 0.001）。
结果表明，尿酸是导致声带振动减弱的因素，Na+是增加振动波差异的因素，肌酐增加了NHR率。这些变量的作用在理解声带生理学方面可被视为具有重要意义。
