慢性疼痛综合征及其喉部表现。
Chronic Pain Syndromes and Their Laryngeal Manifestations.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
出版信息
JAMA Otolaryngol Head Neck Surg. 2020 Jun 1;146(6):543-549. doi: 10.1001/jamaoto.2020.0530.
IMPORTANCE
Fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) are traditionally considered as distinct entities grouped under chronic pain syndrome (CPS) of an unknown origin. However, these 3 disorders may exist on a spectrum with a shared pathophysiology.
OBJECTIVE
To investigate whether the clinical presentation of FMS, IBS, and CFS is similar in a population presenting with voice and laryngeal disorders.
DESIGN, SETTING, AND PARTICIPANTS: This case series was a retrospective review of the medical records and clinical notes of patients treated between January 1, 2016, and December 31, 2017, at the Johns Hopkins Voice Center in Baltimore, Maryland. Patients with at least 1 CPS of interest (FMS, IBS, or CFS) were included (n = 215), along with patients without such diagnoses (n = 4034). Diagnoses, demographic, and comorbidity data were reviewed. Diagnoses related to voice and laryngeal disorders were subdivided into 5 main categories (laryngeal pathology, functional voice disorders, airway problems, swallowing problems, and other diagnoses).
MAIN OUTCOMES AND MEASURES
Prevalence and odds ratios of 45 voice and laryngeal disorders were reviewed. Odds ratios (ORs) were calculated by comparing patients with CPS with control patients.
RESULTS
In total, 4249 individuals were identified; 215 (5.1%) had at least 1 CPS and 4034 (94.9%) were control participants. Patients with CPS were 3 times more likely to be women compared with the control group (173 of 215 [80.5%] vs 2318 of 4034 [57.5%]; OR, 3.156; 95% CI, 2.392-4.296), and the CPS group had a mean (SD) age of 57.80 (15.30) years compared with the mean (SD) age of 55.77 (16.97) years for the control group. Patients with CPS were more likely to present with functional voice disorders (OR, 1.812; 95% CI, 1.396-2.353) and less likely to present with laryngeal pathology (OR, 0.774; 95% CI, 0.610-0.982) or airway problems (OR, 0.474; 95% CI, 0.285-0.789).
CONCLUSIONS AND RELEVANCE
The voice and airway presentation of patients with FMS, IBS, and/or CFS appears to be indistinguishable from each other. This finding suggests that these 3 diseases share upper airway symptoms.
重要性
纤维肌痛综合征（FMS）、肠易激综合征（IBS）和慢性疲劳综合征（CFS）传统上被认为是起源不明的慢性疼痛综合征（CPS）中的不同实体。然而，这 3 种疾病可能存在于具有共同病理生理学的谱系中。
目的
研究 FMS、IBS 和 CFS 的临床表现在出现声音和喉部疾病的人群中是否相似。
设计、地点和参与者：本病例系列研究回顾性分析了 2016 年 1 月 1 日至 2017 年 12 月 31 日期间在马里兰州巴尔的摩的约翰霍普金斯声音中心接受治疗的患者的病历和临床记录。纳入至少有 1 种感兴趣的 CPS（FMS、IBS 或 CFS）的患者（n=215），以及没有此类诊断的患者（n=4034）。审查了诊断、人口统计学和合并症数据。与声音和喉部疾病相关的诊断分为 5 个主要类别（喉部病理学、功能性声音障碍、气道问题、吞咽问题和其他诊断）。
主要结局和测量
回顾了 45 种声音和喉部疾病的患病率和比值比（OR）。通过比较 CPS 患者与对照患者，计算了 OR。
结果
共确定了 4249 人；215 人（5.1%）至少有一种 CPS，4034 人（94.9%）为对照参与者。与对照组相比，CPS 患者中女性的比例高 3 倍（215 例[80.5%] vs 4034 例[57.5%]；OR，3.156；95%CI，2.392-4.296），CPS 组的平均（SD）年龄为 57.80（15.30）岁，而对照组的平均（SD）年龄为 55.77（16.97）岁。CPS 患者更有可能出现功能性声音障碍（OR，1.812；95%CI，1.396-2.353），而不太可能出现喉部病理学（OR，0.774；95%CI，0.610-0.982）或气道问题（OR，0.474；95%CI，0.285-0.789）。
结论和相关性
FMS、IBS 和/或 CFS 患者的声音和气道表现似乎彼此无法区分。这一发现表明，这 3 种疾病具有共同的上呼吸道症状。
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