分别应用pH〈4或pH〈5作为24h多通道腔内阻抗-pH监测诊断咽喉反流事件阈值的比较  

A comparison of pH 〈 4 and pH 〈 5 as thresholds for 24-hour pH monitoring in the diagnosis of laryngopharyngeal reflux

作　　者：王嘉森[1] 李进让[1] 

机构地区：[1]海军总医院耳鼻咽喉头颈外科,北京100048

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第9期661-665,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的研究分别应用pH〈4或pH〈5作为判定咽喉反流事件的病理阈值时，24 h多通道腔内阻抗（multichannel intraluminal impedance, MII）联合pH监测与反流症状指数（reflux symptom index, RSI）、反流体征评分（reflux finding score, RFS）诊断结果的一致性。方法选取2014年2月至2015年12月入海军总医院耳鼻咽喉头颈外科的可疑咽喉反流的110例患者行24 h MII－pH监测，并填写症状体征量表。统计咽喉部pH〈4的反流次数、pH〈5的反流次数、RSI、RFS。将应用pH〈4或pH〈5作为判定咽喉反流事件的病理阈值时的pH监测诊断结果，与RSI、RFS的诊断结果行一致性分析。并以RSI、RFS为参考，分别统计应用pH〈4或pH〈5作为判定阈值时pH监测诊断结果的敏感度和特异度。各项反流参数用M[P25，P75，P95]表示。结果110例患者中咽喉部pH〈4反流次数为0 [0，3.0，5.5]、pH〈5反流次数为0[0，4.0，8.5]。应用pH〈4作为判定阈值时阳性率34.5%（38/110），与RSI、RFS诊断结果的一致性中等（κ＝0.483）。应用pH〈5作为判定阈值时阳性率41.8%（46/110），与RSI、RFS诊断结果的一致性中等（κ＝0.540），一致性高于应用pH〈4时。以RSI、RFS为参考，应用pH〈4时pH监测诊断结果的敏感度和特异度分别为54.7%和93.4%，应用pH〈5时敏感度和特异度分别为65.6%和91.3%。结论应用pH〈5反流次数≥3次作为判定咽喉反流事件的病理阈值时，24 h MII－pH监测与RSI、RFS诊断结果的一致性较好。在分析pH监测结果时参考pH〈5反流次数，或可提高其诊断咽喉反流性疾病的敏感度。ObjectiveTo evaluate the consistency between 24-hour pH monitoring, reflux symptom index（RSI） and reflux finding score（RFS） when using pH〈4 or pH〈5 as threshold for 24-hour pH monitoring in the diagnosis of laryngopharyngeal reflux. MethodsPatients who presented with suspicious laryngopharyngeal reflux between February 2014 and December 2015 were included in this study. pH〈4 and pH〈5 reflux episodes, RSI and RFS were collected. The consistency between 24-hour pH monitoring and scale results were analyzed when pH〈4 or pH〈5 as threshold respectively. The sensitivity and specificity of 24-hour pH monitoring were calculated separately. ResultsMedian number（M[P25, P75, P95]） of reflux events were 0 [0, 3.0, 5.5] when using pH〈4 as pathological threshold and 0 [0, 4.0, and 8.5] using pH〈5 as pathological threshold. Laryngopharyngeal reflux was determined in 34.5% patients depending on 24-hour pH monitoring when pH〈4 was used as threshold, chi-square revealed medium consistency （κ=0.483） between pH monitoring and scale result. If pH〈5 was used as threshold, 41.8% patients were detected with laryngopharyngeal reflux, and the consistency of pH monitoring and scale result was medium（κ=0.540）. With RSI and RFS for reference, the sensitivity and specificity of 24-hour pH monitoring were 54.7% and 93.4% respectively when pH〈4 was used as threshold. If pH〈5 was used as threshold, the sensitivity and specificity of 24-hour pH monitoring were 65.6% and 91.3% respectively. ConclusionsCompared with pH〈4 as pathological threshold, the consistency of pH monitoring and scale results was a little better using pH〈5 as pathological threshold.

关 键 词：喉咽反流 食管PH监测 体征和症状 

分 类 号：R766.5[医药卫生—耳鼻咽喉科]