Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析  

Correlation analysis between Ryan index and reflux symptom index and reflux finding score,in the diagnosis of laryngopharyngeal reflux diseases

作　　者：王刚[1,2] 吴玮 王磊[1,2] 刘红丹 徐小杭[3] 徐冰心 丁瑞英[1,2] 周莹 韩浩伦 龚敬[1,2] 李保卫 孙喆喆[1,2] WANG Gang;WU Wei;WANG Lei;LIU Hongdan;XU Xiaohang;XU Bingxin;DING Ruiying;ZHOU Ying;HAN Haolun;GONG Jing;LI Baowei;SUN Zhezhe(Department of Otolaryngology Head and Neck Surgery, Chinese PLA 306th Hospital, Beijing 100101, China;State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, Beijing 100101, China;Molecular Biology Research Laboratory, Johns Hopkins University, Baltimore 21218, USA)

机构地区：[1]中国人民解放军第306医院耳鼻咽喉头颈外科,北京100101 [2]国家环境保护环境感官应激与健康重点实验室,北京100101 [3]约翰霍普金斯大学分子生物学研究室,美国巴尔的摩21218

出　　处：《山东大学耳鼻喉眼学报》2018年第4期48-52,共5页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的探讨Ryan指数与反流症状指数量表(RSI)、反流体征量表(RFS)在咽喉反流性疾病诊断中的相关性。方法回顾性分析以咽喉部不适症状就诊,病程1个月以上的行咽部pH检测的230例患者临床资料。所有患者均同时行电子喉镜检测,并行RSI、RFS评估。结果 Ryan指数阳性率为15.2%(35/230)。RSI、RFS、RSI或RFS及RSI且RFS阳性率分别为46.5%、28.7%、60.9%、13.9%。Ryan指数阳性组患者RFS评分高于Ryan指数阴性组患者,RSI评分与Ryan指数阴性组患者差异无统计学意义。RFS阳性,RSI或RFS,RSI且RFS阳性组Ryan指数阳性率高于RFS阴性,RSI或RFS,RSI且RFS阴性组。Ryan指数阳性与RSI、RFS、RSI或RFS及RSI且RFS阳性的一致性检验的kappa值分别为-0.06,0.394,0.116和0.172。以pH监测作为金标准时,RSI、RFS、RSI或RFS及RSI且RFS的敏感性分别为37.1%,74.3%,82.9%,28.6%;特异性分别为51.8%,79.5%,43.1%,88.2%;阳性预测值分别为12.1%,39.4%,20.7%,30.3%;阴性预测值分别为82.1%,94.5%,93.3%,87.3%。RSI与直立位及平卧位Ryan指数的相关系数分别为-0.056和-0.083;RFS与直立位及平卧位Ryan指数的相关系数分别为0.425和0.166。结论咽部pH检测是直接反映咽喉部反流的客观、无创的检测方法。RFS与Ryan指数有一定的正相关性,但量表与Ryan指数一致性差。尚需进一步研究更准确的、反映咽喉反流的量表及pH诊断指数。Objective To explore the correlation between Ryan index and reflux symptom index（RSI） and reflux finding score（RFS）,in the diagnosis of laryngopharyngeal reflux diseases.Methods In a retrospective study,the clinical data of 230 patients presenting at the hospital with suffering from laryngopharyngeal discomfort for more than a month,in our hospital from February 2016 to November 2016,were analyzed.All patients were received underwent electronic laryngoscopy,assessment of RSI and RFS,and pharyngeal pH monitoring.Results There were 35 patients（15.2%） whose with positive Ryan index were scorepositive（15.2%）.The positive rate of RSI,RFS,RSI or RFS,and RSI and RFS were positive in 46.5%,28.7%,60.9%,and 13.9% of the patients,respectively.The RFS score in the Ryan index positive group was higher than that in the Ryan index negative group,while the RSI score in the Ryan index positive group was not statistically different from that in the Ryan index negative group.The Ryan index positive rates in the RFS,RSI or RFS,and RSI and RFS positive groups were higher than that in the RFS,RSI or RFS,and RSI and RFS negative groups.The kappa values between the Ryan index group and RSI,RFS,RSI or RFS,and RSI and RFS groups were-0.06,0.394,0.116,and 0.172,respectively.When pH monitoring was regarded as the gold standard,the sensitivity of RSI,RFS,RSI or RFS,and RSI and RFS were 37.1%,74.3%,82.9%,and 28.6%,respectively;the specificity was were 51.8%,79.5%,43.1%,and 88.2%,respectively;the positive predictive values was were 12.1%,39.4%,20.7%,and 30.3%,respectively;and the negative predictive values was were 82.1%,94.5%,93.3%,and 87.3%,respectively.The correlation coefficients between RSI and upright and supine Ryan scores were-0.056 and-0.083,respectively;the correlation coefficients between RFS and upright and supine Ryan scores were 0.425 and 0.166,respectively.Conclusion Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly.There is a positive correlation

关 键 词：咽喉反流性疾病 咽部pH检测 Ryan指数 反流症状指数量表 反流体征评分量表 

分 类 号：R766[医药卫生—耳鼻咽喉科]