合并胃食管反流病对咽喉反流性疾病临床特征影响的研究  

Effect of gastroesophageal reflux disease on the clinical characteristics of patients with laryngopharyngeal reflux disease

作　　者：汪晓宇 李进让[1,2] 张金红 王嘉森 刘志 张纯 Wang Xiaoyu;Li Jinrang;Zhang Jinhong;Wang Jiasen;Liu Zhi;Zhang Chun(Navy Clinical College,the Fifth School of Clinical Medicine,Anhui Medical University,Hefei 230032,China;Department of Pharyngology,Laryngology&Phonosurgery,the Sixth Medical Center of PLA General Hospital,National Clinical Research Center for Otolaryngologic Diseases,Beijing 100048,China)

机构地区：[1]安徽医科大学第五临床医学院海军临床学院,合肥230032 [2]解放军总医院第六医学中心耳鼻咽喉头颈外科医学部咽喉嗓音外科,国家耳鼻咽喉疾病临床医学研究中心,北京100048

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第10期1178-1184,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨胃食管反流病(GERD)对咽喉反流性疾病(LPRD)患者临床特征的影响。方法回顾性分析2020年11月至2021年10月在解放军总医院第六医学中心咽喉嗓音外科就诊的具有LPRD症状的141例患者资料,男性118例,女性23例,年龄28~75(56.72±10.04)岁。被纳入的患者同时进行24 h下咽食管腔内多通道阻抗pH(24 h-HEMII-pH)监测、多时点唾液胃蛋白酶检测、反流症状指数(RSI)和反流体征评分(RFS)量表评估。24 h-HEMII-pH监测结果中有一次咽喉部反流事件作为LPRD的诊断标准,24 h记录食管下段pH<4.0的时间大于4.0%或DeMeester评分>14.7作为GERD的诊断标准。其中,LPRD和GERD均为阳性的患者被划分为L&G组,LPRD阳性而GERD阴性的患者被划分为IL组,LPRD阴性而GERD阳性的患者被划分为IG组,LPRD和GERD均为阴性的患者被划分为N组。统计分析各组患者反流的临床特征及唾液胃蛋白酶检测的差异。应用SPSS 23.0软件进行统计学分析。结果根据24 h-HEMII-pH结果,116例(82.3%)患者被诊断为LPRD,45例(31.9%)患者被诊断为GERD,其中IL组有82例(58.2%),L&G组有34例(24.1%),IG组有11例(7.8%),N组有14例(9.9%)。基于唾液胃蛋白酶检测,共有106例患者结果为阳性,L&G组的总唾液胃蛋白酶检测阳性率(94.1%)、晨起检测的阳性率(70.6%)均显著高于IL组(75.6%,26.8%)、IG组(63.6%,27.3%)和N组(35.7%,28.6%),χ^(2)值分别为19.01和20.81,P值均<0.001。L&G组患者的RSI评分(14.0)显著高于IL组(7.0)、IG组(1.0)和N组(0),H=52.26,P<0.001。L&G组和IL组在RFS的差异无统计学意义(Z=-0.92,P>0.05)。结论合并GERD使LPRD患者的临床症状更明显,唾液胃蛋白酶检测阳性率更高。Objective To investigate the effect of gastroesophageal reflux disease(GERD)on the clinical characteristics of patients with laryngopharyngeal reflux disease(LPRD).Methods The data of 141 patients with symptoms of LPRD,who were admitted to the Department of Pharyngology,Laryngology&Phonosurgery at the Sixth Medical Center of the PLA General Hospital from November 2020 to October 2021,were retrospectively analyzed.There were 118 males and 23 females,aged 28-75(56.72±10.04)years old.The included patients underwent simultaneous 24-hour hypopharyngeal and esophageal multichannel intraluminal impedance pH monitoring(24h-HEMII-pH),salivary pepsin test at multiple times,Reflux Symptom Index(RSI),and Reflux Finding Score(RFS).One laryngopharyngeal reflux event on 24 h-HEMII-pH monitoring results was used as a diagnostic criterion for LPRD.And the duration of lower esophageal pH<4.0>4.0%at 24 h or DeMeester score>14.7 were used as diagnostic criteria for GERD.Among them,patients with both positive LPRD and GERD were classified as L&G group,patients with positive LPRD and negative GERD were classified as IL group,patients with negative LPRD and positive GERD were classified as IG group,and patients with both negative LPRD and GERD were classified as N group.The differences in the clinical characteristics of reflux and salivary pepsin assay in each group were statistically analyzed.SPSS 23.0 software was applied for statistical analysis.Results According to the 24 h-HEMII-pH results,116(82.3%)patients were diagnosed with LPRD and 45(31.9%)with GERD,including 82(58.2%)in the IL group,34(24.1%)in the L&G group,11(7.8%)in the IG group,and 14(9.9%)in the N group.Based on the salivary pepsin test,a total of 106 patients had positive results,and the L&G group had a significantly higher rate of positive total salivary pepsin test(94.1%)and positive morning test(70.6%)than the IL group(75.6%,26.8%),IG group(63.6%,27.3%)and N group(35.7%,28.6%),with chi-square values of 19.01 and 20.81,both with P<0.001.The patients in the L&G grou

关 键 词：胃食管反流病 咽喉反流性疾病 24 h下咽食管腔内多通道阻抗pH监测 酸反流 唾液胃蛋白酶 

分 类 号：R581[医药卫生—内分泌] R766.5[医药卫生—内科学]