食管上括约肌压力联合唾液胃蛋白酶对咽喉反流的诊断价值  

Diagnostic value of upper esophageal sphincter pressure combined with salivary pepsin for laryngopharyngeal reflux

作　　者：刘俊伟 刘世喜[1] 邹剑[1] 何雯[1] 张恒 涂颖 郑仕诚 LIU Junwei;LIU Shixi;ZOU Jian;HE Wen;ZHANG Heng;TU Ying;ZHENG Shicheng(Department of Otolaryngology-Head&Neck Surgery,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Otolaryngology,Head and Neck Surgery,the First People’s Hospital of Longquanyi District,Chengdu/West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of GAstroenterology,the First People’s Hospital of Longquanyi District,Chengdu/West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China)

机构地区：[1]四川大学华西医院耳鼻咽喉-头颈外科,成都610041 [2]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)耳鼻咽喉头颈外科,成都610100 [3]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)消化内科,成都610100

出　　处：《华西医学》2023年第9期1333-1337,共5页West China Medical Journal

基　　金：成都市龙泉驿区卫建系统科研课题(WJKY002);四川省医学会消化内镜专委会(捷祥)专项科研课题(2021XHNJ22)。

摘　　要：目的探讨食管高分辨率测压联合唾液胃蛋白酶浓度在咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)中的诊断价值。方法选择2022年1月—10月以“咽喉不适”为主诉于成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)耳鼻喉头颈外科就诊的患者。根据入院时的反流体征评分和反流症状指数评分指数将患者分为LPRD组和非LPRD组。收集患者基本信息、食管高分辨测压参数及唾液胃蛋白酶浓度。结果共纳入患者112例。其中,LPRD组68例(60.7%),非LPRD组44例(39.3%)。LPRD组的年龄(P=0.007)低于非LPRD组,而唾液胃蛋白酶浓度(P<0.001)、食管上括约肌(upper esophageal sphincter,UES)静息压(P<0.001)和远端收缩积分(P=0.007)则均高于非LPRD组。多因素logistic回归分析结果显示,唾液胃蛋白酶浓度[比值比(odds ratio,OR)=1.077,95%CI(1.035,1.120),P<0.001]、UES静息压[OR=1.035,95%CI(1.019,1.052),P<0.001]是诊断LPRD的独立因素。与唾液胃蛋白酶浓度、UES静息压比较,联合指标(唾液胃蛋白酶浓度+UES静息压)受试者工作曲线下面积(0.971)、特异度(0.99)、灵敏度(0.77)均较高。结论食管高分辨率测压和唾液胃蛋白酶浓度对诊断LPRD作用显著,联合应用可提高诊断价值,也可作为LPRD诊断的替代方法。Objective To investigate the diagnostic value of esophageal high-resolution manometry combined with salivary pepsin levels in laryngopharyngeal reflux disease(LPRD).Methods The patients with the chief complaint of“throat discomfort”for treatment at the Department of Otolaryngology,Head and Neck Surgery,the First People’s Hospital of Longquanyi District,Chengdu/West China Longquan Hospital Sichuan University between January and October 2022 was selected.According to the reflux findings score and refluxsymptomindex at admission,the enrolled patients were divided into LPRD group and non-LPRD group.The basic patient information,esophageal high resolution manometry,and salivary pepsin concentration of included patients were collected.Results A total of 112 patients were included.Among them,there were 68 cases(60.7%)in the LPRD group and 44 cases(39.3%)in the non-LPRD group.The LPRD group was significantly younger(P=0.007),but the salivary pepsin concentration(P<0.001),upper esophageal sphincter(UES)resting pressure(P<0.001)and distal contractile integral(P=0.007)were all higher than the non-LPRD group.The results of multivariate logistic regression analysis showed that salivary pepsin concentration[odds ratio(OR)=1.077,95%CI(1.035,1.120),P<0.001]and UES resting pressure[OR=1.035,95%CI(1.019,1.052),P<0.001]were independent factors for the diagnosis of LPRD.The area under the working curve(0.971),specificity(0.99),and sensitivity(0.77)in the combined index were higher than those of saliva pepsin concentration and UES resting pressure.Conclusion Esophageal high resolution manometry and salivary pepsin are significant for the diagnosis of LPRD,and their combined application can improve the diagnostic value and also serve as an alternative method for the diagnosis of LPRD.

关 键 词：咽喉反流 唾液胃蛋白酶 食管高分辨率测压 

分 类 号：R571[医药卫生—消化系统]