口咽、食管同步Dx-pH检测研究咽喉反流性疾病

doi:10.6040/j.issn.1673-3770.0.2019.114

摘要/Abstract

摘要： 目的

采用口咽、食管同步Dx-pH检测探讨咽喉反流性疾病（LPRD）与胃食管反流病（GERD）的关系。

方法

回顾2017年6月至12月在耳鼻咽喉头颈外科就诊，疑有咽喉反流的患者资料。56例患者具有完整的反流症状指数量表（RSI）及反流体征量表（RFS）评分，胃食管反流问卷（GerdQ）结果，口咽、食管同步Dx-pH检测结果及胃镜检查结果，纳入分析研究。

结果

根据口咽、食管同步Dx-pH检测结果，Ryan指数阳性17例，70.6%（12/17）的LPRD患者为单纯LPRD，高于LPRD合并GERD；单纯LPRD组与LPRD合并GERD组咽部酸暴露时间百分比及酸反流总次数差异无统计学意义，单纯GERD组与LPRD合并GERD组食管端各反流指标也无统计学差异。Ryan阳性患者中，11例GerdQ、Dx-pH食管探头及胃镜检查结果阴性，即64.7%（11/17）的LPRD患者无论从症状还是客观检查上都不合并GERD，为单纯LPRD。

结论

LPRD与GERD可以独立存在，多数LPRD患者不伴有GERD，LPRD的发病与GERD严重程度无关。

关键词: 咽喉反流性疾病, 胃食管反流病, Dx-pH监测

Abstract: Objective

To investigate the relationship between laryngopharyngeal reflux disease（LPRD）and gastroesophageal reflux disease (GERD) by simultaneous Dx-pH monitoring of the oropharynx and esophagus.

Methods

This was a retrospective study of 56 patients, who had presented with suspected laryngopharyngeal reflux at the Department of Otolaryngology Head and Neck Surgery, Chinese PLA 306th Hospital, from June to December 2017. All patients were evaluated using the reflux symptom index (RSI), reflux finding score (RFS), gastroesophageal reflux disease questionnaire (GerdQ), simultaneous 24 hour Dx-pH monitoring of the oropharynx and esophagus, and gastroscopy.

Results

Synchronous pH monitoring revealed 17 cases had a positive Ryan score, implying LRPD, of which, 12 cases (70.6%, 12/17) were diagnosed with LPRD alone. Further, 20 cases were diagnosed with GERD, of which, 15 cases (75%, 15/20) were GERD alone. The number of patients with only LPRD was higher than the number diagnosed with both LPRD and GERD (29.4%, 5/17). There were no statistical differences in total percent acid exposure time or the total number of oropharyngeal pH events between the “LPRD only” and the “LPRD+GERD” groups. Additionally, there were no statistical differences in the esophageal reflux indices between the “GERD only” group and the “LPRD+GERD” group. Eleven cases (64.7%, 11/17) of LPRD were negative for GERD, determined by the GerdQ, Dx-pH esophageal probe tests, and gastroscopy.

Conclusion

LPRD and GERD can exist independently. Most LPRD cases are not accompanied by GERD and LPRD is not secondary to severe GERD.

Key words: Laryngopharyngeal reflux disease, Gastroesophageal reflux disease, Dx-pH monitoring.

中图分类号:

R766

王磊,王刚,吴玮,刘红丹,徐冰心,李鑫,韩浩伦,李保卫,丁瑞英,李连勇. 口咽、食管同步Dx-pH检测研究咽喉反流性疾病[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 101-106.

Lei WANG,Gang WANG,Wei WU,Hongdan LIU,Bingxin XU,Xin LI,Haolun HAN,Baowei LI,Ruiying DING,Lianyong LI. Simultaneous Dx-pH monitoring of the oropharynx and esophagus for laryngopharyngeal reflux disease research[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 101-106.

图/表 2

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表2

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组别	口咽部探头（pH<5.5）		食管LES上5 cm探头（pH<4.0）
组别	AET	酸反流总次数	AET	酸反流总次数	持续超过5 min酸反流次数	最长酸暴露时间（min）
单纯LPRD组（x±s）	9.47±11.68	78.33±90.78	0.65±0.68	19.00 (2.75,33.50)	0.17±0.39	1.75±2.01
LPRD合并GERD组[M(P25,P75)]	2.26 (0.62,15.91)	123.00 (30.50, 237.50)	11.80 (5.34,15.40)	132.00 (78.00, 190.00)	7.00 (2.50, 10.00)	23.00 (10.00, 31.00)
Z	-0.422	-0.897	-3.166	-3.059	-3.543	-3.192
P	0.673	0.370	0.002	0.002	＜0.001	0.001

组别	咽部探头（pH<5.5）		食管LES上5cm探头（pH<4.0）
组别	AET	酸反流总次数	AET	酸反流总次数	持续超过5min酸反流次数	最长酸暴露时间（min）
单纯GERD组（x±s）	0.44±1.10	2.67±6.32	19.81±14.54	153.00 (115.00;188.00)	8.00 (2.00;18.00)	70.47±93.84
LPRD合并GERD组[M(P25,P75)]	2.26 (0.62,15.91)	123.00 (30.50,237.50)	11.80 (5.34,15.40)	132.00 (78.00,190.00)	7.00 (2.50,10.00)	23.00 (10.00,31.00)
Z	-3.005	-3.399	-0.829	-0.873	-0.395	-0.743
P	0.003	0.001	0.407	0.383	0.693	0.457

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