山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (6): 89-95.doi: 10.6040/j.issn.1673-3770.0.2022.350

• 论著 • 上一篇    

幽门螺旋杆菌感染对症状性咽喉反流患者唾液胃蛋白酶浓度的影响

邵娜,张青青,刘小红,谢萌,郭瑞昕,马思敬,刘海琴,任晓勇,罗花南   

  1. 西安交通大学第二附属医院 耳鼻咽喉头颈外科, 陕西 西安 710004
  • 发布日期:2022-12-07
  • 通讯作者: 罗花南. E-mail:luohuanan@126.com
  • 基金资助:
    国家自然科学基金(82171129)

Effects of Helicobacter pylori infection on salivary pepsin concentration in patients with symptomatic laryngopharyngeal reflux

SHAO Na, ZHANG Qingqing, LIU Xiaohong, XIE Meng, GUO Ruixin, MA Sijing, LIU Haiqin, REN Xiaoyong, LUO Huanan   

  1. Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China
  • Published:2022-12-07

摘要: 目的 探讨幽门螺旋杆菌(HP)感染对症状性咽喉反流(LPR)患者唾液胃蛋白酶浓度的影响。 方法 将咽部异物感、反复清嗓等非特异性症状为主诉的229例LPR初诊患者作为研究对象。应用14C呼气试验将所有LPR患者分为HP阳性组和HP阴性组,并分别给予HP根除治疗(三联疗法)与抑酸治疗。所有患者在初诊及治疗后复诊时均收集唾液样本(HP阳性者复诊时复查14C呼气试验),并比较治疗前后反流症状指数量表(reflux symptom index, RSI)、反流体征评分量表(reflux finding score, RFS)评分和唾液胃蛋白酶浓度变化。 结果 HP阳性的LPR患者其RSI及RFS总分与HP阴性者相比无显著差异(11.00 vs 9.00, P=0.077; 8.50 vs 9.00, P=0.415),但HP阳性者其声嘶(P=0.005)、烦人的咳嗽(P=0.016)等症状评分,声带水肿(P=0.002)体征评分及唾液胃蛋白酶浓度显著高于HP阴性者(94.90 μg/mL vs 45.28 μg/mL, P<0.001),且治疗后HP阳性的LPR患者RSI和RFS评分唾液胃蛋白酶浓度的下降程度均显著高于HP阴性者(P=0.012,P=0.019,P=0.013,P=0.027)。 结论 HP感染的LPR患者应用HP根除治疗后部分症状、体征评分和唾液胃蛋白酶浓度均显著下降,提示HP感染在LPR的发病过程中发挥重要作用。

关键词: 幽门螺旋杆菌感染, 咽喉反流, 唾液胃蛋白酶, 反流症状指数量表, 反流体征评分量表

Abstract: Objective To examine the effect of Helicobacter pylori(HP)infection on the salivary pepsin concentration in patients with symptomatic laryngopharyngeal reflux(LPR). Methods We enrolled 229 newly diagnosed outpatients with LPR who complained of non-specific symptoms, including pharyngeal foreign body sensation and repeated throat clearing. HP infection was confirmed by performing a 14C breath test, and patients in the HP-positive and HP-negative groups were prescribed HP eradication treatment(triple therapy)and proton pump inhibitors, respectively. Saliva samples were collected from all patients at initial diagnosis and post-treatment follow-ups(the HP-positive group underwent the 14C breath test at follow-up visits), and differences in the reflux symptom index(RSI)score, the reflux finding score(RFS)score, and salivary pepsin concentration were compared before and after treatment. Results There were no significant differences in total RSI and RFS scores between HP-positive and HP-negative patients with LPR(11.00 vs 9.00, P=0.077; 8.50 vs 9.00, P=0.415). However, scores for symptoms and signs such as hoarseness(P=0.005), annoying cough(P=0.016), vocal cord edema(P=0.002), and salivary pepsin concentration(94.90 μg/mL vs 45.28 μg/mL, P<0.001)were significantly higher in HP-positive patients than those in HP-negative patients with LPR. Furthermore, compared with HP-negative patients with LPR, HP-positive patients exhibited a more significant reduction in RSI and RFS scores and salivary pepsin concentrations after treatment(P=0.012,P=0.019,P=0.013,P=0.027). Conclusion HP eradication therapy could significantly reduce scores of specific symptoms and signs, as well as the salivary pepsin concentration in HP-infected patients with LPR, suggesting that HP infection plays an important role in the pathogenesis of LPR.

Key words: Helicobacter pylori infection, Laryngopharyngeal reflux, Saliva pepsin, Reflux symptom index, Reflux finding score

中图分类号: 

  • R766.5
[1] Krause AJ, Walsh EH, Weissbrod PA, et al. An update on current treatment strategies for laryngopharyngeal reflux symptoms[J]. Ann N Y Acad Sci, 2022, 1510(1): 5-17. doi:10.1111/nyas.14728.
[2] O'Hara J, Fisher H, Hayes L, et al. ‘Persistent throat symptoms’ versus ‘laryngopharyngeal reflux’: a cross-sectional study refining the clinical condition[J]. BMJ Open Gastroenterol, 2022, 9(1): e000850. doi:10.1136/bmjgast-2021-000850.
[3] Kowalik K, Krzeski A. The role of pepsin in the laryngopharyngeal reflux[J]. Pol Otolaryngol, 2017, 71(6): 7-13. doi:10.5604/01.3001.0010.7194.
[4] Runggaldier D, Hente J, Brockmann-Bauser M, et al. Current possibilities and challenges in the diagnosis of laryngopharyngeal reflux[J]. HNO, 2021, 69(11): 861-867. doi:10.1007/s00106-021-01006-3.
[5] Goel AN, Omorogbe A, Hackett A, et al. Risk factors for multiple tympanostomy tube placements in children: systematic review and meta-analysis[J]. Laryngoscope, 2021, 131(7): E2363-E2370. doi:10.1002/lary.29342.
[6] 曾宪廷, 王广科, 孙占伟, 等. 伴咽喉反流的难治性鼻窦炎术后应用质子泵抑制剂的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 189-194. doi:10.6040/j.issn.1673-3770.0.2021.512. ZENG Xianting, WANG Guangke, SUN Zhanwei, et al. Postoperative efficacy of proton pump inhibitor in the treatment of difficult-to-treat rhinosinusitis with laryngopharyngeal reflux[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 189-194. doi:10.6040/j.issn.1673-3770.0.2021.512.
[7] Lechien JR, Saussez S, Muls V, et al. Laryngopharyngeal reflux: evolution and predictive value of symptoms and pH-impedance features on clinical evolution[J]. Otolaryngol Head Neck Surg, 2022: 1945998221075009. doi:10.1177/01945998221075009.
[8] 孙喆喆, 吴玮, 王刚. 管腔内pH监测在反流性疾病中的应用[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 90-94. doi:10.6040/j.issn.1673-3770.0.2019.036. SUN Zhezhe, WU Wwei, WANG Gang. Utility of intraluminal pH monitoring in reflux diseases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 90-94. doi:10.6040/j.issn.1673-3770.0.2019.036.
[9] Li YD, Xu GF, Zhou BD, et al. Effects of acids, pepsin, bile acids, and trypsin on laryngopharyngeal reflux diseases: physiopathology and therapeutic targets[J]. Eur Arch Otorhinolaryngol, 2022, 279(6): 2743-2752. doi:10.1007/s00405-021-07201-w.
[10] Wang JS, Li JR, Nie Q, et al. Are multiple tests necessary for salivary pepsin detection in the diagnosis of laryngopharyngeal reflux? [J]. Otolaryngol Head Neck Surg, 2022, 166(3): 477-481. doi:10.1177/01945998211026837.
[11] Yang H, Hu B. Immunological perspective: Helicobacter pylori infection and gastritis[J]. Mediators Inflamm, 2022: 2944156. doi:10.1155/2022/2944156.[PubMed]
[12] Malik TF, Gnanapandithan K, Singh K. Peptic Ulcer Disease[M]. In: StatPearls [Internet]. Treasure Island(FL): StatPearls Publishing, 2022: 11.
[13] Oster P, Vaillant L, Riva E, et al. Helicobacter pylori infection has a detrimental impact on the efficacy of cancer immunotherapies[J]. Gut, 2022, 71(3): 457-466. doi:10.1136/gutjnl-2020-323392.
[14] Gao PP, Cai N, Yang XR, et al. Association of Helicobacter pylori and gastric atrophy with adenocarcinoma of the esophagogastric junction in Taixing, China[J]. Int J Cancer, 2022, 150(2): 243-252. doi:10.1002/ijc.33801.
[15] Yan P, Yu BC, Li M, et al. Association between nonalcoholic fatty liver disease and Helicobacter pylori infection in Dali City, China[J]. Saudi Med J, 2021, 42(7): 735-741. doi:10.15537/smj.2021.42.7.20210040.
[16] Tezer MS, Kockar MC, Koçkar O, et al. Laryngopharyngeal reflux finding scores correlate with gastroesophageal reflux disease and Helicobacter pylori expression[J]. Acta Otolaryngol, 2006, 126(9): 958-961. doi:10.1080/00016480500529314.
[17] Oridate N, Takeda H, Yamamoto J, et al. Helicobacter pylori seropositivity predicts outcomes of acid suppression therapy for laryngopharyngeal reflux symptoms[J]. Laryngoscope, 2006, 116(4): 547-553. doi:10.1097/01.mLG.0000201907.24514.6A.
[18] Toros SZ, Toros AB, Yüksel OD, et al. Association of laryngopharyngeal manifestations and gastroesophageal reflux[J]. Eur Arch Otorhinolaryngol, 2009, 266(3): 403-409. doi:10.1007/s00405-008-0761-2.
[19] 侯波, 梁程程, 魏东敏, 等. 耳鼻咽喉门诊咽喉良性病变老年患者喉镜观察与嗓音声学分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 20-25. doi:10.6040/j.issn.1673-3770.1.2020.111. HOU Bo, LIANG Chengcheng, WEI Dongmin, et al. Laryngoscopy observation and voice acoustic analysis of elderly patients with benign laryngopharyngeal lesions in an ENT out-patient clinic[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 20-25. doi:10.6040/j.issn.1673-3770.1.2020.111.
[20] Lechien JR, Schindler A, Hamdan AL, et al. The development of new clinical instruments in laryngopharyngeal reflux disease: the international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(5S): S85-S91. doi:10.1016/j.anorl.2018.05.013.
[21] 蔡建平. 奥美拉唑、克拉霉素、阿莫西林三联疗法对幽门螺杆菌感染的治疗效果[J]. 泰山医学院学报, 2014, 35(5): 441-442. doi:10.3969/j.issn.1004-7115.2014.05.046.
[22] 张青青, 谢萌, 郭瑞昕, 等. 质子泵抑制剂对咽喉反流患者唾液胃蛋白酶浓度的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(11): 965-970. doi:10.13201/j.issn.2096-7993.2021.11.002. ZHANG Qingqing, XIE Meng, GUO Ruixin, et al. Effect of proton pump inhibitort on salivary pepsin concentration in patients with laryngopharyngeal reflux[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(11): 965-970. doi:10.13201/j.issn.2096-7993.2021.11.002.
[23] Singh GB, Yvette War G, Shukla S, et al. The role of Helicobacter Pylori and laryngopharyngeal reflux in recurrent tonsillitis[J]. Int J Pediatr Otorhinolaryngol, 2020, 138(2): 110376. doi:10.1016/j.ijporl.2020.110376.
[24] Yılmaz T, Bajin MD, Günaydın RÖ, et al. Laryngopharyngeal reflux and Helicobacter pylori[J]. World J Gastroenterol, 2014, 20(27): 8964-8970. doi:10.3748/wjg.v20.i27.8964.
[25] du PY, Zong SM, Wen YY, et al. Association between Helicobacter pylori and otitis media with effusion in children: a systematic review[J]. Int J Pediatr Otorhinolaryngol, 2020, 135: 110091. doi:10.1016/j.ijporl.2020.110091.
[26] Flores-Treviño CE, Urrutia-Baca VH, Gómez-Flores R, et al. Molecular detection of Helicobacter pylori based on the presence of cagA and vacA virulence genes in dental plaque from patients with periodontitis[J]. J Dent Sci, 2019, 14(2): 163-170. doi:10.1016/j.jds.2019.01.010.
[27] Chang SH, Hsieh PL, Tsai GJ. Chitosan inhibits Helicobacter pylori growth and urease production and prevents its infection of human gastric carcinoma cells[J]. Mar Drugs, 2020, 18(11): 542. doi:10.3390/md18110542.
[28] Gu HY. Role of flagella in the pathogenesis of Helicobacter pylori[J]. Curr Microbiol, 2017, 74(7): 863-869. doi:10.1007/s00284-017-1256-4.
[29] Jeyamani L, Jayarajan J, Leelakrishnan V, et al. CagA and VacA genes of Helicobacter pylori and their clinical relevance[J]. Indian J Pathol Microbiol, 2018, 61(1): 66-69. doi:10.4103/IJPM.IJPM_234_17.
[30] Nakajima S, Bamba N, Hattori T. Histological aspects and role of mast cells in Helicobacter pylori-infected gastritis[J]. Aliment Pharmacol Ther, 2004, 20(1): 165-170. doi:10.1111/j.1365-2036.2004.01974.x.
[31] Lv YP, Teng YS, Mao FY, et al. Helicobacter pylori-induced IL-33 modulates mast cell responses, benefits bacterial growth, and contributes to gastritis[J]. Cell Death Dis, 2018, 9(5): 457. doi:10.1038/s41419-018-0493-1.
[32] Shishkina VV, Klochkova SV, Alexeeva NT, et al. Discussion of the immunomorphological role of interactions between mast cells and Helicobacter pylori in the gastric mucosa[J]. Vopr Pitan, 2022, 91(1): 98-108. doi:10.33029/0042-8833-2022-91-1-98-108.
[33] Baj J, Korona-Gowniak I, Forma A, et al. Mechanisms of the epithelial-mesenchymal transition and tumor microenvironment in Helicobacter pylori-induced gastric cancer[J]. Cells, 2020, 9(4): 1055. doi:10.3390/cells9041055.
[34] Siupsinskiene N, Katutiene I, Jonikiene V, et al. Helicobacter pylori in the tonsillar tissue: a possible association with chronic tonsillitis and laryngopharyngeal reflux[J]. J Laryngol Otol, 2017, 131(6): 549-556. doi:10.1017/S0022215117000597.
[35] Baj J, Forma A, Sitarz M, et al. Helicobacter pylori virulence factors-mechanisms of bacterial pathogenicity in the gastric microenvironment[J]. Cells, 2020, 10(1): E27. doi:10.3390/cells10010027.
[36] Yao XB, Smolka AJ. Gastric parietal cell physiology and Helicobacter pylori-induced disease[J]. Gastroenterology, 2019, 156(8): 2158-2173. doi:10.1053/j.gastro.2019.02.036.
[37] Scida S, Russo M, Miraglia C, et al. Relationship between Helicobacter pylori infection and GERD[J]. Acta Biomed, 2018, 89(8-S): 40-43. doi:10.23750/abm.v89i8-S.7918.
[38] Yucel O. Interactions between Helicobacter pylori and gastroesophageal reflux disease[J]. Esophagus, 2019, 16(1): 52-62. doi:10.1007/s10388-018-0637-5.
[39] Chung SJ, Lim SH, Choi J, et al. Helicobacter pylori serology inversely correlated with the risk and severity of reflux esophagitis in Helicobacter pylori endemic area: a matched case-control study of 5, 616 health check-up koreans[J]. J Neurogastroenterol Motil, 2011, 17(3): 267-273. doi:10.5056/jnm.2011.17.3.267.
[40] Liu L, Gao HW, Wang HJ, et al. Comparison of esophageal function tests to investigate the effect of Helicobacter pylori infection on gastroesophageal reflux disease(GERD)[J]. Med Sci Monit, 2018, 24: 4791-4797. doi:10.12659/MSM.908051.
[41] Ashktorab H, Entezari O, Nouraie M, et al. Helicobacter pylori protection against reflux esophagitis[J]. Dig Dis Sci, 2012, 57(11): 2924-2928. doi:10.1007/s10620-012-2349-3.
[42] Heda R, Toro F, Tombazzi CR. Physiology, pepsin[J].In: StatPearls [Internet]. Treasure Island(FL): StatPearls Publishing; 2022:8.
[43] Hoppo T, Zaidi AH, Matsui D, et al. Sep70/Pepsin expression in hypopharynx combined with hypopharyngeal multichannel intraluminal impedance increases diagnostic sensitivity of laryngopharyngeal reflux[J]. Surg Endosc, 2018, 32(5): 2434-2441. doi:10.1007/s00464-017-5943-9.
[44] Liu DL, Qian TT, Sun S, et al. Laryngopharyngeal reflux and inflammatory responses in mucosal barrier dysfunction of the upper aerodigestive tract[J]. J Inflamm Res, 2020, 13: 1291-1304. doi:10.2147/JIR.S282809.
[45] Do gru M, Kuran G, Haytoglu S, et al. Role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion[J]. J Int Adv Otol, 2015, 11(1): 66-71. doi:10.5152/iao.2015.642.
[46] di Mario F, Crafa P, Barchi A, et al. Pepsinogen II in gastritis and Helicobacter pylori infection[J]. Helicobacter, 2022, 27(2): e12872. doi:10.1111/hel.12872.
[47] Yuan L, Zhao JB, Zhou YL, et al. Type I and type II Helicobacter pylori infection status and their impact on gastrin and pepsinogen level in a gastric cancer prevalent area[J]. World J Gastroenterol, 2020, 26(25): 3673-3685. doi:10.3748/wjg.v26.i25.3673.
[48] Bulmer DM, Ali MS, Brownlee IA, et al. Laryngeal mucosa: its susceptibility to damage by acid and pepsin[J]. Laryngoscope, 2010, 120(4): 777-782. doi:10.1002/lary.20665.
[49] Kumral TL, Gökden Y, Saltürk Z, et al. The effect of gastric Helicobacter pylori colonization on nasal functions[J]. Ear Nose Throat J, 2019, 98(6): 346-350. doi:10.1177/0145561319840825.
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