酸反流事件阈值设定对咽喉酸反流性疾病诊疗的影响

doi:10.6040/j.issn.1673-3770.0.2024.057

摘要/Abstract

摘要： 目的探讨24 h多通道腔内阻抗pH 监测(24-hour multichannel intraluminal impedance pH monitoring, 24 h MII-pH)与经验性质子泵抑制剂治疗(proton pump inhibitor, PPI)这两种咽喉反流性疾病(laryngopharyngeal reflux disease, LPRD)诊断方法的异同,分析24h MII-pH监测阴性患者从经验性PPI治疗中获益的情况。方法选取疑似LPRD患者70例。完成反流症状指数(reflux symptom index, RSI)评分及反流体征量表(reflux finding score, RFS)量表评估,并进行24 h MII-pH监测及经验性PPI治疗8周。统计分别以pH<4及pH<5作为24 h MII-pH监测中界定咽喉部酸反流事件的病理阈值的诊断结果,与经验性PPI治疗进行一致性分析,并观察以pH<4作为阈值诊为阴性但以pH<5阈值诊为阳性患者的PPI治疗效果。结果 70例中经验性PPI治疗有效者41例。以pH<4作为界定咽喉部酸反流事件的病理阈值时,阳性者35例,与经验性PPI治疗的诊断结果一致性中等(κ=0.429),诊断敏感度68.3%。以pH<5作为界定咽喉部酸反流事件的病理阈值时,阳性者47例,与经验性PPI治疗的诊断结果一致性中等(κ=0.514),诊断敏感度87.8%。共12例患者为以pH<4为阈值时阴性但以pH<5为阈值时阳性的患者。这12例患者中,经验性PPI治疗有效者共8例,治疗有效率为66.7%。结论以pH<5作为界定咽喉部酸反流事件的病理阈值时与经验性PPI治疗的诊断结果一致性良好;在以pH<4为阈值诊断阴性但以pH<5为阈值诊断阳性的患者中,仍存在经验性PPI治疗有效的患者,说明适当提高pH阈值可以增加24h MII-pH监测阴性患者从经验性PPI治疗中获益的可能性。。

关键词: 咽喉反流, 24h多通道腔内阻抗pH 监测, 经验性质子泵抑制剂治疗, 反流症状指数, 反流体征量表, 病理阈值

Abstract: Objective To compare the similarities and differences of 24-hour multichannel intraluminal impedance pH monitoring(24 h MII-pH)with empiric proton pump inhibitor(PPI)therapy in the diagnosis of laryngopharyngeal reflux disease(LPRD), and to analyze the benefits of empiric PPI therapy in patients with negative 24 h MII-pH monitoring. Methods A total of 70 patients suspected of having LPRD, who attended the otolaryngology department of our hospital from January 2017 to December 2019, were selected. Reflux symptom index(RSI)and reflux finding score(RFS)were evaluated. 24-hour MII-pH monitoring and empiric PPI treatment for 8 weeks were performed. The diagnostic results of pH<4 and pH<5 as the pathological threshold defining acid reflux events in 24h MII-pH monitoring was statistically analyzed, and the consistency with empiric PPI therapy was calculated separately. The PPI treatment effect of negative patients with pH <4 but positive with pH <5 was observed. Results Of the 70 patients, 41 responded to empirical PPI treatment. When pH <4 was used as the pathological threshold, 35 patients were positive, the diagnostic results were moderate(κ=0.429)with empiric PPI therapy, and the diagnostic sensitivity was 68.3%. When pH <5 was used as the pathological threshold, 47 patients were positive, the diagnostic results were moderate(κ=0.514)with empiric PPI therapy, the diagnostic sensitivity was 87.8%. A total of 12 patients were negative at pH<4 but positive at pH<5. Among these 12 patients, a total of 8(36-28)patients were effectively treated with empiric PPI treatment, and the treatment response rate was 66.7%. Conclusion The diagnosis of empiric PPI therapy was well consistent with the diagnosis of empiric PPI therapy when pH <5 was used as the pathological threshold. In patients with a negative pH <4 threshold but a positive pH <5 threshold, there are still patients responded to empiric PPI therapy. Suggests that an appropriate increase in the pH threshold could increase the likelihood of benefiting from empiric PPI therapy in patients with negative 24-hour MII-pH monitoring.

Key words: Laryngopharyngeal reflux, 24-hour multichannel intraluminal impedance pH monitoring, Empiric proton pump inhibitor therapy, Reflux symptom index, Reflux sign score, Pathologic threshold

中图分类号:

R766.5

杜晨,闫燕,王丽,鹿培泉. 酸反流事件阈值设定对咽喉酸反流性疾病诊疗的影响[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 115-119.

DU Chen, YAN Yan, WANG Li, LU Peiquan. Impact of acid reflux event thresholds on the diagnosis and management of oesophageal reflux disease[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(6): 115-119.

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