山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (4): 48-52.doi: 10.6040/j.issn.1673-3770.0.2017.507

• ·论著· • 上一篇    下一篇

Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析

王刚1,2,吴玮1,2,王磊1,2,刘红丹1,2,徐小杭3,徐冰心1,2,丁瑞英1,2,周莹1,2,韩浩伦1,2,龚敬1,2,李保卫1,2,孙喆喆1,2   

  1. 1. 中国人民解放军第306医院耳鼻咽喉头颈外科, 北京 100101;
    2. 国家环境保护环境感官应激与健康重点实验室, 北京 100101;
    3. 约翰霍普金斯大学分子生物学研究室, 美国巴尔的摩 21218
  • 收稿日期:2017-12-02 出版日期:2018-07-20 发布日期:2018-07-20
  • 通讯作者: 吴玮. E-mail: ent306ww@126.com

Correlation analysis between Ryan index and reflux symptom index and reflux finding score, in the diagnosis of

WANG Gang1,2, WU Wei1,2, WANG Lei1,2, LIU Hongdan1,2, XU Xiaohang3, XU Bingxin1,2, DING Ruiying1,2, ZHOU Ying1,2, HAN Haolun1,2, GONG Jing1,2,LI Baowei1,2, SUN Zhezhe1,2   

  1. Department of Otolaryngology Head and Neck Surgery, Chinese PLA 306th Hospital, Beijing 100101, China;
  • Received:2017-12-02 Online:2018-07-20 Published:2018-07-20

摘要: 目的 探讨Ryan指数与反流症状指数量表(RSI)、反流体征量表(RFS)在咽喉反流性疾病诊断中的相关性。 方法 回顾性分析以咽喉部不适症状就诊,病程1个月以上的行咽部pH检测的230例患者临床资料。所有患者均同时行电子喉镜检测,并行RSI、RFS评估。 结果 Ryan指数阳性率为15.2%(35/230)。RSI、RFS、RSI或RFS及RSI且RFS阳性率分别为46.5%、28.7%、60.9%、13.9%。Ryan指数阳性组患者RFS评分高于Ryan指数阴性组患者,RSI评分与Ryan指数阴性组患者差异无统计学意义。RFS阳性,RSI或RFS,RSI且RFS阳性组Ryan指数阳性率高于RFS阴性,RSI或RFS,RSI且RFS阴性组。Ryan指数阳性与RSI、RFS、RSI或RFS及RSI且RFS阳性的一致性检验的kappa值分别为-0.06,0.394,0.116和0.172。以pH监测作为金标准时,RSI、RFS、RSI或RFS及RSI且RFS的敏感性分别为37.1%,74.3%,82.9%,28.6%;特异性分别为51.8%,79.5%,43.1%,88.2%;阳性预测值分别为12.1%,39.4%,20.7%,30.3%;阴性预测值分别为82.1%,94.5%,93.3%,87.3%。RSI与直立位及平卧位Ryan指数的相关系数分别为-0.056和-0.083;RFS与直立位及平卧位Ryan指数的相关系数分别为0.425和0.166。 结论 咽部pH检测是直接反映咽喉部反流的客观、无创的检测方法。RFS与Ryan指数有一定的正相关性,但量表与Ryan指数一致性差。尚需进一步研究更准确的、反映咽喉反流的量表及pH诊断指数。

关键词: 咽喉反流性疾病, 反流症状指数量表, 咽部pH检测, Ryan指数, 反流体征评分量表

Abstract: Objective To explore the correlation between Ryan index and reflux symptom index(RSI)and reflux finding score(RFS), in the diagnosis of laryngopharyngeal reflux diseases. Methods In a retrospective study, the clinical data of 230 patients presenting at the hospital with suffering from laryngopharyngeal discomfort for more than a month, in our hospital from February 2016 to November 2016, were analyzed. All patients were received underwent electronic laryngoscopy, assessment of RSI and RFS, and pharyngeal pH monitoring. Results There were 35 patients(15.2%)whose with positive Ryan index were scorepositive(15.2%). The positive rate of RSI, RFS, RSI or RFS, and RSI and RFS were positive in 46.5%,28.7%,60.9%,and 13.9% of the patients, respectively. The RFS score in the Ryan index positive group was higher than that in the Ryan index negative group, while the RSI score in the Ryan index positive group was not statistically different from that in the Ryan index negative group. The Ryan index positive rates in the RFS, RSI or RFS, and RSI and RFS positive groups were higher than that in the RFS, RSI or RFS, and RSI and RFS negative groups. The kappa values between the Ryan index group and RSI, RFS, RSI or RFS, and RSI and RFS groups were -0.06,0.394,0.116, and 0.172, respectively. When pH monitoring was regarded as the gold standard, the sensitivity of RSI, RFS, RSI or RFS, and RSI and RFS were 37.1%, 74.3%, 82.9%, and 28.6%, respectively; the specificity was were 51.8%, 79.5%, 43.1%, and 88.2%, respectively; the positive predictive values was were 12.1%, 39.4%, 20.7%, and 30.3%, respectively; and the negative predictive values was were 82.1%,94.5%,93.3%,and 87.3%, respectively. The correlation coefficients between RSI and upright and supine Ryan scores were -0.056 and -0.083, respectively; the correlation coefficients between RFS and upright and supine Ryan scores were 0.425 and 0.166, respectively. Conclusion Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly. There is a positive correlation between the RFS and the Ryan index, however, the consistency of correlation between RFS/RSI and Ryan index were is poor. Further studies research areis needed to get moredevelop an accurate scale and pH diagnostic index for the diagnosis of laryngopharyngeal reflux disease.

Key words: Laryngopharyngeal reflux disease, Ryan index, Reflux symptom index, Reflux finding score, Pharyngeal pH monitoring

中图分类号: 

  • R766/R767
[1] Koufman JA. Laryngopharyngeal reflux 2002: a new paradigam of airway disease[J]. Ear Nose Throat J, 2002, 81(9 Suppl 2):2-6.
[2] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组,中华医学会耳鼻咽喉头颈外科学分会咽喉学组.咽喉反流性疾病诊断与治疗专家共识(2015年)[J].中华耳鼻咽喉头颈外科杂志,2016,51(5):324-326. Subspecialty Group of Laryngopharyngology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Subspecialty Group of Laryngopharyngology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Experts consensus on diagnosis and treatment of laryngopharyngeal reflux disease(2015)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(5):324-326.
[3] 郑杰元,张立红,李晶兢,等. 咽喉反流症状指数量表中文版的信度及效度评价[J].中华耳鼻咽喉头颈外科杂志,2012,41(17):894-898. ZHENG Jieyuan, ZHANG Lihong, LI Jingjing, et al. Chinese version of the reflux symptom index was evaluated for reliability and validity[J].Chin J Otorhinolaryngol Head Neck Surg, 2012, 41(17):894-898.
[4] 李进让,Peter C Belafsky,张立红. 中国喉科医师应用反流体征评分量表的信度研究[J].中国耳鼻咽喉头颈外科,2012,19(7):388-390. LI Jinrang, Belafsky PC, ZHANG Lihong. Reliability of the reflux finding score used in Chinese laryngologist[J]. Chin Arch Otolaryngol Head Neck Surg, 2012, 19(7):388-390.
[5] Ayazi S, Lipham JC, Hagen JA, et al. A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold[J]. J Gastrointest Surg, 2009, 13(8):1422-1429.
[6] Branski RC, Bhattacharyya N, Shapiro J. The reliability of the assessment of endoscopic laryneal findings associated with laryngopharyngeal reflux disease[J]. Laryngoscope, 2002, 112(6):1019-1024.
[7] Vaezi MF, Richter JE, Stasney CR, et al. Treatment of chronic posterior laryngitis withesomeprazole[J]. Laryngoscope,2006, 116(2):254-260.
[8] Friedman M, Maley A, Kelley K, et al. Impact of pH monioring on laryngopharyngeal reflux treatment:improved compliance and symptom resolutioin[J]. Otolarygol Head Neck Surg, 2010, 144(4):558-562.
[9] 李进让,肖水芳.咽喉反流疾病诊疗研究中存在的问题[J].中华耳鼻咽喉头颈外科杂志,2014,49(5):353-355. LI Jinrang, XIAO Shuifang. Problems in diagnosis and treatment of laryngopharyngeal reflux disease[J]. Chin J Otorhinolaryngol Head Neck Surg, 2014, 49(5):353-355.
[10] Babaei A, Bhargava V, Mittal RK. Upper esophageal sphincter during transient lower esophageal sphincter relaxation: effects of reflux content and posture[J]. Am J Physiol Gastrointest Liver Physiol, 2010, 298(5):601-607.
[11] 汪忠镐,吴继敏,谭松涛,等.胃食管喉气管反流及其综合征[J].临床误诊误治,2010, 23(5):401-405. WANG Zhonggao, WU Jimin, TAN Songtao, et al. Gastroesophago-larygotracheal reflux and its syndrome[J]. Clin Misdiag Misther, 2010, 23(5):401-405.
[12] 张立红,李娜,郑宏伟,等.咽喉反流的初步诊断[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):105-108. ZHANG Lihong, LI Na, ZHENG Hongwei, et al. A pilot study on the diagnosis of laryngopharyngeal reflux diseases[J]. Chin J Otorhinolaryngol Head Neck Surg, 2009, 44(2):105-108.
[13] 欧阳天斌,唐世雄,张立涛,等. 24 h双探针pH检测在咽喉反流疾病的临床研究[J].中华耳鼻咽喉头颈外科杂志,2012,47(4):320-323. OUYANG Tianbin, TANG Shixiong, ZHANG Litao, et al. Clinical research of 24-hour double-probe pH-metry in the laryngopharygeal reflux diseases[J]. Chin J Otorhinolaryngol Head Neck Surg, 2012, 47(4):320-323.
[14] Friedman M, Hamilton C, Samuelson CG, et al. The value of routine pH monitoring in the diagnosis and treatment of laryngopharyngeal reflux[J]. Otolarygol Head Neck Surg, 2012, 146(6):952-958.
[15] 韩红蕾,赵建辉,张艳丽,等. Dx-pH检测系统在咽喉反流性疾病中的初步应用[J]. 中华耳鼻咽喉头颈外科杂志,2016,51(9):666-670. HAN Honglei, ZHAO Jianhui, ZHANG Yanli, et al. Preliminary application of Dx-pH monitoring system in laryngopharyngeal reflux disease[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(9):666-670.
[16] Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index(RSI)[J]. J Voice, 2002, 16(2):274-277.
[17] Oyer SL, Anderson LC, Halum SL. Influence of anxiety and depression on the predictive value of the reflux symptom index[J]. Ann Otol Rhinol Laryngol, 2009, 118(10):687-692.
[18] Serra A, Coeuzza S, Poli G, et al. Otologie findings in children with gastroesophageal reflux[J]. Int J Pediatr Otorhinolaryngol, 2007, 71(11):1693-1697.
No related articles found!
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 查洋,吕威,亓放,王晓巍,高志强. 上颌窦出血坏死性息肉的CT和MRI特点[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 37 -42 .
[2] 张颖,吴欣怡. 社区人群感染性角膜炎的认知及健康教育调查[J]. 山东大学耳鼻喉眼学报, 2010, 24(4): 52 -54 .
[3] 李文静,申家泉,王聪
. OCT在原发性急性闭角型青光眼中的应用[J]. 山东大学耳鼻喉眼学报, 2009, 23(2): 86 -88 .