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

doi:10.6040/j.issn.1673-3770.0.2022.350

摘要/Abstract

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

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. 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[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 89-95.

SHAO Na, ZHANG Qingqing, LIU Xiaohong, XIE Meng, GUO Ruixin, MA Sijing, LIU Haiqin, REN Xiaoyong, LUO Huanan. Effects of Helicobacter pylori infection on salivary pepsin concentration in patients with symptomatic laryngopharyngeal reflux[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(6): 89-95.

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