单纯咽喉反流患者食管下段黏膜细胞内镜及病理指标变化

doi:10.6040/j.issn.1673-3770.0.2024.197

摘要/Abstract

摘要： 目的探讨单纯咽喉反流(laryngopharyngeal reflux, LPR)患者食管下段黏膜细胞内镜及病理指标变化。方法回顾性分析单纯LPR患者及健康对照者资料,使用细胞内镜进行观察,对比两组间食管下段黏膜上皮乳头内毛细血管襻(intrapapillary capillary loops, IPCLs)数目、形态及鳞状上皮细胞间隙(dilated intercellular spaces, DIS)宽度、细胞数量、细胞核大小、细胞形态的差异,并对两组患者食管下段齿状线上方2 cm处4个象限取活检,采用HE染色,对比两组间病理下乳头内毛细血管扩张、充血、乳头延长;基底层细胞过度增生;嗜酸性粒细胞、中性粒细胞浸润;黏膜上皮细胞间隙增宽;上皮细胞气球样膨胀的差异,并对上述各组间差异进行统计学分析。结果 10例单纯LPR患者组及10例健康者组纳入研究,两组在年龄、性别、体质量指数(Body Mass Index, BMI)、病程上差异均无统计学意义(P>0.05)。在IPCLs的数目增多,DIS宽度增大、细胞数量增多,细胞核变大四项细胞内镜指标及乳头内毛细血管扩张、充血、乳头延长,嗜酸性粒细胞、中性粒细胞浸润、黏膜上皮细胞间隙增宽三项病理指标上差异有统计学意义(P<0.05)。结论单纯LPR患者食管下段黏膜早期已出现细胞内镜及病理微观指标变化。

关键词: 单纯咽喉反流, 细胞内镜, 病理, 食管, 黏膜

Abstract: Objective To investigate the changes in endoscopic and pathological indices of the lower oesophageal mucosa in patients with simple oesophageal reflux. Methods The data of patients with simple LPR and healthy controls were retrospectively analysed and observed using cytotronic endoscopy to compare the number, morphology and dilated intercellular spaces(DIS)width, cell number, cell nucleus size and cell morphology of the intrapapillary capillary loops(IPCLs)in the mucosal epithelium of the lower esophagus between the two groups, and biopsies were taken from 4 quadrants of the lower esophagus 2cm above the dentate line of the two groups using HE staining. width, cell number, nucleus size and cell morphology, and biopsies were taken from 4 quadrants 2 cm above the dentate line in the lower esophagus of the two groups, and HE staining was used to compare the two groups in terms of pathology of dilatation of intrapapillary capillaries, congestion and prolongation of papillae; hyperplasia of cells in the basal layer; infiltration of eosinophils and neutrophils; widening of the intervals between mucosal epithelium; and balloon-like expansion of epithelial cells. swelling, and statistically analysed the differences between the above groups. Results There were no significant differences in age, sex, body mass index(BMI)and disease progression between the two groups(P>0.05). There were significant differences between the two groups in the number of increased IPCLs, the width of the DIS, the number of increased cells and the size of the nucleus, as well as in the three pathological indicators of intrapillary telangiectasia, congestion, papillary elongation, eosinophilic and neutrophil infiltration and widening of the mucosal epithelial space(P<0.05). Conclusion In patients with simple pharyngopharyngeal reflux there were early endoscopic and pathological microscopic changes in the lower oesophageal mucosa.

Key words: Simple pharyngeal reflux, Cytoendoscopy, Pathology, Esophagus, Mucous

中图分类号:

R766.5

李逗,隋昕珂,杨小慢,郭红媛,王敏,钟长青,李连勇. 单纯咽喉反流患者食管下段黏膜细胞内镜及病理指标变化[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 85-90.

LI Dou, SUI Xinke, YANG Xiaoman, GUO Hongyuan, WANG Min, ZHONG Changqing, LI Lianyong. Changes in endoscopic and pathological indices of the lower oesophageal mucosa in patients with simple pharyngeal reflux[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(6): 85-90.

参考文献

[1] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组. 咽喉反流性疾病诊断与治疗专家共识(2022年,修订版)[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(10): 1149-1172. doi:10.3760/cma.j.cn115330-20220711-00428
[2] Haines A, Kohli N, Lerner BA, et al. Examining referral patterns between otolaryngology and gastroenterology: a window into potential inter-specialty knowledge gaps[J]. Ann Otol Rhinol Laryngol, 2020, 129(8): 801-805. doi:10.1177/0003489420916215
[3] Wang L, Wang G, Li LY, et al. Relationship between laryngopharyngeal reflux disease and gastroesophageal reflux disease based on synchronous esophageal and oropharyngeal Dx-pH monitoring[J]. Am J Otolaryngol, 2020, 41(3): 102441. doi:10.1016/j.amjoto.2020.102441
[4] Xiao SF, Li JR, Zheng HL, et al. An epidemiological survey of laryngopharyngeal reflux disease at the otorhinolaryngology-head and neck surgery clinics in China[J]. Eur Arch Otorhinolaryngol, 2020, 277(10): 2829-2838. doi:10.1007/s00405-020-06045-0
[5] Horiuchi Y, Hirasawa T, Ishizuka N, et al. Evaluation of microvascular patterns alone using endocytoscopy with narrow-band imaging for diagnosing gastric cancer[J]. Digestion, 2022, 103(2): 159-168. doi:10.1159/000520276
[6] Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index(RSI)[J]. J Voice, 2002, 16(2): 274-277. doi:10.1016/s0892-1997(02)00097-8
[7] Li JJ, Zhang LH, Zhang CF, et al. Linguistic adaptation, reliability, validation, and responsivity of the Chinese version of reflux symptom index[J]. J Voice, 2016, 30(1): 104-108. doi:10.1016/j.jvoice.2013.12.006
[8] Gelardi M, Silvestri M, Ciprandi G, et al. Correlation between the reflux finding score and the reflux symptom index in patients with laryngopharyngeal reflux[J]. J Biol Regul Homeost Agents, 2018, 32(1 Suppl. 2): 29-31
[9] Lechien JR, Muls V, Dapri G, et al. The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: a contemporary review[J]. Clin Otolaryngol, 2019, 44(5): 784-800. doi:10.1111/coa.13395
[10] 吴迪盼盼, 崔新华, 郭颖, 等. 窄带成像技术在咽喉反流诊断中的优势应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 31-36. doi:10.6040/j.issn.1673-3770.1.2020.108 WU Dipanpan, CUI Xinhua, GUO Ying, et al. Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 31-36. doi:10.6040/j.issn.1673-3770.1.2020.108
[11] 王磊, 李保卫, 王刚, 等. 阻塞性睡眠呼吸暂停低通气综合征患者夜间碱反流初步研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 75-79. doi:10.6040/j.issn.1673-3770.0.2022.138 WANG Lei, LI Baowei, WANG Gang, et al. A preliminary study on nocturnal alkali reflux in OSAHS patients[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 75-79. doi:10.6040/j.issn.1673-3770.0.2022.138
[12] 田秋实. IPCL对非糜烂性胃食管反流病诊断价值的探讨[J]. 临床医药文献电子杂志, 2020, 7(99): 148
[13] Abad MRA, Shimamura Y, Fujiyoshi Y, et al. Endocytoscopy: technology and clinical application in upper gastrointestinal tract[J]. Transl Gastroenterol Hepatol, 2020, 5: 28. doi:10.21037/tgh.2019.11.12
[14] Repici A, Ciscato C, Wallace M, et al. Evaluation of genotoxicity related to oral methylene blue chromoendoscopy[J]. Endoscopy, 2018, 50(10): 1027-1032. doi:10.1055/a-0630-1004
[15] Horiuchi Y, Hirasawa T, Ishizuka N, et al. Diagnostic performance in gastric cancer is higher using endocytoscopy with narrow-band imaging than using magnifying endoscopy with narrow-band imaging[J]. Gastric Cancer, 2021, 24(2): 417-427. doi:10.1007/s10120-020-01125-w
[16] Kumagai Y, Takubo K, Kawada K, et al. Diagnosis using deep-learning artificial intelligence based on the endocytoscopic observation of the esophagus[J]. Esophagus, 2019, 16(2): 180-187. doi:10.1007/s10388-018-0651-7
[17] Kwon RS, Wong Kee Song LM, Adler DG, et al. Endocytoscopy[J]. Gastrointest Endosc, 2009, 70(4): 610-613. doi:10.1016/j.gie.2009.06.030
[18] 褚传莲.非糜烂性反流病的临床特点及共聚焦激光显微内镜在其诊断中的应用[D]. 济南:山东大学, 2012
[19] De Corso E, Baroni S, Salonna G, et al. Impact of bile acids on the severity of laryngo-pharyngeal reflux[J]. Clin Otolaryngol, 2021, 46(1): 189-195. doi:10.1111/coa.13643
[20] 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
[21] Orlando LA, Orlando RC. Dilated intercellular spaces as a marker of GERD[J]. Curr Gastroenterol Rep, 2009, 11(3): 190-194. doi:10.1007/s11894-009-0030-6
[22] Ribolsi M, Perrone G, Caviglia R, et al. Intercellular space diameters of the oesophageal epithelium in NERD patients: head to head comparison between light and electron microscopy analysis[J]. Dig Liver Dis, 2009, 41(1): 9-14. doi:10.1016/j.dld.2008.07.318
[23] Xue Y, Zhou LY, Lin SR. Dilated intercellular spaces in gastroesophageal reflux disease patients and the changes of intercellular spaces after omeprazole treatment[J]. Chin Med J, 2008, 121(14): 1297-1301
[24] van Malenstein H, Farré R, Sifrim D. Esophageal dilated intercellular spaces(DIS)and nonerosive reflux disease[J]. Am J Gastroenterol, 2008, 103(4): 1021-1028. doi:10.1111/j.1572-0241.2007.01688.x
[25] Mastracci L, Spaggiari P, Grillo F, et al. Microscopic esophagitis in gastro-esophageal reflux disease: individual lesions, biopsy sampling, and clinical correlations[J]. Virchows Arch, 2009, 454(1): 31-39. doi:10.1007/s00428-008-0704-8
[26] Farré R, van Malenstein H, De Vos R, et al. Short exposure of oesophageal mucosa to bile acids, both in acidic and weakly acidic conditions, can impair mucosal integrity and provoke dilated intercellular spaces[J]. Gut, 2008, 57(10): 1366-1374. doi:10.1136/gut.2007.141804
[27] Sharma P, Wani S, Bansal A, et al. A feasibility trial of narrow band imaging endoscopy in patients with gastroesophageal reflux disease[J]. Gastroenterology, 2007, 133(2): 454-464. doi:10.1053/j.gastro.2007.06.006
[28] Lynch CR, Wani S, Rastogi A, et al. Effect of acid-suppressive therapy on narrow band imaging findings in gastroesophageal reflux disease: a pilot study[J]. Dis Esophagus, 2013, 26(2): 124-129. doi:10.1111/j.1442-2050.2012.01335.x

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