Dx-pH监测系统在咽喉反流性疾病中的应用

Clinical Study of Dx-pH Monitoring System in the Application of Laryngopharyngeal Reflux Disease

常玮;徐文;丁秀;

1:首都医科大学附属北京同仁医院耳鼻咽喉头颈外科

摘要

目的探讨应用Dx-pH监测系统诊断咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)的诊断标准。方法选取2017年1月至2018年1月就诊的临床高度怀疑咽喉反流性疾病的患者45例,所有患者填写反流症状指数(reflux symptom index,RSI)量表,并依据频闪喉镜检查进行反流体征评分量表(reflux finding score,RFS)评分;分析24 h Dx-pH监测结果,将RSI、RFS作为参考,分别以Ryan指数及pH<6.5、pH<6.0阈值下反流事件作为阳性标准,对Dx-pH监测系统诊断咽喉反流性疾病的敏感度及特异度进行比较。结果依据Ryan指数诊断LPRD,45例患者中阳性率20.0%(9/45);以pH<6.5作为标准阈值,阳性诊断率95.56%(43/45);以pH<6.0作为标准阈值,阳性诊断率84.44%(38/45),Ryan指数的阳性率低于后两者,差异均有统计学意义(P<0.05),而后两者之间差异无统计学意义(P>0.05)。以Ryan指数判定LPRD的结果与RSI、RFS量表判定结果一致性差(κ=-0.087),以pH<6.0为阈值检验结果与量表判定结果一致性一般(κ=0.219),以pH<6.5为阈值检验结果与量表判定结果一致性差(κ=0.051)。以RSI、RFS为参考,Ryan指数诊断LPRD的敏感度及特异度分别为16.13%、71.43%;以pH<6.0为阈值作为结果判定的敏感度及特异度分别为90.32%、28.57%;以pH<6.5为阈值作为结果判定的敏感度及特异度分别为96.77%、7.14%。结论应用DX-PH检测系统诊断LPRD时,以pH<6.0阈值下存在咽喉反流事件为标准,LPRD的阳性诊断率高于Ryan指数;其检验结果与RSI及RFS量表评估结果的一致性最佳,同时敏感度及特异度达到了较好的均衡。

关键词

咽喉反流;Dx-pH监测;诊断标准

基金项目(Foundation):

作者

常玮;徐文;丁秀;

参考文献

1 Belafsky PC,Postma GN,Amin MR,et al.Symptoms and findings of laryngopharyngeal reflux[J].Ear Nose Throat J,2002,81(9 Suppl 2):10.

2 Printza A,Kyrgidis A,Oikonomidou E,et al.Assessing laryngopharyngeal reflux symptoms with the Reflux Symptom Index:validation and prevalence in the Greek population[J].Otolaryngol Head Neck Surg,2011,145:974.

3 Yadlapati R,Pandolfino JE,Lidder AK,et al.Oropharyngeal pH testing does not predict response to proton pump inhibitor therapy in patients with laryngeal symptoms[J].American Journal of Gastroenterology,2016,111:1517.

4 Saritas Yuksel E,Hong SS,Strugala V,et al.Rapid salivary pepsin test:Blinded assessment of test performance in gastroesophageal reflux disease[J].Laryngoscope,2012,122:1312.

5 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,2016,51:324.

6 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,2009,13:1422.

7 Becker V,Graf S,Schlag C,et al.First agreement analysis and day-to-day comparison of pharyngeal pH monitoring with pH/impedance monitoring in patients with suspected laryngopharyngeal reflux[J].J Gastrointest Surg,2012,16:1096.

8 Wilhelm D,Jell A,Feussner H,et al.Pharyngeal pH monitoring in gastrectomy patients – what do we really measure[J]?United European Gastroenterol J,2016,4:541.

9 Chiou E,Rosen R,Jiang H,et al.Diagnosis of supra-esophageal gastric reflux:correlation of oropharyngeal pH with esophageal impedance monitoring for gastro-esophageal reflux[J].Neurogastroenterol Motil,2011,23:717.

10 Baliga S,Muglikar S,Kale R.Salivary pH:A diagnostic biomarker[J].Journal of Indian Society of Periodontology,2013,17:461.

11 Johnston N,Bulmer D,Gill GA,et al.Cell biology of laryngeal epithelial defenses in health and disease:further studies[J].Annals of Otology Rhinology & Laryngology,2003,112:481.

12 Wiener GJ,Tsukashima R,Kelly C,et al.Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux[J].J Voice,2009,23:498.

13 Yadlapati R,Adkins C,Jaiyeola DM,et al.Abilities of oropharyngeal pH tests and salivary pepsin analysis to discriminate between asymptomatic volunteers and subjects with symptoms of laryngeal irritation[J].Clinical Gastroenterology & Hepatology,2015,14:535.

本文信息

PDF(118K)

本文关键词相关文章

咽喉反流 Dx-pH监测诊断标准

本文作者相关文章

常玮徐文丁秀