经验性治疗与Dx-pH监测诊断咽喉反流的一致性比较

A Comparison of the Consistency between Empiric Medical Therapy and Dx-pH Monitoring in the Diagnosis of LPRD

王磊;王刚;孙喆喆;刘红丹;韩浩伦;李保卫;张艺俨;龚敬;周莹;张晓丽;吴玮;

1:战略支援部队特色医学中心耳鼻咽喉头颈外科

2:国家环境保护环境感官应激与健康重点实验室

摘要
目的探讨经验性治疗及24小时Dx-pH检测诊断以声嘶为主诉者咽喉反流性疾病(laryngopharyngeal reflux disease, LPRD)的一致性。方法对以声嘶为主诉或主诉之一、非首选手术治疗、可疑存在咽喉反流的成年患者50例给予反流症状指数量表(reflux symptom index, RSI)、反流体征评分量表(reflux finding score, RFS)评估并行24小时Dx-pH监测后,建议改善生活方式并给予经验性抗反流药物(质子泵抑制剂+促胃肠动力药物)治疗8周。患者8周后复测RSI,评估治疗效果及经验性药物治疗与Dx-pH监测诊断LPRD的一致性。结果 8周经验性药物治疗后,RSI评分提示显效16例,有效13例,无效21例,即所有患者中诊断LPRD 29例,阳性率58.00%。29例患者RSI每项评分治疗后均较治疗前降低(P<0.05)。治疗前Dx-pH监测Ryan指数阳性14例,阳性率28.00%;以治疗效果为标准,Ryan指数诊断LPRD敏感性34.48%,特异性80.95%,阳性预测值71.43%,阴性预测值47.22%,两种诊断方法一致性差(Kappa=0.141,P=0.230)。Ryan阴性,但治疗显效、有效的19例患者中,pH6.0阈值下≥3次反流事件者18例。结论以声嘶为主诉患者中有较高的咽喉反流发生率,Ryan指数诊断LPRD虽然特异性高,但敏感性不足,容易造成漏诊。
关键词
咽喉反流;声嘶;口咽pH监测;质子泵抑制剂
基金项目(Foundation):
作者
王磊;王刚;孙喆喆;刘红丹;韩浩伦;李保卫;张艺俨;龚敬;周莹;张晓丽;吴玮;
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