老年人群咽喉反流性疾病发生的危险因素及合并肺炎患者的临床特征分析

Risk factors for the occurrence of laryngopharyngeal reflux disease in the aged and the clinical characteristics of patients complicated with pneumonia

目的探究老年人群咽喉反流性疾病发生的危险因素,并分析合并肺炎患者的临床特征。方法回顾性纳入2020年6月至2022年7月于解放军总医院第二医学中心行24 h咽喉pH值监测的患者,以及2017年3月至2022年7月于该院行24 h食管pH值监测结果阳性的患者。24 h咽喉反流监测结果阳性的为咽喉反流组,阴性者为非咽喉反流组;单纯合并胃食管反流病的肺炎患者为食管反流肺炎组,单纯合并咽喉反流性疾病的肺炎患者为咽喉反流肺炎组。收集患者的基本资料、共患疾病情况、用药情况及相关检查检验结果等。采用多因素logistic回归模型分析老年人群中咽喉反流性疾病的危险因素,并分析其与肺炎发生的关系。结果最终纳入80例24 h咽喉pH值监测的患者,咽喉反流组34例均男性,年龄(73±12)岁;非咽喉反流组46例[男44例,女2例,年龄(78±11岁)]。多因素logistic回归分析显示,老年人群咽喉反流性疾病的危险因素包括≤70岁的人群(OR=13.07,95%CI:2.53~67.68)、体质指数(BMI)(OR=1.37,每增加1 kg/m^(2),95%CI:1.03~1.83)、服用安定类药物(OR=8.00,95%CI:1.40~45.73)、钙通道阻滞剂(OR=5.27,95%CI:1.13~24.53)均P<0.05;服用抑酸剂(OR=0.19,95%CI:0.04~0.90,P=0.035)是老年人群发生咽喉反流性疾病的保护因素。与非咽喉反流组相比,咽喉反流组的肺炎发生率更高[44.1%(15/34)比21.7%(10/46),P=0.033]。食管反流肺炎组共32例[男31例,女1例,年龄(84±12)岁];咽喉反流肺炎组共15例[男15例,年龄(79±11)岁];与咽喉反流肺炎组患者相比,食管反流肺炎组使用抗生素疗程更长[(27.7±27.0)比(14.6±13.9)d,P=0.034],发生频率更高[(4.3±3.0)比(1.8±1.5)次/年,P<0.001],最高体温更高[(38.2±0.9)比(37.6±1.1)℃,P=0.037]。结论老年人群咽喉反流性疾病的危险因素包括年龄≤70岁、较高的BMI、服用安定类药物、钙通道阻滞剂。咽喉反流性疾病肺炎发病率更高,但肺炎病情较轻。

Objective To investigate the risk factors for the occurrence of laryngopharyngeal reflux disease in the aged,and to analyze the characteristics of patients with pneumonia.Methods Patients who underwent 24-hour laryngopharyngeal pH monitoring from June 2020 to July 2022 and the positive patients of those who underwent 24-hour esophageal pH monitoring from March 2017 to July 2022 at the Second Medical Center of the PLA General Hospital were enrolled retrospectively.Positive results of 24-hour laryngopharyngeal reflux monitoring were in the laryngopharyngeal reflux group,and the negative results were in the non-laryngopharyngeal reflux group.Patients with pneumonia and simple gastroesophageal reflux disease were in the esophageal reflux pneumonia group,and patients with pneumonia and simple laryngopharyngeal reflux disease were in the laryngopharyngeal reflux pneumonia group.Patients′basic data,co-morbidities,drug use and relevant examination and test results were collected.Multivariate logistic regression analysis was used to analyze the risk factors of laryngopharyngeal reflux disease in the aged and its relationship with pneumonia.Results A total of 80 patients with 24-hour laryngopharyngeal pH monitoring were enrolled finally,including 34 cases,all male,aged(73±12)years,in the laryngopharyngeal reflux group,and 46 cases[44 males,2 females,aged(78±11)years]in the non-laryngopharyngeal reflux group.Multivariate logistic regression analysis showed that the risk factors of laryngopharyngeal reflux disease in the aged included age≤70 years(OR=13.07,95%CI:2.53-67.68),body mass index(BMI)(OR=1.37,each additional 1 kg/m^(2),95%CI:1.03-1.83),use of antipsychotic drugs(OR=8.00,95%CI:1.40-45.73)and calcium channel blockers(OR=5.27,95%CI:1.13-24.53)(all P<0.05).The protective factors of the laryngopharyngeal reflux disease in the aged included antacids(OR=0.19,95%CI:0.04-0.90,P=0.035).The incidence of pneumonia was higher in the laryngopharyngeal reflux group compared with the non-laryngopharyngeal reflux group[44.1%(15/34)vs 21.7%(10/46),P=0.033].The esophageal reflux pneumonia group included 32 cases[31 males and 1 females,aged(84±12)years].The laryngopharyngeal reflux pneumonia group included 15 cases[15 males,aged(79±11)years].Compared to the patients in the laryngopharyngeal reflux pneumonia group,the patients in the esophageal reflux pneumonia group had a longer course of antibiotics[(27.7±27.0)vs(14.6±13.9)days,P=0.034],a higher frequency of seizure frequency[(4.3±3.0)vs(1.8±1.5)times/year,P<0.001]and a higher maximal body temperature[(38.2±0.9)vs(37.6±1.1)℃,P=0.037].Conclusions The risk factors of laryngopharyngeal reflux disease in the aged included age≤70 years,higher BMI,use of antipsychotic drugs and calcium channel blockers.The incidence of pneumonia in laryngopharyngeal reflux disease is higher,but the condition of pneumonia is milder.