埃索美拉唑治疗咽喉反流的疗效评估

Evaluatement of efficacy of esomeprazole treatment in patients with laryngopharyngeal reflux

目的:探讨质子泵抑制剂埃索美拉唑治疗咽喉反流的疗效。方法:2009-06-2010-03期间门诊患者按反流症状指数(RSI)量表、反流检查计分(RFS)量表,以RSI>13分和RFS>7分筛选主诉为咽喉反流相关症状的患者,ELESA法检测唾液中存在的胃蛋白酶,确诊为咽喉反流者纳入研究对象,按要求完成8周正规埃索美拉唑治疗方案;完成8周疗程后再次RSI、RFS量表评分,ELESA法检测唾液中的胃蛋白酶。结果:经8周治疗后,24例患者症状明显好转,2例症状改善不明显。治疗前后RSI量表症状评分呈正态分布,经配对t检验,治疗前后RSI量表症状得分明显下降,差异有统计学意义(t=8.152,P<0.01);所有患者体征均改善。治疗前后RFS量表体征评分呈正态分布,经配对t检验,治疗前后RFS量表体征得分明显下降,差异有统计学意义(t=9.704,P<0.01);21例患者唾液中胃蛋白酶浓度下降,5例上升,治疗前后浓度差异比较,呈非正态分布,采用两样本相关非参数检验,差异有统计学意义(Z=-3.213,P<0.01)。结论:26例咽喉反流患者经每日2次的埃索美拉唑治疗,大部分患者咽喉反流症状和体征得到改善,唾液中胃蛋白酶含量显著下降。

Objective：To evaluate the efficacy of proton pump inhibitor（PPI） therapy with esomeprazole on laryngopharyngeal reflux（LPR） by pepsin immtmoassay in the sputum.Method：From June 2009 to March 2010,patients in the ENT outpatient department of Nanfang hospital with a reflux finding score（RFS） 7 and a reflux symptom index（RSI） 13 were selected.Their sputum was obtained in the morning for pepsin assey.Twenty-six patients with positive results of pepsin assey were enrolled and received esomeprazole 20 mg twice daily for two months.They paid return visits every two weeks.RSI,RFS and pepsin concentration in the sputum were assessed at baseline and after two months.Pepsin in the sputum was measured by enzymelinked immunoadsorbent assay.Result：After 8 weeks,24 patients got symptom improvements except 2.All got improved results of laryngoscope exams.RSI and RFS scores before and after PPI treatment reached statistical signification by paired t-test（t=8.152,P0.01;t=9.704,P0.01）.21 patients＇ pepsin concentrations decresed except 5.Nonparametric tests were used because the reduction of pepsin concentrations before and after PPI treatment were not normally distributed（Z=-3.213,P0.01）.Reductions of total RSI and RFS scores as well as pepsin concentrations were significantly higher after two months.Conclusion：Twice-daily PPI treatment for two months demonstrated a significantly greater improvement in laryngeal appearance and LPR symptoms for most patients in this study,which can result in significantly decreased levels of pepsin in sputum.