24h双探针pH检测在咽喉反流疾病的临床研究

Clinical research of 24.hour double-probe pH-metry in the laryngopharyngeal reflux diseases

目的探讨24h双探针pH检测在咽喉反流疾病（laryngopharyngeal reflux disease，LPR）诊治中的临床意义。方法依据pH检测24h内食管上端反流事件次数超过6．9次为基线将难治性咽喉炎患者分为LPR组和对照组各17例，并给予咽喉炎常规治疗＋抑酸治疗。分析pH检测与反流症状指数（The reflux symptom index，RSI）量表和反流检查（The reflux finding score，RFS）评分的一致性，比较两组治疗前后RSI、RFS的变化情况。结果LPR组坐立位反流次数中位数（10．0）明显高于平卧位（3．0），两者差异有统计学意义（Z=-3．62，P〈0．01），而对照组两者差异无统计学意义（Z=-0．60，P〉0．05）。pH检测判断LPR阳性结果与RSI量表、RSI量表＋RFS评分的判断结果差异无统计学意义（P〉0．05），Kappa检验有统计学意义（κ值分别为0．47和0．53，P值均〈0．01）。治疗后LPR组与对照组的RSI、RFS均有不同程度下降，但LPR组的下降幅度明显高于对照组，差异均有统计学意义（t值分别为3．74、3．01，P值均〈0．01）。结论pH检测是LPR临床抗酸治疗的重要依据。

Objective To determine the clinical value of 24 h double-probe pH-metry for the diagnosis and treatment of laryngopharyngeal reflux （LPR）. Methods According to the pH-metry results （whether the reflux events record in the upper esophagus is more than 6. 9 ）, patients of refractory pharyngolaryngitis were divided into LPR and control groups （each of 17 cases ）. All patients treated with anti-acid therapy and conventional pharyngo-laryngitis therapy. Correlation between pH-metry and the reflux symptom index （RSI） , the reflux symptom index （RFI） were analyzed. Changes of the RSI and RFI in different group were calculated in post-treatment. Results In the LPR group , the median reflux events of the upright time were higher than the supine time （ Z = - 3.62, P 〈 0. 01 ）, but the difference was not discovered in the control group（ Z = - 0. 60, P 〉 0.05 ）. There were no statistical difference between RSI,RSI and RFS with pH-metry, and with moderate concordance （ ~ were 0.47,0. 53, P 〈 0. 01, respectively）. Compared to pre-treatment, the RSI and RFI were decreased both in LPR group and contorl group, Amplitude decreased in LPR group significantly higher than the contorl groups, with statistical difference （t were 3.74,3.01, P 〈0.01, respectively）. Conclusion The 24 h double-probe pH-metry is significant for the anti-acid therapy of LPR.