铝碳酸镁联合质子泵抑制剂治疗胃食管反流性咽喉炎疗效观察

Efficacy of Hydrotalcite Combined with Proton Pump Inhibitor for Gastroesophageal Reflux Laryngopharyngitis

背景:与胃食管反流相关的慢性咽喉炎称为胃食管反流性咽喉炎(GERL)。GERL常规治疗效果欠佳,临床上常表现为难治性咽喉炎。目的:观察铝碳酸镁联合质子泵抑制剂(PPI)治疗GERL的疗效和安全性。方法:600例根据临床症状、咽喉部体征和24 h双通道食管pH监测结果诊断的GERL患者纳入研究。患者随机分为治疗组和对照组,每组300例。两组患者均接受常规治疗,治疗组在常规治疗的基础上加用铝碳酸镁片1.0 g tid和雷贝拉唑钠肠溶片20 mg bid,疗程4～6周。比较两组患者的24 h食管pH监测结果和临床症状评分,根据临床症状和体征改善情况进行疗效评价。结果:治疗组与对照组基线情况差异无统计学意义。治疗后,治疗组食管近、远端pH<4时间百分比和DeMeester计分较治疗前明显降低,且明显低于对照组治疗后,差异均有统计学意义(P<0.01);治疗组临床症状评分改善情况和总有效率(96.7%对66.3%)亦显著优于对照组(P<0.01)。两组治疗过程中均未出现严重不良反应。结论:在常规治疗咽喉炎的基础上联合应用铝碳酸镁和PPI对GERL疗效显著且安全,值得在临床上推广应用。

Gastroesophageal reflux laryngopharyngitis （GERL） is a subtype of chronic laryngopharyngitis which is associated with gastroesophageal reflux. Patients in this condition are difficult to achieve optimal efficacy by conventional therapy and are frequently present as refractory laryngopharyngitis. Aims： To assess the efficacy and safety of hydrotalcite combined with proton pump inhibitor （PPI） for GERL. Methods： Six hundred GERL patients with laryngopharyngeal signs and symptoms and confirmed by 24-hour dual-probe esophageal pH monitoring were enrolled and randomly divided into two groups, treatment group （n = 300） and control group （n = 300）. All patients received conventional therapy. Patients in treatment group received hydrotalcite tablets 1.0 g tid combined with sodium rabeprazole enteric-coated tablets 20 mg bid for 4-6 weeks in addition. Results of 24-hour esophageal pH monitoring and clinical symptom score were compared between the two groups. The efficacy was evaluated based on improvement of clinical signs and symptoms. Results： Patient characteristics at baseline were similar in both groups. After treatment, the time percentage of pH 〈 4 in proximal and distal esophagus, as well as the DeMeester score in treatment group were significantly decreased （P 〈 0.01 ） and were superior to those in control group after treatment （P 〈 0.01 ）. Improvement in clinical symptom score and the overall efficacy （96.7% vs. 66.3% ） in treatment group were also superior to those in control group （P 〈 O. 01 ）. No severe adverse events were seen during treatment course in both groups. Conclusions： Hydrotalcite combined with PPI and conventional therapy is safe and effective for GERL and worthy of wide application.