鼻腔胃蛋白酶检测与pH监测法在诊断咽喉反流中的应用

Application of pepsin detection in nasal cavity and pH monitoring in the diagnosis of larynghopharyngeal reflux

目的:探讨慢性鼻-鼻窦炎(CRS)与咽喉反流(LPR)的相关性,以及鼻腔分泌物中胃蛋白酶浓度检测与24 h咽喉pH监测两种方法在诊断LPR中的应用。方法:对50例CRS患者(CRS组)及20例健康志愿者(对照组),分别行24 h咽喉pH监测和酶联免疫吸附试验测定患者鼻腔分泌物中胃蛋白酶浓度。结果:CRS患者行24 h pH监测示LPR的发生率为84%,对照组为25%,两组间比较差异有统计学意义(P<0.01)。CRS组胃蛋白酶阳性率在为88%,对照组为30%,两组间比较差异有统计学意义(P<0.01)。以鼻腔分泌物中胃蛋白酶浓度作为LPR的诊断指标,灵敏度为88%,特异度为70%,误诊率为30%,漏诊率为12%。配对卡方检验Kappa=0.765,两种检查方法一致性较好。结论:鼻腔分泌物中胃蛋白酶浓度检测可作为LPR诊断的可靠指标。

Objective To explore the application of pepsin detection in nasal cavity and pH monitoring in the diagnosis of larynghopharyngeal reflux （LPR）. Methods Fifty patients with CR$ and 20 healthy volunteers were recruited. They received 24-hour pH monitoring in larynghopharyngeal and pepsin detection in nasal cavity by enzyme -linked immunoabsorbent assay （ELISA）. Results The LPR incidence rate in CRS patients by 24-hour pH monitoring was significant higher than that in healthy volunteers group （P 〈 0.01）（84%, 25%, respectively）. The pepsin positive rate was significant higher than that in healthy volunteers group（P 〈 0.01）（88%, 30%, respectively）. The pepsin concentration in nasal secretions was used in the diagnosis index of LPR, the sensitivity, specificity, misdiagnosis rate and the missed diagnosis were g8%, 70%, 30%, 12%, respectively. The method was well consistent with the examination of pH monitoring （Kappa 〉 0.75, P 〈 0.01）. Conclusion The examination of pepsin in nasal secretions may provided believable indicator for the diagnosis of LPR.