24 h多通道腔内阻抗联合pH监测诊断咽喉反流的初步应用

Application of 24-hour multichannel intraluminal impedance in combination with pH monitoring for the diagnosis of laryngopharyngeal reflux： a pilot study

目的 研究24 h多通道腔内阻抗联合pH监测（multichannel intraluminal impedance,MII-pH）在诊断咽喉反流中的特点和问题.方法 对2014年2-12月怀疑存在咽喉反流的60例患者行24 h MII-pH监测,统计pH＜4的波形次数、伪像、酸反流次数、弱酸反流次数、弱碱反流次数、酸反流时间、酸清除时间、立位酸反流次数、卧位酸反流次数以及反流症状指数、反流体征评分量表.结果 软件分析识别出咽喉部pH ＜4的反流波形45次,人工分析观察到咽喉部pH ＜4的波形140次,其中由反流引起的咽喉部pH ＜4的波形78次（55.7％）,其余为各类伪像62次（44.3％）,人工分析与软件自动分析的一致性一般（κ =0.234）.60例患者中咽喉反流阳性17例（28.3％）,17例阳性患者各项反流参数用M[P25,P75]表示,其中酸反流次数5.0[4.0,8.8]、弱酸反流次数6.5[5.3,0.3]、弱碱反流次数1.0[0.0,2.0]、酸反流总时间3.8[2.3,7.2] min、酸清除时间36.0[21.5,57.6]s,立位酸反流次数4.0[3.0,4.8]、卧位酸反流次数1.5[0.0,2.3],咽喉反流中立位酸反流次数多于卧位,差异有统计学意义（Z=-2.571,P＜0.05）.24 h MII-pH监测与反流症状指数、反流体征评分量表结果的一致性中等（κ =0.590）.结论 对反流图形进行软件自动分析时存在漏判和误判,人工分析反流图形可提高结果的准确性.24 h MII-pH监测的可重复性较好,但诊断咽喉反流性疾病时存在假阳性和假阴性的问题,应结合病史和喉镜检查综合分析.

Objective To explore the diagnostic characteristics of 24 hours multichannel intraluminal impedance-pH （MII-pH） monitoring in patients with laryngopharyngeal reflux （LPR）.Methods Patients who were suspected to have laryngopharyngeal reflux （LRP） between February and December 2014 were included.The frequency of pH 〈 4 waveform,artifacts,numbers of acid reflux events,weakly acidic reflux events,weakly alkaline reflux events,time of acid exposure,time of acid clearance,acid reflux events in upright position and supine position,reflux symptom index （RSI） and reflux findings score （RFS） were analyzed.Results Forty-five times pH 〈 4 reflux waveform were identified according to software analysis.140 pH drops of 4 were observed according to manual analysis,in which 78 times were caused by reflux and 62 artifacts.The consistency of manual analysis and software automatically analysis was general （κ =0.234）.The positive rate of 60 patients was 28.3% （17/60）.In the 17 LPR patients,the median number[P25,P75] of acid reflux events was 5.0[4.0,8.8],weakly acidic reflux events was 6.5 [5.3,10.3],weakly alkaline reflux events was 1.0 [0.0,2.0],time of acid exposure was 3.8 [2.3,7.2] min,time of acid clearance was 36.0 [21.5,57.6] s,acid reflux events in upright position was 4.0[3.0,4.8] and in supine position was 1.5 [0.0,2.3].All the data were approximately identical with the domestic and foreign literature.24 hours MII-pH monitoring and RSI ＋ RFS had medium consistency （κ =0.590）.Conclusions 24 hours MII-pH monitoring has ideal repeatability,but false positive and false negative can not be avoided completely.The diagnosis of laryngopharyngeal reflux shoull be combined with medical history and laryngoscopy.