儿童腺样体肥大与咽喉反流的相关性研究

Study on the correlation between adenoid hypertrophy and laryngopharyngeal reflux in children

目的:探讨儿童腺样体肥大与咽喉反流的相关性,评估咽喉反流症状指数量表(RSI)及咽喉反流体征量表(RFS)对预测腺样体肥大与咽喉反流相关的准确性。方法:因腺样体肥大行手术治疗的患儿71例,完成RSI及RFS量表评估。留取患儿手术切除的腺样体组织行胃蛋白酶(pepsin)免疫组织化学染色。根据pepsin染色阳性结果,对RSI、RFS量表预测腺样体肥大患儿合并咽喉反流的敏感性与特异性进行评估。结果:71例腺样体肥大患儿中,RSI>13分4例(5.63%),RFS>7分26例(36.62%),两项评分均为阳性1例(1.41%)。在腺样体肥大组织中检测到pepsin表达52例,总阳性率73.24%(52/71),以强阳性(15/71,21.13%)和阳性(23/71,32.39%)为主。腺样体肥大分级越高,pepsin表达强度越高(r=0.476,P<0.01)。以腺样体组织pepsin阳性做为诊断咽喉反流的金标准,RSI及RFS敏感性分别为5.77%、34.62%,特异性分别为94.74%、57.89%。pepsin染色强度与烦人的咳嗽呈正相关(r=0.356,P=0.002),与喉室消失呈负相关(r=-0.212,P=0.038)。结论:儿童腺样体肥大与咽喉反流存在相关性,咽喉反流在腺样体的发展进程中起重要作用。RSI及RFS的敏感性低,不适用于腺样体肥大儿童存在咽喉反流的筛查。当腺样体肥大儿童长期咳嗽且行电子鼻咽喉镜检查发现喉室消失表现时,应警惕存在咽喉反流。

Objective：To discuss the correlation between adenoid hypertrophy and laryngopharyngeal reflux in children,and to determine the accuracy of reflux symptom index（RSI）and reflux finding score（RFS）in predicting adenoid hypertrophy and laryngopharyngeal reflux（LPR）.Method：Assessment of RSI and RFS was performed in71 children with adenoid hypertrophy who underwent surgery.The adenoid biopsy specimens were examined by pepsin immunohistochemical staining.According to the positive results of pepsin staining to evaluate the sensitivity and specificity of RSI and RFS to predict LPR.Result：Among the 71 children with adenoid hypertrophy,RSI was greater than 13 points in 4 cases（5.63%）,RFS was greater than 7 points in 26 cases（36.62%）,and 1（1.41%）was positive in both scores.Pepsin expression was detected in 52 cases of adenoid hypertrophy tissues,with a total positive rate of 73.24%（52/71）,most were strong positive（15/71,21.13%）and positive（23/71,32.39%）.The higher the adenoid hypertrophy grade,the higher the expression level of pepsin（r=0.476,P〈0.01）.Define the positive rate of pepsin as the gold standard for the diagnosis of LPR,the sensitivity and specificity of RSI and RFS were 5.77%,34.62% and 94.74%,57.89% respectively.Pepsin staining intensity was positively correlated with troublesome or annoying cough（r=0.356,P=0.002）and was negatively correlated with ventricular obliteration（r=-0.212,P=0.038）.Conclusion：There is a correlation between adenoid hypertrophy and LPR in children,LPR plays an important role in the development of adenoid and the role and mechanism of pepsin in adenoid hypertrophy needs further studyAs the low sensitivity of RSI and RFS,it is not suitable for the screening of adenoid hypertrophy in children with LPR.Children with adenoid hypertrophy cough for a long time and the laryngoscopy shows the ventricular obliteration,the presence of LPR should be warned.