精神心理因素对咽喉反流性疾病的影响

Influence of psychological factors on laryngopharyngeal reflux disease

目的联合使用反流相关量表、情绪量表及24 h咽部pH监测(Dx pH),探讨心理因素对咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)症状、体征及酸暴露情况的影响。方法回顾2017年6月至2018年8月,在解放军第306医院耳鼻咽喉头颈外科就诊,疑有咽喉反流患者的检查资料,共535例患者具有完整的焦虑自评量表(SAS)、抑郁自评量表(SDS)、反流症状指数量表(RSI)、反流体征量表(RFS)及咽部24h Dx pH检测结果,纳入分析研究。结果Ryan阳性患者中合并精神心理障碍发生率与Ryan阴性中合并精神心理障碍发生率比较,差异无统计学意义(P=0.940)。精神心理障碍组RSI阳性率高于无精神心理障碍组(P<0.001);SAS、SDS不同程度异常组RSI分值均高于SAS、SDS正常组(P<0.001,P=0.005)。RSI与Ryan诊断一致率在精神心理障碍组为51.2%,低于无精神心理障碍组(71.0%)。结论处于轻中度焦虑或抑郁状态的患者,并未合并更多的咽喉反流发生率,但会将自身主观症状放大,干扰RSI对LPRD诊断的准确性,是造成LPRD患者RSI与Dx pH监测结果不一致的原因之一。

Objective To investigate the effects of psychological factors on symptoms,signs and acid exposure of laryngopharyngeal reflux disease(LPRD).Methods This was a retrospective study with 535 patients with suspicious LPRD in the department of otolaryngology head and neck surgery of the 306th Hospital of PLA from June 2017 to August 2018.All the patients were surveyed by using reflux symptom index(RSI),reflux finding score(RFS),self rating anxiety scale(SAS),self rating depression scale(SDS)and simultaneous 24 hour Dx pHmonitoring was performed.Results The incidence of mental disorders in Ryan positive patients was not signifi cantly different from that in Ryan negative patients(P=0.940).The positive rate of RSI in mental disorder group was significantly higher than that in non mental disorder group(P<0.001);RSI score in SAS and SDS abnormal group was significantly higher than that in SAS and SDS normal group(P<0.001,P=0.005).The diagnostic coincidence rate of RSI and Ryan score in mental disorder group was 51.2%,which was significantly lower than that in non mental disorder group(71.0%)(P<0.001).Conclusions There is not higher incidence of laryngo pharyngeal reflux inpatients with light anxiety or depression,which will interfere with the diagnosis accuracy of RSI for LPRD seriously.It is one of the reasons why inconsistence between RSI and Dx pH monitoring exists in the diagnosis of LPRD.