口腔唾液胃蛋白酶检测对咽喉反流患者的诊断价值

Diagnostic value of oral salivary pepsin detection in patients with laryngopharyngeal reflux

目的探讨口腔唾液胃蛋白酶检测对咽喉反流患者的诊断价值。方法选取2017年1月至2018年10月陕西省人民医院收治的118例咽喉反流患者为研究对象,其中单纯咽喉炎94例,咽喉占位性病变24例,使用24 h双探头试管pH值监测法、酶联免疫吸附法对患者进行检查诊断,记录患者反流症状指数评分表和反流体征指数评分表诊断结果,并采用Kappa检验两种诊断方法一致性,ROC曲线检测口腔唾液胃蛋白酶检测法和24 h双探头试管pH值监测法对咽喉反流的诊断价值。结果反流症状指数评分表和反流体征指数评分表评估的阳性率为56.78%,其中反流症状指数评分表评估阳性率为47.46%,反流体征指数评分表评估阳性率为9.32%;单纯咽喉炎患者Ryan指数阳性率为5.32%,咽喉占位性病变患者Ryan指数阳性率为29.17%,差异有显著统计学意义(P<0.01);单纯咽喉炎患者存在1次及以上pH<6.0反流情况阳性率为50.00%,明显低于咽喉占位性病变患者的70.83%,差异有统计学意义(P<0.05);患者症状发作15 min唾液胃蛋白酶阳性率为44.07%,明显高于其余时间段(晨起7.63%,餐后1 h 3.39%,睡前4.24%),差异均有统计学意义(P<0.05);单纯咽喉炎患者唾液胃蛋白酶阳性率为53.19%,明显低于咽喉占位性病变患者的83.33%,差异有统计学意义(P<0.05);构建两种检测方法ROC曲线,发现口腔唾液胃蛋白酶检测法诊断咽喉反流ROC曲线下面积分别为症状明显时0.874(0.722,1.000),餐后1 h 0.825(0.669,0.979),晨起0.760(0.601,0.918),大于24 h双探头试管pH值监测法[症状明显时0.736(0.718,1.000),餐后1 h 0.737(0.651,0.935),晨起0.682(0.593,0.829)],差异均有统计学意义(P<0.05)。结论口腔唾液胃蛋白酶检测法较之咽部pH检测法能更好检测诊断咽喉反流疾病,可推广应用。

Objective To investigate the value of oral salivary pepsin detection in the diagnosis of patients with laryngopharyngeal reflux.Methods One hundred and eighteen patients with laryngopharyngeal reflux admitted to Shaanxi Provincial People's Hospital from January 2017 to October 2018 were selected as the research subjects,including 94 patients of simple pharyngitis and 24 patients of throat mass lesions.The diagnosis results of reflux symptom index score table and reflux sign index score table were recorded,and Kappa test was used analyze the consistency of the two diagnostic methods.ROC curve was used to analyze the value of oral saliva pepsin detection method and 24-hour dual-probe pH monitoring in the diagnosis of reflux.Results The positive rate was 56.78%for reflux symptom index and reflow sign index,47.46%for reflux symptom index and 9.32%for reflux sign index.The positive rate of Ryan index was 5.32%in patients with simple laryngitis and 29.17%in patients with space-occupying lesions of larynx(P<0.01).The positive rate of reflux with pH<6.0 once or more in patients with simple laryngitis was 50.00%,which was significantly lower than 70.83%in patients with space-occupying lesion of larynx(P<0.05).The positive rate of salivary pepsin at 15 minutes after the onset of symptoms was 44.07%,which was significantly higher than that of other periods(7.63%in the morning,3.39%at 1 h after a meal,and 4.24%before bedtime),and the differences were statistically significant(P<0.05).The positive rate of salivary pepsin in patients with simple pharyngitis was 53.19%,which was significantly lower than 83.33%of patients with space-occupying lesion of larynx(P<0.05).The ROC curves of the two detection methods were constructed.The area under the ROC curve of oral saliva pepsin for the diagnosis of laryngopharyngeal reflux were 0.874(0.722,1.000)when the symptoms were obvious,0.825(0.669,0.979)at 1 h after meal,0.760(0.601,0.918)in the morning,significantly greater than corresponding 0.736(0.718,1.000),0.737(0.651,0.935),0.682(0.593,0.829)of 24-hour dual-probe pH monitoring(P<0.05).Conclusion Oral salivary pepsin assay can better detect and diagnose laryngopharyngeal reflux disease than pharyngeal pH test,which should be popularized.