Dx-pH监测与质子泵抑制剂诊断性试验在咽喉反流性疾病诊断中的相关性分析

Correlation analysis between Dx-pH monitoring and proton pump inhibitor test in the diagnosis of laryngopharyngeal reflux disease

目的探讨24 h咽喉Dx-pH监测与质子泵抑制剂(PPI)诊断性试验(简称PPI试验)在咽喉反流性疾病(LPRD)诊断中的相关性。方法收集2017年10月至2018年10月,杭州市中医院耳鼻咽喉科60例经临床反流症状指数(RSI)和反流体征评分(RFS)量表评估疑似诊断LPRD且从未接受过PPI治疗的患者,其中男28例,女32例,年龄16~72岁,中位年龄38岁。所有患者先行24 h咽喉Dx-pH监测,再接受8周的PPI试验治疗,根据治疗后RSI评分评估疗效。数据统计分析采用Kruskal-Wallis检验、Student Newman Keuls检验和一致性检验。结果(1)60例患者中Ryan指数阳性13例,阴性47例,阳性率21.7%(13/60);PPI试验结果阳性33例,阴性27例,阳性率55.0%(33/60)。13例Ryan指数阳性患者中PPI试验结果阳性13例,阴性0例;47例Ryan指数阴性患者中PPI试验结果阳性20例,阴性27例。若以PPI试验阳性作为确诊LPRD的金标准,Ryan指数的敏感度为39.4%,特异度为100%,阳性预测值为100%,阴性预测值为57.4%。Ryan指数与PPI试验结果一致性检验Kappa值为0.369(P<0.01)。(2)选择24 h咽喉酸反流事件≥3次作为诊断指数,60例患者中阳性34例,阳性率为56.7%(34/60);34例患者中PPI试验阳性29例,阴性5例;而在24 h咽喉酸反流事件<3次的26例患者中,PPI试验阳性4例,阴性22例。以PPI试验阳性作为确诊LPRD的金标准,24 h咽喉酸反流事件≥3次指数的敏感度为87.9%,特异度为81.5%,阳性预测值为85.3%,阴性预测值为84.6%。24 h咽喉酸反流事件≥3次与PPI试验结果比较一致性检验Kappa值为0.696(P<0.01)。结论24 h咽喉Dx-pH监测以咽喉酸反流事件≥3次作为LPRD诊断指数时与PPI试验结果相关性较好;24 h咽喉Dx-pH监测技术可作为疑似LPRD患者的确诊手段,临床尚需完善更灵敏准确的诊断指数。

Objective The consistency of 24-hour oropharyngeal Dx-pH monitoring and proton pump inhibitor(PPI)test in the diagnosis of laryngopharyngeal reflux disease(LPRD)was investigated.Methods Sixty patients with laryngopharyngeal reflux(LPR)related symptoms who had never received PPI treatment were assessed by reflux symptom index(RSI)and reflux finding score(RFS)between October 2017 and October 2018,including 28 males and 38 females,aged from 16 to 72 years,with a medium age of 38 years.Prior to treatment,all patients were evaluated with 24 hours oropharyngeal Dx-pH monitoring(Restech).After empiric therapy with PPI twice-daily for 8 weeks,the efficacy was evaluated according to posttreatment RSI score.The data was analysed with Kruskal-Wallis test,Student Newman Keuls test and consistency check.Results(1)Among all 60 patients,13 patients(21.7%)had pathologic Ryan score and all resulted responsive to PPI;27 patients(45.0%)with a negative Ryan score were unresponsive to PPI;20 patients(33.3%)despite a negative Ryan score resulted responsive to PPI therapy.Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD,the sensitivity,specificity,positive predictive value and negative predictive value of Ryan score were 39.4%,100%,100%and 57.4%respectively.The Kappa value was 0.369(P<0.01).(2)Among 34 patients(56.7%)with positive Dx-pH results(24-hour oropharyngeal acid reflux events≥3 times),29 patients were positive and 5 patients were negative in PPI test.Among 26 patients with negative Dx-pH results(24-hour oropharyngeal acid reflux events<3 times),4 patients were positive and 22 patients were negative in PPI test.Considering responsiveness to PPI therapy as the gold standard for the diagnosis of LPRD,the sensitivity,specificity,positive predictive value and negative predictive value of 24-hour oropharyngeal acid reflux events were 87.9%,81.5%,85.3%and 84.6%respectively.The Kappa value was 0.696(P<0.01).Conclusions There is a positive correlation between 24-hour oropharyngeal Dx-pH monitoring positive results(24-hour oropharyngeal acid reflux events≥3 times)and PPI test in the diagnosis of LPRD.The 24-hour oropharyngeal Dx-pH monitoring can be a promising tool for the diagnosis of suspected LPRD patients,and more sensitive and accurate Dx-pH diagnostic index will be required in the clinic.