连续48 h口咽pH监测在咽喉反流性疾病中诊断作用的研究

The role of continuous 48 h oropharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease

目的探索咽喉反流日变异来源及48 h口咽动态pH监测(Dx-pH监测)在咽喉反流性疾病(LPRD)诊断中的价值。方法回顾性分析2018年6月至2021年6月在战略支援部队特色医学中心耳鼻咽喉头颈外科就诊的72例疑似LPRD患者资料,男43例,女29例,年龄19~74(50.4±15.1)岁。所有患者均住院完成连续48 h口咽Dx-pH监测,比较前后2个24 h的Ryan指数、W指数的一致性及各项反流参数的相关性,使用SPSS 24.0软件进行统计学分析。结果72例研究对象均顺利完成48 h Dx-pH监测,Ryan指数前24 h阳性11例(15.2%),后24 h阳性17例(23.6%),前后均阳性5例(6.9%),任一个24 h阳性23例(31.9%),Kappa=0.211,P=0.064,前后结果不一致的有18例(25%),前后阳性率差异无统计学意义(P=0.234),48 h监测较24 h监测阳性例数增加109.1%。W指数前24 h阳性49例(68.1%),后24 h阳性53例(73.6%),前后均阳性42例(58.3%),任一个24 h阳性58例(80.6%),Kappa=0.477,P<0.001,前后结果不一致的有16例(22.2%),前后阳性率差异无统计学意义(P=0.804),48 h监测较24 h监测阳性例数增加18.4%。前后各项反流参数差异均无统计学意义(P>0.05)。相关性比较显示,立位各项反流参数相关性较低,卧位各项反流参数相关性较高。结论咽喉反流有日变异性,将Dx-pH监测时间延长至48 h有助于减少日变异性导致的漏诊。

Objective To investigate the daily variation of LPR and the significance of 48-hour oropharyngeal pH monitoring in the diagnosis of LPRD.Methods 72 subjects with suspected LPRD who were treated in our department from June 2018 to June 2021 were included.All patients were hospitalized to complete continuous 48-hour oropharyngeal Dx-pH monitoring.The consistency of Ryan index and W index and the correlation of various reflux parameters between the first and second 24-hour were compared.SPSS 24.0 was used for statistical analysis.Results All 72 subjects successfully completed 48-hour oropharyngeal Dx-pH monitoring.Ryan index was positive in 11 cases(15.2%)in the first 24-hour,in 17 cases(23.6%)in the second 24-hour,in 5 cases(6.9%)both first and second,and in 23 cases(31.9%)in either 24-hour,Kappa=0.211(P=0.064),18 cases(25%)had inconsistent results of the first 24-hour and the second 24-hour,and there was no significant difference in the positive rate between the first and second(P=0.234).The number of positive cases in 48-hour monitoring increased by 109.1%compared with 24-hour monitoring.For W index,49 cases(68.1%)were positive in the first 24-hourf 53 cases(73.6%)were positive in the second 24-hour,42 cases(58.3%)were positive both first and second,and 58 cases(80.6%)were positive in either 24-hour,Kappa=0.477(P<0.001),16 cases(22.2%)had inconsistent results of the first and second,and there was no significant difference in the positive rate between the first and second(P=0.804).The number of positive cases in 48-hour monitoring increased by 18.4%compared with 24-hour monitoring.There was no significant difference in all the reflux parameters of first and second(P>0.05).The correlation comparison showed that the correlation of various reflux parameters in the upright position was lower than that in the supine position.Conclusion Laryngeal reflux has daily variability.Extending the monitoring time of Dx-pH to 48-hour can help reduce the missed diagnosis caused by daily variability;the use of W index can reduce the influence of daily variability on the diagnostic results of LPRD.