咽喉反流在窄带成像下的特征性表现

Characteristics performance of laryngopharyngeal reflux in narrow band imaging

目的研究分析窄带成像(narrow band imaging,NBI)技术在咽喉反流(laryngopharyngeal reflux,LPR)诊断中的应用价值。方法选取2022年9月-2023年4月因咽喉不适就诊于哈尔滨医科大学附属第一医院耳鼻咽喉头颈外科住院部或喉镜室的患者共计275例作为研究对象,所有患者均完成RSI、RFS评分量表和电子喉镜检查(包括普通白光和NBI),根据2022年LPRD专家共识,以RSI和RFS评分量表为诊断标准分为LPR组和非LPR组,采用χ^(2)检验分析不同组间NBI下特征性表现阳性率的差异,NBI与量表诊断方法的一致性采用Kappa分析,以RSI和RFS评分为诊断标准,分析NBI方法的诊断效能。结果LPR组共有190例,其中157例在NBI模式下可见特征性表现,阳性率为82.6%(157/190),非LPR组共有85例,阳性16例,阳性率为18.8%(16/85),2组间阳性率差异有统计学意义(χ^(2)=102.47,P<0.05)。RSI、RFS量表诊断方法与NBI诊断方法的一致率为82.2%(226/275),采用Kappa一致性分析,Kappa=0.605(P<0.05),提示两种诊断方法的一致性良好。以RSI、RFS量表为LPR诊断标准,NBI诊断方法的敏感度为82.6%(157/190),特异度为81.2%(69/85),阳性预测值为90.8%(157/173),阴性预测值为67.6%(69/102)。结论NBI作为一项新型内镜成像技术,能够显示黏膜表面微血管的微小变化,可在LPR诊断中发挥重要作用。

Objective To study the application value of narrow-band imaging in the diagnosis of laryngopharyngeal reflux.Methods A total of 275 patients admitted to the inpatient department or laryngoscopy room of the Otolaryngology Head and Neck Surgery Department of the First Affiliated Hospital of Harbin Medical University from September 2022 to April 2023 due to throat discomfort were selected as the research subjects.All of them completed RSI,RFS scoring scales and electronic laryngoscopy(including ordinary white light and NBI).According to the expert consensus of LPRD in 2022,RSI and RFS scoring scale were used as diagnostic criteria to divide them into LPR group and non-LPR group.Chi-square test was used to analyze the differences of positive rates of characteristic manifestations under NBI among different groups.The consistency of NBI and scale diagnostic methods was analyzed by Kappa,and RSI and RFS scoring were used as diagnostic criteria,The diagnostic efficiency of NBI method was analyzed.Results There were 190 people in the LPR group,157 of whom showed characteristic performance under the NBI mode,with a positive rate of 82.6%(157/190);there were 85 people in the non-LPR group,with a positive rate of 18.8%(16/85).There was a statistically significant difference in the positive rate between the two groups(χ^(2)=102.47,P<0.05).The consistency rate between RSI,RFS and NBI was 82.2%(226/275).Kappa consistency analysis was used,and Kappa=0.605(P<0.05),indicating good consistency between the two diagnostic methods.Using RSI and RFS as diagnostic criteria for LPR,the sensitivity of NBI diagnostic method was 82.6%(157/190),specificity 81.2%(69/85),positive predictive value 90.8%(157/173)and negative predictive value 67.6%(69/102).Conclusion Narrow-band imaging,as a new endoscopic imaging technique,can show small changes in mucosal surface micro vessels and play an important role in the diagnosis of laryngopharyngeal reflux.