Dx-pH监测系统在咽喉反流性疾病中的应用
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摘要
目的探讨应用Dx-pH监测系统诊断咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)的诊断标准。方法选取2017年1月至2018年1月就诊的临床高度怀疑咽喉反流性疾病的患者45例,所有患者填写反流症状指数(reflux symptom index,RSI)量表,并依据频闪喉镜检查进行反流体征评分量表(reflux finding score,RFS)评分;分析24 h Dx-pH监测结果,将RSI、RFS作为参考,分别以Ryan指数及pH<6.5、pH<6.0阈值下反流事件作为阳性标准,对Dx-pH监测系统诊断咽喉反流性疾病的敏感度及特异度进行比较。结果依据Ryan指数诊断LPRD,45例患者中阳性率20.0%(9/45);以pH<6.5作为标准阈值,阳性诊断率95.56%(43/45);以pH<6.0作为标准阈值,阳性诊断率84.44%(38/45),Ryan指数的阳性率低于后两者,差异均有统计学意义(P<0.05),而后两者之间差异无统计学意义(P>0.05)。以Ryan指数判定LPRD的结果与RSI、RFS量表判定结果一致性差(κ=-0.087),以pH<6.0为阈值检验结果与量表判定结果一致性一般(κ=0.219),以pH<6.5为阈值检验结果与量表判定结果一致性差(κ=0.051)。以RSI、RFS为参考,Ryan指数诊断LPRD的敏感度及特异度分别为16.13%、71.43%;以pH<6.0为阈值作为结果判定的敏感度及特异度分别为90.32%、28.57%;以pH<6.5为阈值作为结果判定的敏感度及特异度分别为96.77%、7.14%。结论应用DX-PH检测系统诊断LPRD时,以pH<6.0阈值下存在咽喉反流事件为标准,LPRD的阳性诊断率高于Ryan指数;其检验结果与RSI及RFS量表评估结果的一致性最佳,同时敏感度及特异度达到了较好的均衡。
Objective To explore the criteria for the diagnosis of laryngopharyngeal reflux disease by Dx-pH monitoring system.Methods A total of 45 patients who were highly suspected to have laryngopharyngeal reflux disease from January 2017 to January 2018 were included in this study. All the patients filled in the RSI scale, and the RFS scores were obtained according to the results of stroma laryngoscopy. The results of 24 h Dx-pH monitoring were analyzed retrospectively. With RSI and RFS as references, Ryan index and reflux events with pH<6.5, pH<6.0 threshold as positive criteria, the sensitivity and specificity of Dx-pH monitoring system for diagnosis of 1 aryngopharyngeal reflux disease were compared. A new criterion was used in this study. Results All 45 patients diagnosed with LPRD according to the Ryan index showed the positive rate of 20%(9/45). With pH<6.5 as the standard threshold, the positive diagnosis rate was 95.6%(43/45). With pH<6.0 as the standard threshold, the positive diagnosis rate was 84.4%(38/45). The difference between Ryan index and pH<6.0 or pH<6.5 as threshold positive rate was statistically significant(P<0.05). There was no significant difference in the positive rate of pH<6.0 and pH<6.5 between the two groups(P>0.05). When the Ryan index was used as the threshold,chi-square revealed low consistency(κ=-0.087) between Dx-pH monitoring and scale result.If pH<6.0 was used as the threshold,the consistency of pH monitoring and scale result was common(κ=0.219). If pH<6.5 was used as threshold,the consistency of pH monitoring and scale result was low(κ=0.051). With RSI and RFS for references, the sensitivity and specificity of Ryan index were 16.1% and 71.4%, and the sensitivity and specificity of pH<6.0 as the threshold were 90.3% and 28.6%, and the sensitivity and specificity of pH<6.5 as the threshold were 96.8% and 7.1%, respectively.Conclusion With reflux events of pH<6.5 and pH<6.0 threshold as the standard, the positive diagnosis rate of LPRD is higher than Ryan index. With RSI and RFS for reference, if pH<6.0 was used as threshold,the consistency of pH monitoring and scale result was the best, and its sensitivity and specificity were better than those of the other two standards.
Objective To explore the criteria for the diagnosis of laryngopharyngeal reflux disease by Dx-pH monitoring system.Methods A total of 45 patients who were highly suspected to have laryngopharyngeal reflux disease from January 2017 to January 2018 were included in this study. All the patients filled in the RSI scale, and the RFS scores were obtained according to the results of stroma laryngoscopy. The results of 24 h Dx-pH monitoring were analyzed retrospectively. With RSI and RFS as references, Ryan index and reflux events with pH<6.5, pH<6.0 threshold as positive criteria, the sensitivity and specificity of Dx-pH monitoring system for diagnosis of 1 aryngopharyngeal reflux disease were compared. A new criterion was used in this study. Results All 45 patients diagnosed with LPRD according to the Ryan index showed the positive rate of 20%(9/45). With pH<6.5 as the standard threshold, the positive diagnosis rate was 95.6%(43/45). With pH<6.0 as the standard threshold, the positive diagnosis rate was 84.4%(38/45). The difference between Ryan index and pH<6.0 or pH<6.5 as threshold positive rate was statistically significant(P<0.05). There was no significant difference in the positive rate of pH<6.0 and pH<6.5 between the two groups(P>0.05). When the Ryan index was used as the threshold,chi-square revealed low consistency(κ=-0.087) between Dx-pH monitoring and scale result.If pH<6.0 was used as the threshold,the consistency of pH monitoring and scale result was common(κ=0.219). If pH<6.5 was used as threshold,the consistency of pH monitoring and scale result was low(κ=0.051). With RSI and RFS for references, the sensitivity and specificity of Ryan index were 16.1% and 71.4%, and the sensitivity and specificity of pH<6.0 as the threshold were 90.3% and 28.6%, and the sensitivity and specificity of pH<6.5 as the threshold were 96.8% and 7.1%, respectively.Conclusion With reflux events of pH<6.5 and pH<6.0 threshold as the standard, the positive diagnosis rate of LPRD is higher than Ryan index. With RSI and RFS for reference, if pH<6.0 was used as threshold,the consistency of pH monitoring and scale result was the best, and its sensitivity and specificity were better than those of the other two standards.
引文
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3 Yadlapati R,Pandolfino JE,Lidder AK,et al.Oropharyngeal pH testing does not predict response to proton pump inhibitor therapy in patients with laryngeal symptoms[J].American Journal of Gastroenterology,2016,111:1517.
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5 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组,中华医学会耳鼻咽喉头颈外科学分会咽喉学组.咽喉反流性疾病诊断与治疗专家共识(2015年)[J].中华耳鼻咽喉头颈外科杂志,2016,51:324.
6 Ayazi S,Lipham JC,Hagen JA,et al.A new technique for measurement of pharyngeal pH:normal values and discriminating pH threshold[J].J Gastrointest Surg,2009,13:1422.
7 Becker V,Graf S,Schlag C,et al.First agreement analysis and day-to-day comparison of pharyngeal pH monitoring with pH/impedance monitoring in patients with suspected laryngopharyngeal reflux[J].J Gastrointest Surg,2012,16:1096.
8 Wilhelm D,Jell A,Feussner H,et al.Pharyngeal pH monitoring in gastrectomy patients – what do we really measure[J]?United European Gastroenterol J,2016,4:541.
9 Chiou E,Rosen R,Jiang H,et al.Diagnosis of supra-esophageal gastric reflux:correlation of oropharyngeal pH with esophageal impedance monitoring for gastro-esophageal reflux[J].Neurogastroenterol Motil,2011,23:717.
10 Baliga S,Muglikar S,Kale R.Salivary pH:A diagnostic biomarker[J].Journal of Indian Society of Periodontology,2013,17:461.
11 Johnston N,Bulmer D,Gill GA,et al.Cell biology of laryngeal epithelial defenses in health and disease:further studies[J].Annals of Otology Rhinology & Laryngology,2003,112:481.
12 Wiener GJ,Tsukashima R,Kelly C,et al.Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux[J].J Voice,2009,23:498.
13 Yadlapati R,Adkins C,Jaiyeola DM,et al.Abilities of oropharyngeal pH tests and salivary pepsin analysis to discriminate between asymptomatic volunteers and subjects with symptoms of laryngeal irritation[J].Clinical Gastroenterology & Hepatology,2015,14:535.
2 Printza A,Kyrgidis A,Oikonomidou E,et al.Assessing laryngopharyngeal reflux symptoms with the Reflux Symptom Index:validation and prevalence in the Greek population[J].Otolaryngol Head Neck Surg,2011,145:974.
3 Yadlapati R,Pandolfino JE,Lidder AK,et al.Oropharyngeal pH testing does not predict response to proton pump inhibitor therapy in patients with laryngeal symptoms[J].American Journal of Gastroenterology,2016,111:1517.
4 Saritas Yuksel E,Hong SS,Strugala V,et al.Rapid salivary pepsin test:Blinded assessment of test performance in gastroesophageal reflux disease[J].Laryngoscope,2012,122:1312.
5 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组,中华医学会耳鼻咽喉头颈外科学分会咽喉学组.咽喉反流性疾病诊断与治疗专家共识(2015年)[J].中华耳鼻咽喉头颈外科杂志,2016,51:324.
6 Ayazi S,Lipham JC,Hagen JA,et al.A new technique for measurement of pharyngeal pH:normal values and discriminating pH threshold[J].J Gastrointest Surg,2009,13:1422.
7 Becker V,Graf S,Schlag C,et al.First agreement analysis and day-to-day comparison of pharyngeal pH monitoring with pH/impedance monitoring in patients with suspected laryngopharyngeal reflux[J].J Gastrointest Surg,2012,16:1096.
8 Wilhelm D,Jell A,Feussner H,et al.Pharyngeal pH monitoring in gastrectomy patients – what do we really measure[J]?United European Gastroenterol J,2016,4:541.
9 Chiou E,Rosen R,Jiang H,et al.Diagnosis of supra-esophageal gastric reflux:correlation of oropharyngeal pH with esophageal impedance monitoring for gastro-esophageal reflux[J].Neurogastroenterol Motil,2011,23:717.
10 Baliga S,Muglikar S,Kale R.Salivary pH:A diagnostic biomarker[J].Journal of Indian Society of Periodontology,2013,17:461.
11 Johnston N,Bulmer D,Gill GA,et al.Cell biology of laryngeal epithelial defenses in health and disease:further studies[J].Annals of Otology Rhinology & Laryngology,2003,112:481.
12 Wiener GJ,Tsukashima R,Kelly C,et al.Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux[J].J Voice,2009,23:498.
13 Yadlapati R,Adkins C,Jaiyeola DM,et al.Abilities of oropharyngeal pH tests and salivary pepsin analysis to discriminate between asymptomatic volunteers and subjects with symptoms of laryngeal irritation[J].Clinical Gastroenterology & Hepatology,2015,14:535.