胃蛋白酶检测对喉咽反流的诊断及疗效判定
摘要
以咽异物感、频繁清嗓、慢性咳嗽、发音易倦、吞咽困难等主诉就诊的患者在耳鼻喉科门诊中占有很大比重,医生在排除慢性扁桃体炎、茎突综合征、咽喉部肿瘤以及全身性疾病后,往往诊断为慢性咽炎(chronic pharyngitis),并给予相应治疗,但很多时候,患者经药物治疗后达不到满意疗效,或病情反复不能根治,长期的用药治疗但又效果不佳,常常给患者带来心理负担和经济压力,有些时候药物副作用还可能引发患者机体功能损害。
随医疗水平的不断发展,诊疗技术的不断完善,人们逐渐认识到一种反流性疾病,即喉咽反流(laryngopharyngeal reflux,LPR),其在发病机制、发病条件、反流模式、临床表现、诊疗方法等诸多方面都与胃食管反流(gastroesophageal reflux,GER)有着很大不同。国外已有众多相关临床研究,发现喉咽反流的发病率并不低,在咽异感症状、发音问题、睡眠呼吸功能障碍等患者中都存在喉咽反流相关问题,也是诸如任克间隙水肿、喉狭窄、喉接触性肉芽肿、喉癌等多种疾病的致病因素,已成为国际研究热点问题。但相比之下,国人对喉咽反流的认识尚不足,再加上其缺少便捷、可靠的诊断方法,也没有统一的诊断标准,临床上常常造成诊断延误或误诊、漏诊,从而导致咽异感症的治疗失败。近来,有学者提出喉部痰液/唾液胃蛋白酶检测可做为一种高效、无创、客观的喉咽反流检出方法,但国内鲜有此类研究。
因此,本临床实验通过研究喉部痰液胃蛋白酶检测方法以判断其对喉咽反流的诊断及疗效判定的价值,通过反流症状指数量表与反流检查计分量表临床应用研究以评价其对喉咽反流初筛的意义,从而为喉咽反流与慢性咽炎临床鉴别诊断奠定理论基础。本实验选取2010年6月至2010年9月以咽干、咽喉部异物感、频繁清嗓、慢性咳嗽、发音易倦等症状就诊的123例门诊患者,进行3个月质子泵抑制剂(PPI)诊断性治疗。其中36例患者治疗前后评估反流症状指数(The reflux symptom index,RSI)和反流检查计分(The reflux finding score,RFS),并检测喉部痰液胃蛋白酶质量浓度,诊断性治疗有效者计入咽喉反流组(15例),其余计入慢性咽喉炎组(21例),分析两组指标的差异和痰液胃蛋白酶检测的诊断价值。123例患者按诊断性治疗有效分为喉咽反流组(29例)和慢性咽炎组(94例),对初诊时所填RSI量表和RFS量表各评分项目进行统计学分析,比较两组差异。通过实验可以得出以下结论:
1.喉部痰液胃蛋白酶质量浓度检测可以作为一项客观、有效的指标用于喉咽反流的诊断和疗效判定。
2.诊断性治疗,结合治疗前后RSI量表和RFS量表评分对比,是目前喉咽反流切实有效的诊断方法,适用于各级医院。
Patients with the symptoms of dry pharynx, globus pharyngeus, excessive throat clearing, chronic cough account a large proportion in the ENT clinic. Doctors ruled out chronic tonsillitis, styloid process syndrome, throat cancer, and systemic disease, often diagnosed as chronic pharyngitis and giving appropriate treatment. But very often, patients treated by medication can not reach satisfactory outcome, or disease can not be cure completely. Long-term drug treatment but poorly, patients feel highly psychological burden and economic pressures. Sometimes side effects may also lead to functional impairment in patients with the body.
With the continuous development of healthcare, diagnosis and treatment technology, people gradually realize that a reflux disease: laryngopharyngeal reflux, LPR. Its pathogenesis, disease conditions, reflux pattern, clinical features, treatment methods and many other aspects are very different from gastroesophageal reflux, GER. Large number of foreign clinical studies have found that the incidence of laryngopharyngeal reflux is not low, patients with pharyngeal paresthesia symptoms, pronunciation problems, sleep disorders, respiratory function are almost have high relationship with laryngopharyngeal reflux. For example, international research has become a hot issue in interstitial edema, laryngeal stenosis, laryngeal contact granuloma, laryngeal cancer and other diseases. But in comparison, people's understanding of hypopharyngeal reflux was not enough, and lack of convenient and reliable diagnostic method. No uniform diagnostic criteria, clinical diagnosis is often delayed or result in misdiagnosis, leading to failure treatment symptoms of pharyngeal paresthesia. Recently, some scholars suggested the throat sputum / saliva testing of pepsin can be used as an effective, non-invasive, objective laryngopharyngeal reflux detection methods, but few such studies internally. Therefore, this clinical trials is though pepsin detection method of throat sputum to determine the value and efficacy of laryngopharyngeal reflux diagnosis, and by the reflux symptom table and the reflux finding table to evaluate the clinical significance of screening. So as to laryngopharyngeal reflux and chronic pharyngitis theoretical basis for clinical diagnosis was established. This experimental choosing thirty-six patients with the symptoms of dry pharynx,globus pharyngeus, excessive throat clearing, chronic cough were divided into laryngopharyngeal reflux group and chronic laryngitis group by the results of therapeutic trial taking proton pump inhibitors(PPI) for 3 months .The estimation of the reflux symptom index (RSI), the reflux finding score (RFS) and the detection of pepsin in the sputum were done before and after the treatment. The difference between two groups and the value of the pepsin were analyzed. 123 patients were divided into hypopharyngeal reflux group (29 cases) and chronic pharyngitis (94 cases) according to effective treatment. The reflux symptom table and the reflux finding table were all statistically analyzed and compared between the two groups.
The results are showed as follows:
1. Pepsin level in the sputum might be used as a objective、effective method for diagnosing and evaluating the effectiveness in laryngopharyngeal reflux.
2. Diagnostic treatment, combined with The reflux symptom table and the reflux finding table is an effective diagnostic method of laryngopharyngeal reflux which is suitable for all levels of the hospital.
随医疗水平的不断发展,诊疗技术的不断完善,人们逐渐认识到一种反流性疾病,即喉咽反流(laryngopharyngeal reflux,LPR),其在发病机制、发病条件、反流模式、临床表现、诊疗方法等诸多方面都与胃食管反流(gastroesophageal reflux,GER)有着很大不同。国外已有众多相关临床研究,发现喉咽反流的发病率并不低,在咽异感症状、发音问题、睡眠呼吸功能障碍等患者中都存在喉咽反流相关问题,也是诸如任克间隙水肿、喉狭窄、喉接触性肉芽肿、喉癌等多种疾病的致病因素,已成为国际研究热点问题。但相比之下,国人对喉咽反流的认识尚不足,再加上其缺少便捷、可靠的诊断方法,也没有统一的诊断标准,临床上常常造成诊断延误或误诊、漏诊,从而导致咽异感症的治疗失败。近来,有学者提出喉部痰液/唾液胃蛋白酶检测可做为一种高效、无创、客观的喉咽反流检出方法,但国内鲜有此类研究。
因此,本临床实验通过研究喉部痰液胃蛋白酶检测方法以判断其对喉咽反流的诊断及疗效判定的价值,通过反流症状指数量表与反流检查计分量表临床应用研究以评价其对喉咽反流初筛的意义,从而为喉咽反流与慢性咽炎临床鉴别诊断奠定理论基础。本实验选取2010年6月至2010年9月以咽干、咽喉部异物感、频繁清嗓、慢性咳嗽、发音易倦等症状就诊的123例门诊患者,进行3个月质子泵抑制剂(PPI)诊断性治疗。其中36例患者治疗前后评估反流症状指数(The reflux symptom index,RSI)和反流检查计分(The reflux finding score,RFS),并检测喉部痰液胃蛋白酶质量浓度,诊断性治疗有效者计入咽喉反流组(15例),其余计入慢性咽喉炎组(21例),分析两组指标的差异和痰液胃蛋白酶检测的诊断价值。123例患者按诊断性治疗有效分为喉咽反流组(29例)和慢性咽炎组(94例),对初诊时所填RSI量表和RFS量表各评分项目进行统计学分析,比较两组差异。通过实验可以得出以下结论:
1.喉部痰液胃蛋白酶质量浓度检测可以作为一项客观、有效的指标用于喉咽反流的诊断和疗效判定。
2.诊断性治疗,结合治疗前后RSI量表和RFS量表评分对比,是目前喉咽反流切实有效的诊断方法,适用于各级医院。
Patients with the symptoms of dry pharynx, globus pharyngeus, excessive throat clearing, chronic cough account a large proportion in the ENT clinic. Doctors ruled out chronic tonsillitis, styloid process syndrome, throat cancer, and systemic disease, often diagnosed as chronic pharyngitis and giving appropriate treatment. But very often, patients treated by medication can not reach satisfactory outcome, or disease can not be cure completely. Long-term drug treatment but poorly, patients feel highly psychological burden and economic pressures. Sometimes side effects may also lead to functional impairment in patients with the body.
With the continuous development of healthcare, diagnosis and treatment technology, people gradually realize that a reflux disease: laryngopharyngeal reflux, LPR. Its pathogenesis, disease conditions, reflux pattern, clinical features, treatment methods and many other aspects are very different from gastroesophageal reflux, GER. Large number of foreign clinical studies have found that the incidence of laryngopharyngeal reflux is not low, patients with pharyngeal paresthesia symptoms, pronunciation problems, sleep disorders, respiratory function are almost have high relationship with laryngopharyngeal reflux. For example, international research has become a hot issue in interstitial edema, laryngeal stenosis, laryngeal contact granuloma, laryngeal cancer and other diseases. But in comparison, people's understanding of hypopharyngeal reflux was not enough, and lack of convenient and reliable diagnostic method. No uniform diagnostic criteria, clinical diagnosis is often delayed or result in misdiagnosis, leading to failure treatment symptoms of pharyngeal paresthesia. Recently, some scholars suggested the throat sputum / saliva testing of pepsin can be used as an effective, non-invasive, objective laryngopharyngeal reflux detection methods, but few such studies internally. Therefore, this clinical trials is though pepsin detection method of throat sputum to determine the value and efficacy of laryngopharyngeal reflux diagnosis, and by the reflux symptom table and the reflux finding table to evaluate the clinical significance of screening. So as to laryngopharyngeal reflux and chronic pharyngitis theoretical basis for clinical diagnosis was established. This experimental choosing thirty-six patients with the symptoms of dry pharynx,globus pharyngeus, excessive throat clearing, chronic cough were divided into laryngopharyngeal reflux group and chronic laryngitis group by the results of therapeutic trial taking proton pump inhibitors(PPI) for 3 months .The estimation of the reflux symptom index (RSI), the reflux finding score (RFS) and the detection of pepsin in the sputum were done before and after the treatment. The difference between two groups and the value of the pepsin were analyzed. 123 patients were divided into hypopharyngeal reflux group (29 cases) and chronic pharyngitis (94 cases) according to effective treatment. The reflux symptom table and the reflux finding table were all statistically analyzed and compared between the two groups.
The results are showed as follows:
1. Pepsin level in the sputum might be used as a objective、effective method for diagnosing and evaluating the effectiveness in laryngopharyngeal reflux.
2. Diagnostic treatment, combined with The reflux symptom table and the reflux finding table is an effective diagnostic method of laryngopharyngeal reflux which is suitable for all levels of the hospital.
引文
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[2]郭志祥,郭睿.重视咽异感症的诊治[J].中华耳鼻咽喉头颈外科杂志,2005,40(8):638-639.
[3]杨伟炎,倪道凤.咽喉要道应予重视[J].中华耳鼻咽喉头颈外科杂志,2005,40(4):241-242.
[4]孔维佳.耳鼻咽喉头颈外科学[M].北京:人民卫生出版社,2010.357-358.
[5]朱国,孙栓柱,马丽,等.1000例咽异感症病因诊断分析[J].中国中西医结合耳鼻咽喉科杂志,2007,15(2):142-143.
[6]李进让,陈曦.茎突综合征[J].中国耳鼻咽喉头颈外科杂志,2005,12(7):465-466.
[7]李丽,王宁宇,葛晓辉.鼻后滴漏综合征[J].国外医学.耳鼻咽喉科学分册,2005,29(3):164-166.
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