喉咽反流性疾病的临床治疗研究

目的 探讨喉咽反流性疾病(LPRD)的诊疗方法,同时观察LPRD患者幽门螺杆菌检出率。 方法 156例反流症状指数(RSI)>13分和/或反流体征指数(RFS)>7分临床确诊为LPRD的患者,进行¹³C-尿素呼气试验(¹³C-UBT)^［4］检测,检出Hp阳性患者(I组)进行2周的幽门螺杆菌四联疗法^［5］(奥美拉唑+枸橼酸铋钾+阿莫西林+克林霉素)+甘桔冰梅片治疗后停药4周,观察Hp转阴率及LPRD转阴率;将Hp阴性患者随机分为2组,II组30例单纯给予甘桔冰梅片治疗4周后观察LPRD转阴率,III组30例给予奥美拉唑+莫沙必利+甘桔冰梅片治疗4周后观察LPRD转阴率。 结果 Hp阳性检出率为61.54%(96/156),经治疗2周后停药,4周复查Hp转阴率为78.12%(75/96),I组治疗后LPRD转阴率为67.71%(65/96),II组转阴率为53.33%(16/30),III组转阴率为96.67%(29/30)。经治疗后,三组RSI和RFS评分均较治疗前降低,差异有统计学意义(t=6.73,P<0.001)。治疗后III组与II组比较,III组的RSI和RFS评分更低。 结论 喉咽反流是导致咽喉炎的重要病因,使用抑酸剂及消化道促动力剂可明显改善喉咽反流的症状及体征。

Research on diagnosis and treatment of laryngopharyngeal reflux disease

Objective To discuss the diagnosis and treatment method of laryngopharyngeal reflux disease (LPR D), and to observe the detection rate of helicobacter pylori from the patients with LPR D.Methods A Total of 156 LPR D patients with reflux symptom index (RSI)over 13 and/or reflux symptom index (RFS)>7 were supplied with 13 C-U-rea Breath Test (13 C-UBT).The Hp positive patients (n =96,group I)were administrated with quadruple therapy (Omeprazole +Bismuth Potassium Citrate +Amoxicillin +Clindamycin)and Ganju Bingmei tablets for 2 weeks,fol-lowed up with a 4 weeks of withdrawal period.The primary ourcome observed was of Hp negative transformation rate and curative effect evaluation before and after the treatment; Hp negative patients were divided into group II and group III,with 30 cases in each group.The group II was given Ganju Bingmei tablets for 4 weeks and the group III was ad-ministrated with Omeprazole +Bismuth Potassium Citrate and Ganju Bingmei Tablets for 4 weeks.The main outcome was LPR Dand HP negative-converting rate.Results The Hp negative-converting rate was 78.12% (75 /96)in group I.The LPR Dnegative-converting rate in group I,group II and group III was 67.71%(65 /96),53.33%(16 /30)and 96.67%(29 /30),respectively.The score of RSI and RFS were decreased in all three groups after treatment,and dropped more significantly in group III (Statistic:6.73,P <0.001).Conclusion Laryngopharyngeal reflux,as an im-portant cause of sphagitis,can be improved by using antiacid and gastrointestinal prokinetic agents.