多通道食管腔内阻抗-pH监测对胃食管反流性咳嗽的诊断价值

 目的 探讨多通道食管腔内阻抗-pH监测（MII-pH）对胃食管反流性咳嗽（GERC）的诊断价值和局限性。方法 选择2010年5月—2011年7月在同济大学附属同济医院呼吸内科门诊就诊的可疑GERC患者，进行MII-pH，并经药物抗反流治疗证实诊断。分析MII-pH对GERC诊断的灵敏度、特异度、假阳性率、假阴性率、总符合率、阳性预计值和阴性预计值，并计算AUC_ROC和Kappa值。结果 在接受MII-pH的56例患者中，35例结果阳性，30例（85.7%）确诊为GERC，其中酸反流引起者25例（83.3%），非酸反流引起者5例（16.7%）。在21例MII-pH阴性结果患者中，有6例（28.6%）经药物抗反流治疗，GERC诊断得到证实。MII-pH对GERC的诊断灵敏度为83.3%，特异度75.0%，假阳性率25.0%，假阴性率16.7%，总符合率80.4%，阳性预测值85.7%，阴性预测值71.4%，AUC_ROC 0.792，Kappa值0.577。结论 MII-pH能识别包括非酸反流在内的所有GERC，是较灵敏可靠的GERC诊断手段。

The diagnostic value of multichannel intraluminal esophageal impedance and pH monitoring in gastroesophageal reflux-related cough

Objective To evaluate the diagnostic value and limitation of multichannel intraluminal esophageal impedance and pH (MII-pH) monitoring on the diagnosis of gastroesophageal reflux-related chronic cough (GERC). Methods The patients with suspicious GERC consecutively referred to our respiratory clinic between May 2010 and July 2011 underwent a MII-pH monitoring, and received anti-reflux drug therapy, irrespective of the laboratory findings. Chronic cough due to gastroesophageal reflux was determined when there was a favorable response to anti-reflux therapy. Then, the sensitivity, specificity, false positive and negative rate, total consistence, positively and negatively predictive value, the area under the curve of ROC and the Kappa value of the laboratory investigation were calculated for the diagnosis of GERC. Results During the research period, 56 patients completed MII-pH monitoring. Among them, the abnormal reflux was found in 35 patients, and GERC was finally confirmed in 30 patients (85.7%) including 25 patients (83.3%) due to acid reflux and 5 patients (16.7%) due to non-acid reflux. In the remaining 21 patients with normal reflux episodes, 6 patients (28.6%) could be explained by non-acid reflux for their cough because of a relatively predominant weakly acid reflux and favorable response to empirical anti-reflux therapy. For the diagnosis of GERC, MII-pH monitoring had the sensitivity of 83.3%, the specificity of 75.0%, false positive rate of 25.0%, false negative rate of 16.7%, total consistence of 80.4%, positive predictive value of 85.7%, negative predictive value of 71.4%, the area under the curve of ROC of 0.792 and Kappa value of 0.577 respectively.Conclusion MII-pH is a sensitive and reliable tool for the diagnosis of GERC due to its ability to detect both acid and non-acid reflux.