口咽、食管同步Dx-pH检测研究咽喉反流性疾病

采用口咽、食管同步Dx-pH检测探讨咽喉反流性疾病（LPRD）与胃食管反流病（GERD）的关系。     

Dx-pH监测与胃蛋白酶反流试纸条在咽喉反流诊断中的一致性分析

目的分析胃蛋白酶试纸条、Dx-pH监测及RSI（reflux symptom index）与RFS（reflux finding score）量表在咽喉反流性疾病(LPRD)中的一致性。方法回顾性分析2017年8月—2019年2月就诊于解放军总医院第六医学中心耳鼻咽喉科的110例喉科疾病住院患者的临床资料,记录患者的RSI和RSF两类量表的评分数值、Dx pH监测后的Ryan指数, 胃蛋白酶试纸盒的检测结果,用Kappa分析三者间的相关性。结果110例患者中胃蛋白酶反流检测阳性75例,阴性35例,阳性率68.18%;Dx pH检测阳性率22.73%（25/110）,两者间诊断一致率为41.82%;RSI、RFS量表诊断LPRD阳性率90%（99/110）, 与胃蛋白酶反流检测一致率74.55%;且两者间一致性较高（k=0.324）。以Dx-pH监测为参考标准,胃蛋白酶检测的敏感度为72.00% (18/25)、特异度为32.94% (28/85);以RSI、RFS量表诊断为参考标准,敏感度73.73%,特异度为81.82%, 阳性预测值为97.33%。结论RSI、RSF评分与胃蛋白酶反流试纸条结果间的一致性相较于其他检查更高,胃蛋白酶反流试纸虽然不能成为诊断咽喉反流性疾病的金标准,但是作为一项新的无创诊断技术之一, 可以联合Dx pH监测及RSI、RFS量表广泛应用于临床。     

咽喉不适症状与胃食管反流性疾病间相关性研究

目的 探讨咽喉不适症状与胃食管反流性疾病的相关性.方法 选择我院胃食管反流性疾病患者72例,按RSI量表的不同分为正常组18例、轻度组32例和重度组22例,记录食管测压和24h食管PH指标,采用pearson分析咽喉不适与胃食管反流性疾病的相关性.结果 正常组、轻度组、重度组酸反流时间、酸反流次数、长反流次数、长反流时...     

咽喉反流的研究进展

大多数学者认为,当患者以慢性声嘶、咽异物感、频繁清嗓、慢性咳嗽、吞咽困难及痰液增多等症状就诊时,临床医师应该考虑咽喉反流的存在。咽喉反流普遍存在并影响着人们的健康与生活质量。但是目前对于咽喉反流的诊断、治疗等仍存在较多的争议,本文简要综述如下。1流行病学Conno     

咽喉反流与声带息肉之间的相关性研究

目的探讨咽喉反流与声带息肉之间的关系。方法选取2010年3月～2011年3月手术后经病理确诊的声带息肉患者15例,术后经患者同意行24 h双探头pH监测观察咽喉反流及胃食管反流与声带息肉的关系。结果 15例患者进行监测,咽喉部反流阳性6例(40%),食管反流阳性1 3例(8 6.6 7%),两者均阳性6例(4 0%)。在6例咽喉部反流阳性患者中,5例(8 3.3 3%)反流症状数量表阳性,4例(66.67%)反流检查计分阳性;13例食管反流阳性的患者中9例(69.23%)反流症状数量表阳性,11例(84.62%)反流检查计分阳性。结论上消化道及咽喉反流在声带息肉的发生、发展中可能起到一定的作用,胃反流物刺激可能是声带息肉发生的直接病因或是诱因之一。     

咽喉反流与发声障碍的相关性研究

目的:探讨咽喉反流的嗓音学特征及其对患者生活质量的影响,分析主客观评估方法的相关性。方法:对196例可疑有咽喉反流的患者行一般情况调查、电子鼻咽喉镜检查、反流症状指数量表(RSI)和反流检查计分量表(RFS)评估,将其中RSI评分>13分、RFS评分>7分定为阳性。将2个量表评分均为阳性的100例患者作为研究对象,进一步进行嗓音障碍指数量表(VHI)评估、嗓音声学分析及电声门图检查,并与健康对照组比较。结果:男女基频均比健康对照组降低,基频微扰、振幅微扰及标准化噪声能量增高,接触率降低,最大发声时间缩短,与健康对照组比较,差异均有统计学意义(均P<0.01)。VHI量表评估生理P评分最高,其次为功能F评分,情感E评分最低。咽喉反流患者的RSI与VHI有一定相关性(P<0.05),而RFS与RSI、VHI无明显相关性(P>0.05)。咽喉反流患者的嗓音障碍指数评估示生理、功能和情感之间明显相关。结论:嗓音声学分析及电声门图检测从客观上提示咽喉反流相关的嗓音障碍疾病严重影响了喉的发声功能,使基频下降、声带振动不稳定、声门闭合不良及声门接触时间缩短。主客观评估方法的相关性结果提示具有明显咽喉反流症状的患者并不一定具有明显的咽喉反流体征。     

咽喉反流

咽喉反流(laryngopharyngeal reflux,LPR)是一组以胃食管反流为病因而产生的咽喉部病变及其相应的临床症候群,目前LPR和胃食管反流之间关系日益受到耳咽喉科医师的重视.本文简要综述了咽喉反流的解剖学发病机制、检查手段、临床诊断和治疗.     

咽喉反流的研究进展

咽喉反流(laryngopharyngeal reflux,LPR)定义为胃内容物异常反流入上呼吸道而引起的一种慢性症状或黏膜损伤.胃内容物除了胃蛋白酶和胃酸以外,还包括胆汁酸以及胰酶,它们都能使不能耐受这些物质的组织受到损伤.LPR能引起喉后部炎、喉部接触性溃疡、声门下狭窄、喉痉挛、发声困难、咽炎、哮喘、肺炎、夜间呼吸困难等多种症状.最近,LPR还被怀疑是引起无烟酒接触史的喉癌患者患病的主要因素,尽管目前反流与癌症的确切关系尚不明确.目前,明确LPR的发病机制、诊断及治疗方式仍是尚待进一步探究的问题.     

咽喉反流与胃食管反流

胃食管内容物反流至咽喉部可造成局部损伤,是目前临床上难治性慢性咽喉炎的常见原因.现对其流行病学、发病机制、诊断及治疗进行综述.     

咽喉反流性疾病与自主神经功能障碍的相关性研究

目的了解咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)患者的自主神经功能状态,探讨咽喉反流性疾病与自主神经功能障碍的相关性。方法对疑为LPRD的患者采用反流症状指数量表(reflux symptom index,RSI)和反流体征评分量表(reflux finding score,RFS)进行评分。对RSI>13分和RFS>7分的81例疑似LPRD患者进行心率变异性(heart rate variability,HRV)检查,并均予质子泵抑制剂诊断性治疗,有效者确诊为LPRD,最终纳入病例组,共53例;选择同期55例健康志愿者纳入对照组。根据自主神经功能评价时域指标(连续RR间期标准差、RR间期差值均方根)、频域指标(总功率、低频和高频功率、标准化低频和高频功率、低频功率占总功率比值、高频功率占总功率比值、低频功率与高频功率比值),进一步分析自主神经受累程度与RSI及RFS的关系。结果①病例组中代表迷走神经功能活性的连续RR间期差值的均方根、高频功率(0.15~0.40 Hz)、标准化的高频功率、高频功率占总功率的比值均较对照组明显降低,差异有统计学意义(P<0.05);②病例组中代表交感迷走平衡的低频功率与高频功率的比值较对照组明显升高,差异有统计学意义(P<0.05);③两组间平均连续RR间期标准差、总功率(0.00~0.40 Hz)、低频功率(0.04~0.15 Hz)、低频功率占总功率的比值差异无统计学意义(P>0.05);④RSI评分、RFS评分、病程均与高频功率的数值呈负性线性相关关系(r=-0.89、-0.77、-0.315,P<0.05);低频功率与高频功率比值与病程呈正性线性相关关系(r=0.315,P<0.05)。结论LPRD患者存在以迷走神经活性降低为主的自主神经功能障碍,LPRD的严重程度与自主神经功能障碍具有明显相关性,尤其与迷走神经功能活性呈负相关。     

Empiric esomeprazole in the treatment of laryngopharyngeal reflux

OBJECTIVE: Objectives were to determine the efficacy of empiric treatment with esomeprazole for patients diagnosed with laryngopharyngeal reflux and to determine a treatment paradigm for this patient population. STUDY DESIGN: Prospective study. METHODS: Patients were treated with a once-daily dose of 40 mg esomeprazole for 8 weeks. All patients completed a subjective symptom scale (rating laryngeal symptoms and esophageal symptoms) and scoring of flexible fiberoptic examination before treatment and at 4 and 8 weeks of treatment. Nonresponders (<50% reduction in symptom score) were recommended to undergo 24-hour dual-probe pH study while on a regimen of 40 mg esomeprazole once a day, to evaluate for the adequacy of acid suppression. RESULTS: Thirty patients completed the course of therapy. After 4 weeks of treatment, only 8 of 30 patients had significant improvement of their overall symptoms (8 of 30 improved on laryngeal score, and 11 of 18 improved on esophageal score). At 8 weeks of treatment, 19 of 30 patients had significant improvement on their overall symptoms (18 of 30 on laryngeal score, and 13 of 18 on their esophageal score). Five of seven nonresponders who agreed to be tested had positive findings on pH studies (on medication regimen) at 1 cm above the upper esophageal sphincter. Four of 10 nonresponders improved further after increasing their dosage to 40 mg twice a day. Laryngeal examination scores were statistically improved in responders after 8 weeks of treatment. CONCLUSIONS: Laryngopharyngeal reflux symptoms require at least 8 weeks of treatment for significant improvement in the majority of patients. Esophageal symptoms improve sooner. Nonresponders at a daily dose of 40 mg should be treated with a dosage of 40 mg twice daily, and pH study on medication reserved for nonresponders at this higher dose. Laryngeal examination scores showed mild but statistically significant improvement at 8 weeks of therapy in responders.     

Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease

Background: pH monitoring can reflect the changes in H⁺ in the airway.

Objectives: To explore the utility of pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease (LPRD).

Material and methods: Clinical data from 956 suspected LPRD patients from February 2016 to March 2018 were analyzed retrospectively.

Results: One hundred forty-one patients had positive Ryan score. The positive rates of reflux symptom index (RSI), reflux finding score (RFS), RSI and RFS and RSI or RFS were 14.7%, 32.5%, 21.9%, 7.8% and 46.5%, respectively. The RFS in the positive Ryan score group was higher than that in the negative Ryan score group [(6?±?3.5) vs. (4.8?±?2.9)], while the RSI was not significantly different from that in the negative Ryan score group [(10.9?±?8) vs. (11.3?±?7.1)]. Regarding Ryan score as the gold standard in the diagnosis of LPRD, the sensitivity, specificity, positive and negative predictive value of identifying LPRD by RSI/RFS were 15.9%, 86.3%, 50.4% and 54%, respectively.

Conclusions: Ryan score, RSI and RFS have poor correlation in detecting LPRD. Some patients may be missed with the Ryan score as a diagnostic criterion.

Significance: Pharyngeal pH monitoring is useful and more appropriate index is expected.     

咽喉反流的中医认识及辨证治疗

正咽喉痛、异物感、恶心、干呕、咽干、吭咯、咯痰,咽喉部灼烧感等都是耳鼻喉科门诊的常见主诉,目前医生和患者常在咽喉部追究其病因,然而绝大多数(约95%~98%)针对上述症状的喉内镜描述中,除了"咽部黏膜充血、淋巴滤泡增生、会厌囊肿"等外,与临床症状并不相符。从解剖上来说,颈部除了咽部外,还有喉部、颈段气管、颈段食管、甲状腺等器     

An assessment of olfactory function in patients with laryngopharyngeal reflux disease

Conclusions: The results reported here indicate that there was a statistically significant difference in the olfactory functions of laryngopharyngeal reflux patients vs the healthy group. To the best of the authors’ knowledge, this study is the first to evaluate the olfactory function of patients diagnosed with laryngopharyngeal reflux using an objective method, 24-h pH monitoring.

Objectives/Hypothesis: The aim of this study was to investigate olfactory functions in laryngopharyngeal reflux (LPR) patients and compare the results with healthy controls.

Methods: A total of 60 participants; 30 men and women with a diagnosis of laryngopharyngeal reflux and 30 healthy controls, were included in the study. Patients in the laryngopharyngeal reflux group were evaluated by the Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and finally 24-h pH monitoring to confirm the diagnosis of laryngopharyngeal reflux. The Sniffin’ Sticks olfactory test results of the laryngopharyngeal reflux and control groups were compared, and the relationship between the study findings and the olfactory parameters were evaluated.

Results: The odor threshold, odor discrimination, odor identification, and TDI scores of the laryngopharyngeal reflux group were significantly lower than those of the control group. Also there was a statistically significant negative correlation detected between the olfactory test and some symptom and finding scores.