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。

Association between Laryngopharyngeal Reflux Disease and Autonomic Nerve Dysfunction

Objective To investigate the autonomic nervous function state of patients with laryngopharyngeal reflux disease(LPRD),and to clarify the association between laryngopharyngeal reflux disease and autonomic nerve dysfunction.Methods The patients likely to be LPRD in the outpatient department were scored by the reflux symptom index scale(RSI)and the reflux finding score(RFS).The 5-minute short-term heart rate variability(HRV)tests were performed in 81 patients suspected with LPRD.All the patients were treated with proton pump inhibitors.Patients with effective treatment were diagnosed as LPRD and a total of 53 cases were finally included in the LPRD group,while 55 healthy volunteers were recruited as the control group.The relationship between the degree of autonomic nerve dysfunction and reflux symptom index score and reflux finding score were analyzed according to the results of autonomic nervous function evaluation.Results The RMSSD,HF,HFnu,and HF%representing vagal nerve function in the LPRD group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The LF/HF representing sympathovagal balance ratio in the LPRD group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in SDNN,TP,LF and LF%between the two groups(P>0.05).The RSI score,RFS,and the duration of disease were all in negative linear correlation with HF value(r=-0.89,-0.77,-0.315,P<0.05);there was a positive linear correlation between the course of disease and LF/HF value(r=0.315,P<0.05).Conclusion Patients of LPRD suffered with autonomic nerve dysfunction are mainly associated with the reduction of vagal activity.The severity of LPRD is significantly correlated with autonomic nerve dysfunction,especially negatively correlated with vagal activity.