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。

Consistency analysis of Dx pH monitoring and pepsin test strip in the diagnosis of laryngopharyngeal reflux

ObjectiveTo analyze the consistencies of pepsin test strip, Dx pH monitoring, reflux symptom index (RSI) and reflux finding score (RFS) scales in patients with laryngopharyngeal reflux disease (LPRD).MethodsClinical data of 110 patients with laryngeal diseases hospitalized in our department from Aug 2017 to Feb 2019 were analyzed retrospectivel. The RSI and RSF values, Ryan index of Dx pH monitoring and the results of pepsin test strip were recorded, and their correlations were analyzed by Kappa method.ResultsOf the 110 patients, pepsin test showed positive result in 75 cases with a positive rate of 68.18%, and the positive rate of Dx pH detection was 22.73%, the diagnostic consistency rate between the two methods was 41.82%. The positive rate of RSI and RFS values was 90%, which was more consistent (k=0.324) with pepsin reflux test (74.55%) than the Dx pH monitoring . Taking the Dx pH monitoring as the reference, the sensitivity and specificity of pepsin test strip was 72% (18/25) and 32.94% (28/85). Taking the RSI and RFS scales as the reference, the sensitivity and specificity of pepsin test was 71.73% and 81.82%,respectively, with a positive predictive value of 97.33%.ConclusionsThe consistency between RSI/ RSF score and the pepsin test strip is higher than that of other examinations. As a new non invasive diagnostic technology, although pepsin test can not be the golden criterion for the diagnosis of LPR, it can be widely used combining with Dx pH monitoring and RSI and RFS scales in clinical practice.