全天咽喉pH检测在诊断反流性咽喉部疾病中的作用

目的探讨24h咽喉pH检测在咽喉反流性疾病诊断中的价值。方法选取2006年8月至10月于北京同仁医院就诊由同一医师诊断可疑有反流性咽喉炎患者50例，征得患者同意后以就诊时间为配伍因素，按区组随机排列方法采用半随机分组。第一组25例患者均行24h咽喉pH检测，筛选出阳性患者作为试验组接受奥美拉唑抗酸治疗；第二组25例患者直接给予相同药物及剂量的试验性抗酸治疗作为对照组。服药3个月后进行随访，根据反流症状评分对比治疗前后效果，以主观症状评估总分下降≤4分为治疗无效，〉4分为有效。结果行24h咽喉pH检测的25例患者中有病理性咽喉部反流者17例，阳性率为68.0％（17／25）。24h平均总反流次数（35．71±41．70）次（x±s，以下同），总反流时间（35．71±33．19）min，总反流指数即每小时反流次数（1．53±1．73）次／h，每次反流平均时间（1．12±0．91）min。抗酸治疗前试验组症状评估总分平均（14．88±4．11）分，对照组总分平均（13．00±4．17）分，组间差异采用t检验，无统计学意义（P〉0．05）。在抗酸治疗3个月后随访，试验组有效率为82．4％（14／17），对照组失访2例，其余患者治疗有效率为52．2％（12／23）。试验组症状评估总分平均下降（7．47±3．18）分，对照组症状评估总分下降（3．96±4．25）分，总分差值比较，差异有统计学意义（P〈0．01）。结论24h咽喉pH检测作为诊断咽喉反流性疾病的金标准，可以作为临床中可疑咽喉反流患者的确诊检查手段，并可大大提高抗酸治疗的有效性，值得在临床普遍开展和推广。

Clinical value of 24-hour pH monitoring in patients with laryngopharyngeal reflux disease

OBJECTIVE: To explore the diagnostic values of 24-hour pH monitoring in patients with laryngopharyngeal reflux disease (LPRD). METHODS: Fifty patients with suspected laryngopharyngeal reflux were enrolled into this study. Twenty five patients had 24-hour pH monitoring, antacid treatment with omeprazole was given in study group with pathologic reflux. The remaining 25 patients as control group only had the same antacid treatment. All the patients had 3 months follow up, and treatment effect was evaluated according to clinical manifestation improvement. After 3 month treatment followed up, it was defined as inefficacy treatment if the clinical manifestation score decrease was equal or less than 4, defined as efficacy if the score decrease was more than 4. RESULTS: Seventeen of 25 patients had pathologic reflux, positive rate was 68.0%. The mean times of total acid reflux was 35.71 +/- 41.70 (x +/- s), the mean total reflux time was (35.71 +/- 33.19) min, the mean total reflux index (reflux times per hour) was (1.53 +/- 1.73)/h, the mean reflux time was (1.12 +/- 0.91) min. Before antacid treatment, the mean clinical manifestation score was 14. 88 +/- 4.11 in study group and 13.00 +/- 4.17 in control group. There was no significant difference between the two groups (t = 1.444, P > 0.05). The validity of study group was 82.4% (14/17), Among the control group, two cases were out of followed, and the validity of remained patients was 52. 2% (12/23). The mean decreased score of clinical manifestation in study group was 7.47 +/- 3.18 and 3.96 +/- 4.25 in control group. There was significant difference between the two groups (t = 2. 864, P = 0.007). CONCLUSIONS: The dual-probe 24-hour pH monitoring is considered the gold standard for diagnosis of LPRD and it is essential in patients who have laryngopharyngeal complaints and is capable to improve the effect of antacid treatment significantly. It's worthy of clinical application.