24小时多通道腔内阻抗-pH监测和Dx-pH监测诊断咽喉反流的比较研究

摘要

目的 分析24小时多通道腔内阻抗(multichannel intraluminal impedance,MII)-pH(简称24 h MII-pH)监测和Dx-pH监测在诊断咽喉反流时的一致性及特点.方法 选取2017年3-10月就诊于海军总医院耳鼻咽喉头颈外科存在咽喉反流相关症状或相关疾病的52例患者,同时行24 h MII-pH监测和Dx-pH监测,记录患者咽喉部反流阳性事件次数、酸清除时间以及Ryan指数.数据统计分析采用Mann-Whitney U检验和一致性检验.结果 52例患者MII-pH监测诊断咽喉反流阳性率30.7％(16/52),Dx-pH监测诊断咽喉反流阳性率26.9％(14/52),MII-pH监测和Dx-pH监测一致性一般(κ=0.626).若以MII-pH监测为参考金标准,则Dx-pH监测诊断咽喉反流的灵敏度为68.8％(11/16),特异度为91.7％(33/36).所有患者中MII-pH监测共发现下咽部反流阳性事件(pH ＜4)62次,Dx-pH监测共发现口咽部反流阳性事件(直立位pH ＜5.5或卧位pH ＜5.0)50次.MII-pH监测和Dx-pH监测均发现的阳性事件共44次,中位酸清除时间为22.8[13.5;42.6]s,MII-pH监测发现而Dx-pH监测未发现的阳性事件共18次,中位酸清除时间为5.2[3.5;6.5]s,两者酸清除时间差异有统计学意义(U=858.5,P＜0.05).结论 24 h MII-pH和Dx-pH监测在诊断咽喉反流时的一致性一般,两者在诊断咽喉反流时具有互补性.Dx-pH监测可准确测量气道pH值变化,但对于酸清除时间短的酸反流事件存在漏诊的可能.%Objective The consistency and characteristics of 24-hour multichannel intraluminal impedance(MII)-pH monitoring and Dx-pH monitoring in the diagnosis of laryngopharyngeal reflux were investigated.Methods Fifty-two patients with laryngopharyngeal reflux related symptoms or disease between March and October 2017 were included in this study.All patients were evaluated with 24-hour MII-pH monitoring and Dx-pH monitoring at the same time,recording each patient's number of positive laryngopharyngeal reflux events,time of acid clearance and Ryan index.The data was analysed with MannWhitney U test and consistency check.Results Among all 52 patients,16 patients(30.7％) had a positive MII-pH monitoring result and 14 patients(26.9％) had a positive Dx-pH monitoring results.The consistency of both technique for measurement of laryngopharyngeal reflux was general (κ =0.626).With MII-pH monitoring for reference,the sensitivity and specificity of 24-hour pH monitoring were 68.8％ and 91.7％.A total of 62 positive reflux events (pH ＜ 4) were measured with MII-pH monitoring,and 50 positive reflux events(upright pH ＜ 5.5 or supine pH ＜ 5.0)were detected by Dx-pH monitoring.There were 44 positive reflux events detected by both techniques,the mean time of acid clearance was 22.8 [13.5;42.6] s.Correspondingly,18 reflux events were measured by MII-pH monitoring without positive results of Dx-pH monitoring,the mean time of acid clearance was 5.2 [3.5;6.5] s.There was significant difference in the time of acid clearance between two groups (U =858.5,P ＜ 0.05).Conclusions Dx-pH monitoring can accurately measure the change of pH value in airway,but exists the possibility of misdiagnosis especially when the time of acid clearance in laryngopharynx is short.MII-pH and Dx-pH monitoring can be complementary technique in the diagnosis of laryngopharyngeal reflux.