分别应用pH＜4或pH＜5作为24h多通道腔内阻抗-pH监测诊断咽喉反流事件阈值的比较

摘要

Objective To evaluate the consistency between 24-hour pH monitoring,reflux symptom index(RSI) and reflux finding score(RFS) when using pH ＜4 or pH ＜5 as threshold for 24-hour pH monitoring in the diagnosis of laryngopharyngeal reflux.Methods Patients who presented with suspicious laryngopharyngeal reflux between February 2014 and December 2015 were included in this study.pH ＜4 and pH ＜ 5 reflux episodes,PSI and RFS were collected.The consistency between 24-hour pH monitoring and scale results were analyzed when pH ＜ 4 or pH ＜ 5 as threshold respectively.The sensitivity and specificity of 24-hour pH monitoring were calculated separately.Results Median number (M [P25,P75,P95]) of reflux events were 0 [0,3.0,5.5] when using pH ＜4 as pathological threshold and 0 [0,4.0,and 8.5] using pH ＜ 5 as pathological threshold.Laryngopharyngeal reflux was determined in 34.5％ patients depending on 24-hour pH monitoring when pH ＜ 4 was used as threshold,chi-square revealed medium consistency (K =0.483) between pH monitoring and scale result.If pH ＜ 5 was used as threshold,41.8％ patients were detected with laryngopharyngeal reflux,and the consistency of pH monitoring and scale result was medium (κ =0.540).With PSI and RFS for reference,the sensitivity and specificity of 24-hour pH monitoring were 54.7％ and 93.4％ respectively when pH ＜4 was used as threshold.If pH ＜5 was used as threshold,the sensitivity and specificity of 24-hour pH monitoring were 65.6％ and 91.3％ respectively.Conclusions Compared with pH ＜4 as pathological threshold,the consistency of pH monitoring and scale results was a little better using pH ＜ 5 as pathological threshohl.%目的 研究分别应用pH ＜4或pH ＜5作为判定咽喉反流事件的病理阈值时,24h多通道腔内阻抗(multichannel intraluminal impedance,MII)联合pH监测与反流症状指数(reflux symptom index,PSI)、反流体征评分(reflux finding score,RFS)诊断结果的一致性.方法 选取2014年2月至2015年12月入海军总医院耳鼻咽喉头颈外科的可疑咽喉反流的1 10例患者行24 h MII-pH监测,并填写症状体征量表.统计咽喉部pH ＜4的反流次数、pH ＜5的反流次数、PSI、RFS.将应用pH ＜4或pH ＜5作为判定咽喉反流事件的病理阈值时的pH监测诊断结果,与RSI、RFS的诊断结果行一致性分析.并以RSI、RFS为参考,分别统计应用pH ＜4或pH ＜5作为判定阈值时pH监测诊断结果的敏感度和特异度.各项反流参数用M[P25,P75,P95]表示.结果 110例患者中咽喉部pH ＜4反流次数为0[0,3.0,5.5]、pH ＜5反流次数为0[0,4.0,8.5].应用pH ＜4作为判定阈值时阳性率34.5％(38/110),与RSI、RFS诊断结果的一致性中等(κ=0.483).应用pH ＜5作为判定阈值时阳性率41.8％(46/110),与RSI、RFS诊断结果的一致性中等(κ=0.540),一致性高于应用pH ＜4时.以RSI、RFS为参考,应用pH ＜4时pH监测诊断结果的敏感度和特异度分别为54.7％和93.4％,应用pH ＜5时敏感度和特异度分别为65.6％和91.3％.结论 应用pH ＜5反流次数≥3次作为判定咽喉反流事件的病理阈值时,24 h MII-pH监测与PSI、RFS诊断结果的一致性较好.在分析pH监测结果时参考pH ＜5反流次数,或可提高其诊断咽喉反流性疾病的敏感度.