分泌性中耳炎与胃食管反流病相关性的初步研究
发布时间：2018-06-15 05:41
本文选题：分泌性中耳炎 + 胃食管反流病 ； 参考：《天津医科大学》2017年硕士论文
【摘要】：目的:胃食管反流病(gastro-esophageal reflux disease,GERD)常引起许食管外症状,如呼吸道症状、咽部症状,甚至导致哮喘症状。随着分泌性中耳炎患者中耳积液中胃内容物(胃蛋白酶、胃蛋白酶原、HP、胆汁酸等)的检出,有人提出GERD与分泌性中耳炎(secretory otitis media,SOM)发病有关。GERD与分泌性中耳炎是否相关及其相互作用机制成为近年研究热点。本研究的目的是比较GERD在SOM及非SOM中的患病率,明确SOM与GERD的相互关系及GERD相关性中耳炎与年龄关系,GERD是否为SOM发病原因,二者的关系尚不明确,明确其相互关系可为临床耳鼻咽喉科医生提高SOM的诊治率提供新的理论依据。方法:对2013年9月至2016年9月在天津医科大学第一中心医院耳鼻喉科门诊及住院确诊的52例(59耳)初发或复发SOM患者的临床资料进行分析,患者病程2月-4年不等,除外胃肠肿瘤、鼻咽部肿瘤患者、腺样体肥大、扁桃体肥大≥II°者,除外合并先天性胃肠道畸形、免疫功能低下、脑瘫、脑外伤合并脑积液漏者等疾病者。并以52例非SOM的健康体检人群作为对照组。对所有入组者进行电子耳镜、声阻抗、电测听、24h食管pH监测或胃镜检查或GerdQ评分进行GERD诊断。将SOM组伴有GERD的患者人数与对照组GERD的人数比较,分析GERD与SOM相关性。采用酶联反应免疫吸附法(ELISA法)对SOM组中耳积液进行胃蛋白酶检测,酶标仪测定其含量。根据比较SOM组GERD患者与无GERD患者胃蛋白酶阳性率,并对GERD相关SOM可能发病机制进行讨论。最后对SOM组患者年龄与GERD的相关性进行分析。全部数据采用SPSS19.0进行分析。结果:52例SOM患者中有35例患有GERD,无GERD 17例SOM中GERD阳性率为67.3%。52例对照组中共诊断出GERD患者6名,其阳性率为11.54%。SOM组与对照组GERD阳性率比较差异有统计学意义(p0.05)。GERD患者鼓室积液中检出胃蛋白酶阳性者19例,平均浓度为246.6±229.4 ng/mL,阳性率为54.29%;无GERD患者鼓室积液中检出胃蛋白酶阳性者1例,浓度为195.2 ng/mL,阳性率为5.88%。采用卡方检验对两组胃蛋白酶阳性率进行比较,差异有统计学意义(x2=11.33,P㩳0.05)。SOM组患者年龄与GERD的关系进行分析,发现其发病率在青年、老年、学龄期及学龄前中的患病比例依次增加。结论:GERD在SOM患者的发病率高于非SOM患者,从而推测GERD可能是分泌性中耳炎发病因素之一,且SOM患者鼓室积液中可检出胃蛋白酶,GERD组胃蛋白酶的阳性率和绝对数值都较高说明胃蛋白酶在SOM的发病及病理过程中发挥了重要的作用。这对于临床诊治GERD引起的分泌性中耳炎提供了理论依据。年龄因素影响GERD相关性SOM的发病,由此可推测解剖机能发育、机体的免疫等在其发病中发挥了作用。
[Abstract]:Objective: gastroesophageal reflux disease (GERD) often causes extraesophageal symptoms, such as respiratory symptoms, pharyngeal symptoms, and even asthma symptoms. With the detection of gastric contents (pepsin, pepsinogen, bile acid, etc.) in the middle ear effusion of patients with secretory otitis media, It has been suggested that the relationship between GERD and secretory otitis mediaSom (Som) and the relationship between GERD and secretory otitis media and its interaction mechanism have become a hot topic in recent years. The purpose of this study was to compare the prevalence of GERD in SOM and non-SOM, and to determine the relationship between SOM and GERD and whether GERD-associated otitis media and age were the causes of SOM. The relationship between GERD and GERD was not clear. Clarifying their relationship can provide a new theoretical basis for clinical otolaryngologist to improve the diagnosis and treatment rate of SOM. Methods: from September 2013 to September 2016, the clinical data of 52 patients with initial or recurrent SOM in Otolaryngology Department, first Central Hospital of Tianjin Medical University were analyzed. The course of disease ranged from 2 months to 4 years. Patients with gastrointestinal neoplasms, nasopharyngeal neoplasms, adenoid hypertrophy and tonsil hypertrophy 鈮，
本文编号：2020909
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