胃蛋白酶检测对喉咽反流的诊断及疗效判定

发布时间：2018-05-21 14:58

本文选题：喉疾病 + 咽疾病　；参考：《第四军医大学》2011年硕士论文

【摘要】：以咽异物感、频繁清嗓、慢性咳嗽、发音易倦、吞咽困难等主诉就诊的患者在耳鼻喉科门诊中占有很大比重,医生在排除慢性扁桃体炎、茎突综合征、咽喉部肿瘤以及全身性疾病后,往往诊断为慢性咽炎(chronic pharyngitis),并给予相应治疗,但很多时候,患者经药物治疗后达不到满意疗效,或病情反复不能根治,长期的用药治疗但又效果不佳,常常给患者带来心理负担和经济压力,有些时候药物副作用还可能引发患者机体功能损害。随医疗水平的不断发展,诊疗技术的不断完善,人们逐渐认识到一种反流性疾病,即喉咽反流(laryngopharyngeal reflux,LPR),其在发病机制、发病条件、反流模式、临床表现、诊疗方法等诸多方面都与胃食管反流(gastroesophageal reflux,GER)有着很大不同。国外已有众多相关临床研究,发现喉咽反流的发病率并不低,在咽异感症状、发音问题、睡眠呼吸功能障碍等患者中都存在喉咽反流相关问题,也是诸如任克间隙水肿、喉狭窄、喉接触性肉芽肿、喉癌等多种疾病的致病因素,已成为国际研究热点问题。但相比之下,国人对喉咽反流的认识尚不足,再加上其缺少便捷、可靠的诊断方法,也没有统一的诊断标准,临床上常常造成诊断延误或误诊、漏诊,从而导致咽异感症的治疗失败。近来,有学者提出喉部痰液/唾液胃蛋白酶检测可做为一种高效、无创、客观的喉咽反流检出方法,但国内鲜有此类研究。因此,本临床实验通过研究喉部痰液胃蛋白酶检测方法以判断其对喉咽反流的诊断及疗效判定的价值,通过反流症状指数量表与反流检查计分量表临床应用研究以评价其对喉咽反流初筛的意义,从而为喉咽反流与慢性咽炎临床鉴别诊断奠定理论基础。本实验选取2010年6月至2010年9月以咽干、咽喉部异物感、频繁清嗓、慢性咳嗽、发音易倦等症状就诊的123例门诊患者,进行3个月质子泵抑制剂(PPI)诊断性治疗。其中36例患者治疗前后评估反流症状指数(The reflux symptom index,RSI)和反流检查计分(The reflux finding score,RFS),并检测喉部痰液胃蛋白酶质量浓度,诊断性治疗有效者计入咽喉反流组(15例),其余计入慢性咽喉炎组(21例),分析两组指标的差异和痰液胃蛋白酶检测的诊断价值。123例患者按诊断性治疗有效分为喉咽反流组(29例)和慢性咽炎组(94例),对初诊时所填RSI量表和RFS量表各评分项目进行统计学分析,比较两组差异。通过实验可以得出以下结论: 1.喉部痰液胃蛋白酶质量浓度检测可以作为一项客观、有效的指标用于喉咽反流的诊断和疗效判定。 2.诊断性治疗,结合治疗前后RSI量表和RFS量表评分对比,是目前喉咽反流切实有效的诊断方法,适用于各级医院。
[Abstract]:Patients with foreign body sensation in the pharynx, frequent throat clearing, chronic cough, weariness of pronunciation, dysphagia and so on occupied a large proportion in the otolaryngology outpatient clinic. The doctor was ruling out chronic tonsillitis, styloid process syndrome, etc. Pharynx and larynx tumors and systemic diseases are often diagnosed as chronic pharyngitis and treated accordingly. However, in many cases, the patients can not get satisfactory results after drug treatment, or their condition is repeatedly unable to be cured. Long-term drug treatment but not good results, often bring psychological burden and economic pressure to patients, sometimes side effects may also lead to the patient's body function damage. With the development of medical treatment and the improvement of diagnosis and treatment technology, people have come to realize a kind of reflux disease, that is, laryngopharyngeal reflux LPRP, which is involved in pathogenesis, condition, reflux mode and clinical manifestation. The methods of diagnosis and treatment are very different from gastroesophageal reflux (GER). There have been many related clinical studies abroad, and it has been found that the incidence of laryngopharyngeal reflux is not low. There are problems related to larynx reflux in patients such as pharynx symptoms, pronunciation problems, sleep apnea dysfunction and so on, such as Renke space edema. The causes of laryngeal stricture, laryngeal contact granuloma and laryngeal cancer have become a hot topic in international research. However, in contrast, people in China still do not know enough about laryngopharyngeal reflux, coupled with the lack of convenient and reliable diagnostic methods and the lack of a unified diagnostic standard. In clinical practice, the diagnosis is often delayed or misdiagnosed, and the diagnosis is missed. This leads to the failure of the treatment of pharynx allelopathy. Recently, some scholars have suggested that the detection of pepsin in sputum and saliva can be used as an effective, non-invasive and objective method for detecting laryngopharyngeal reflux, but there are few such studies in China. Therefore, in this clinical experiment, the method of detecting pepsin in sputum of larynx was studied to determine the value of pepsin in the diagnosis and curative effect of laryngopharyngeal reflux. The clinical application of the reflux symptom index scale and the reflux score scale was studied to evaluate the significance of the reflux screening in order to lay a theoretical foundation for the clinical differential diagnosis of laryngopharyngeal reflux and chronic pharyngitis. From June 2010 to September 2010, 123 outpatients with symptoms such as pharyngeal dry, foreign body sensation in throat, frequent throat clearing, chronic cough, and weariness of pronunciation were treated with proton pump inhibitor PPI for 3 months. The reflux symptom index (reflux symptom) and the reflux finding score were evaluated before and after treatment in 36 patients, and the pepsin concentration in the sputum of larynx was measured. 15 cases of laryngeal reflux group and 21 cases of chronic pharyngitis group were included in the effective diagnostic treatment. The difference between the two groups and the diagnostic value of pepsin detection in sputum were analyzed. 123 patients were divided into two groups according to the effective diagnostic treatment of laryngopharynx. 29 cases of reflux group (n = 29) and 94 cases of chronic pharyngitis group (n = 94). The scores of RSI scale and RFS scale were analyzed statistically. The differences between the two groups were compared. The following conclusions can be drawn from the experiment: 1. The determination of pepsin concentration in sputum of larynx can be used as an objective and effective index to diagnose and evaluate the curative effect of laryngopharyngeal reflux. 2. Diagnostic therapy, combined with RSI scale and RFS scale before and after treatment, is a practical and effective diagnostic method for laryngopharynx reflux, which is suitable for hospitals at all levels.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766

【引证文献】