Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Dis Esophagus. 2010 Sep;23(7):540-4. doi: 10.1111/j.1442-2050.2010.01060.x. Epub 2010 Apr 29.
Twenty-four-hour ambulatory multichannel intraluminal impedance (MII)-pH detects both acid and nonacid reflux (NAR). A computer-based program (Autoscan™, Sandhill Scientific, Highlands Ranch, CO, USA) automates the detection of reflux episodes, increasing the ease of study interpretation. Inter-observer agreement between multiple reviewers and with Autoscan™ for the evaluation of significant NAR with MII-pH has not been studied in the adult population. Twenty MII-pH studies on patients taking a proton pump inhibitor twice daily were randomly selected. Autoscan™ analyzed all studies using the same pre-programmed parameters. Four reviewers interpreted the MII-pH studies, adding or deleting reflux episodes detected by Autoscan™. Positive studies for NAR and total reflux episodes were based on published criteria. Cohen's kappa statistic (κ) evaluated inter-observer agreement between reviewers and Autoscan™ analysis. The average κ for pathologic NAR between reviewers was 0.57 (0.47-0.70), and between reviewers and Autoscan™ was 0.56 (0.4-0.8). When using the total reflux episode number as a marker for pathologic reflux (acid and NAR), the κ score was 0.72 (0.61-0.89) between reviewers, and 0.74 (0.53-0.9) when evaluating total reflux episodes. Two reviewers agreed more often with each other and with Autoscan™ on the number of NAR episodes, while the other two reviewers agreed with each other, but did not agree with either Autoscan™ or the first two reviewers. Inter-observer agreement between reviewers and Autoscan™ for detecting pathologic NAR is moderate, with reviewers either excluding more of the Autoscan™-defined events or excluding fewer events and therefore agreeing with Autoscan™.
24 小时动态多通道腔内阻抗-pH 检测法（MII-pH）可同时检测酸反流和非酸反流（NAR）。基于计算机的程序（AutoscanTM，美国科罗拉多州桑德希尔科学公司）自动检测反流事件，增加了研究解读的便利性。在成人人群中，尚未研究过多 reviewers 与 AutoscanTM 之间评估 MII-pH 中显著 NAR 的一致性。随机选择了 20 项接受质子泵抑制剂（PPI）每日两次治疗的患者的 MII-pH 研究。AutoscanTM 使用相同的预编程参数分析了所有研究。四位 reviewers 解释了 MII-pH 研究，并添加或删除了 AutoscanTM 检测到的反流事件。NAR 和总反流事件的阳性研究基于已发表的标准。Cohen 的kappa 统计量（κ）评估了 reviewers 与 AutoscanTM 分析之间的观察者间一致性。reviewers 之间病理性 NAR 的平均κ值为 0.57（0.47-0.70），reviewers 与 AutoscanTM 之间的平均κ值为 0.56（0.40-0.80）。当使用总反流事件数作为病理性反流（酸和 NAR）的标志物时，两位 reviewers 之间的κ评分为 0.72（0.61-0.89），而当评估总反流事件时，κ评分为 0.74（0.53-0.9）。两位 reviewers 彼此之间以及与 AutoscanTM 之间在 NAR 事件的数量上更常达成一致，而另外两位 reviewers 彼此之间达成一致，但与 AutoscanTM 或前两位 reviewers 不一致。reviewers 与 AutoscanTM 之间检测病理性 NAR 的观察者间一致性为中度，两位 reviewers 排除了更多的 AutoscanTM 定义的事件，或者排除了较少的事件，因此与 AutoscanTM 一致。
