Kamargiannis Nikolaos, Gouveris Haralampos, Katsinelos Panagiotis, Katotomichelakis Michael, Riga Maria, Beltsis Athanasios, Danielides Vasilios
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Ann Otol Rhinol Laryngol. 2011 Nov;120(11):722-6. doi: 10.1177/000348941112001105.
We evaluated the association between pathological acidic laryngopharyngeal reflux (LPR) events and chronic pharyngitis in patients with Reinke's edema.
We performed a prospective controlled study in 20 consecutive patients with Reinke's edema without pathological acidic LPR events (group A) and 40 consecutive patients with Reinke's edema with both clinical symptoms and 24-hour pH-metry suggesting acidic LPR (group B). The severity of acidic LPR was assessed by use of the Reflux Finding Score (RFS), the Reflux Symptom Index (RSI), and dual antimony probe 24-hour pH-metry. The patients were evaluated for the presence of chronic pharyngitis by clinical examination and biopsy specimens taken from the posterior pharyngeal wall. The Chi2 test was used to compare the groups for the presence of pharyngitis. In group B, the RSI, the RFS, and the total duration and number of acidic LPR events on 24-hour pH-metry were compared between patients with and without concomitant pharyngitis by use of the Mann-Whitney test.
Five patients of group A and 20 patients of group B had chronic pharyngitis. Therefore, more patients with Reinke's edema and clinical signs of LPR tended to have chronic pharyngitis than did those with Reinke's edema and no clinical signs of LPR, but the difference was not statistically significant (p = 0.064; odds ratio, 3.0; 95% confidence interval, 0.9 to 9.8). Among group B patients, those with pharyngitis had significantly more acidic LPR events (p < 0.001) and a greater exposure time to gastric fluid (p = 0.008) than did those without pharyngitis. Their RFS and RSI did not differ significantly (p = 0.692 and p = 0.914, respectively).
Only in the subgroup of patients with Reinke's edema and LPR was there a statistically significant correlation between the pH probe results and the incidence of clinical pharyngitis. Awareness should increase among physicians about addressing chronic pharyngitis in therapy for acidic LPR and/or Reinke's edema.
我们评估了病理酸性喉咽反流（LPR）事件与任克氏水肿患者慢性咽炎之间的关联。
我们对20例连续的无病理酸性LPR事件的任克氏水肿患者（A组）和40例连续的既有临床症状且24小时pH监测提示酸性LPR的任克氏水肿患者（B组）进行了一项前瞻性对照研究。使用反流发现评分（RFS）、反流症状指数（RSI）和双锑探头24小时pH监测来评估酸性LPR的严重程度。通过临床检查和从咽后壁获取的活检标本对患者进行慢性咽炎检查。使用卡方检验比较两组咽炎的存在情况。在B组中，使用曼-惠特尼检验比较有和无合并咽炎患者的RSI、RFS以及24小时pH监测中酸性LPR事件的总持续时间和数量。
A组5例患者和B组20例患者患有慢性咽炎。因此，与无LPR临床体征的任克氏水肿患者相比，有LPR临床体征的任克氏水肿患者更易患慢性咽炎，但差异无统计学意义（p = 0.064；优势比，3.0；95%置信区间，0.9至9.8）。在B组患者中，有咽炎的患者比无咽炎的患者有更多的酸性LPR事件（p < 0.001）和更长的胃液暴露时间（p = 0.008）。他们的RFS和RSI无显著差异（分别为p = 0.692和p = 0.914）。
仅在任克氏水肿合并LPR的患者亚组中，pH探头结果与临床咽炎发病率之间存在统计学显著相关性。医生应提高对在酸性LPR和/或任克氏水肿治疗中处理慢性咽炎的认识。
