Xiao Y, Carson D, Boris L, Mabary J, Lin Z, Nicodème F, Cuttica M, Kahrilas P J, Pandolfino J E
Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Gastroenterology and Hepatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Dis Esophagus. 2014 Jan;27(1):5-12. doi: 10.1111/dote.12038. Epub 2013 Feb 26.
Cough and throat clearing might be difficult to differentiate when trying to detect them acoustically or manometrically. The aim of this study was to assess the accuracy of acoustic monitoring for detecting cough and throat clearing, and to also determine whether these two symptoms present with different manometric profiles on esophageal pressure topography. Ten asymptomatic volunteers (seven females, mean age 31.1) were trained to simulate cough and throat clearing in a randomized order every 6 minutes during simultaneous acoustic monitoring and high-resolution manometry. The accuracy of automated acoustic analysis and two blinded reviewers were compared. The pattern of the events and the duration of the pressure changes were assessed using the 30 mmHg isobaric contour. There were 50 cough and 50 throat-clearing events according to the protocol. The sensitivity and specificity of automated acoustic analysis was 84% and 50% for cough, while the blinded analysis using sound revealed a sensitivity and specificity of 94% and 92%. The manometric profile of both cough and throat clearing was similar in terms of qualitative findings; however, cough was associated with a greater number of repetitive pressurizations and a more vigorous upper esophageal sphincter contraction compared with throat clearing. The acoustic analysis software has a moderate sensitivity and poor specificity to detect cough. The profile of cough and throat clearing in pressure topography revealed a similar qualitative pattern of pressurization with more vigorous pressure changes and a greater rate of repetitive pressurizations in cough.
在试图通过声学或测压法检测咳嗽和清嗓时，二者可能难以区分。本研究的目的是评估声学监测在检测咳嗽和清嗓方面的准确性，并确定这两种症状在食管压力地形图上是否呈现不同的测压特征。10名无症状志愿者（7名女性，平均年龄31.1岁）接受培训，在同步声学监测和高分辨率测压期间，每6分钟以随机顺序模拟咳嗽和清嗓。比较了自动声学分析和两名盲法评审员的准确性。使用30 mmHg等压线评估事件模式和压力变化持续时间。根据方案，有50次咳嗽事件和50次清嗓事件。自动声学分析对咳嗽的敏感性和特异性分别为84%和50%，而使用声音的盲法分析显示敏感性和特异性分别为94%和92%。咳嗽和清嗓的测压特征在定性结果方面相似；然而，与清嗓相比，咳嗽与更多的重复性增压和更强烈的食管上括约肌收缩有关。声学分析软件检测咳嗽的敏感性中等，特异性较差。压力地形图中咳嗽和清嗓的特征显示出类似的增压定性模式，咳嗽时压力变化更强烈，重复性增压率更高。
