[症状指数在胃食管反流性慢性咳嗽中的诊断价值]

[The diagnostic value of symptom index in gastroesophageal reflux-induced chronic cough].

作者信息

Yang Zhongmin, Xu Xianghuai, Chen Qiang, Yu Li, Liang Siwei, Lyu Hanjing, Qiu Zhongmin

机构信息

Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.

Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China. Email:

出版信息

Zhonghua Nei Ke Za Zhi. 2014 Feb;53(2):108-11.

PMID:24767161

Abstract

OBJECTIVE

To explore the diagnostic value and optimal cut-off point of symptom index (SI) in gastroesophageal reflux-induced chronic cough (GERC).

METHODS

The recordings of multichannel intraluminal esophageal impedance and pH monitoring were retrospectively analyzed in 118 patients with suspicious GERC. SI for all the refluxes, acid reflux and non-acid reflux was calculated respectively by analyzing the temporal association between detected reflux and cough recorded on diary card. Based on the favorable response to the anti-reflux therapy, the diagnostic value for GERC of SI was evaluated and compared with that of the symptom association probability (SAP).

RESULTS

GERC was definitely determined in 100 patients (84.7%). When SI for all the refluxes was used for the diagnosis of GERC, the cut-off point of ≥ 45% had the highest diagnostic efficacy, with the sensitivity of 56.0%, the specificity of 83.3% and Youden index of 0.393. SI for acid or non-acid reflux had the same optimal cut-off point of ≥ 30% and presented with the similar efficacy in the diagnosis of acid or non-acid GERC. Compared with SAP of ≥ 75%, SI for all the refluxes of ≥ 45% had a lower sensitivity (56.0% vs 75.0%, χ(2) = 7.988, P = 0.005), a higher specificity (83.3% vs 44.4%, χ(2) = 5.900, P = 0.015) and the comparable positive or negative predictive value in the diagnosis of GERC. The diagnostic accuracy for GERC was further improved when combining SI for all the refluxes with SAP.

CONCLUSION

SI for all the refluxes has a diagnostic value similar to SAP and its optimal cut-off point for GERC may be ≥ 45%.

摘要

目的

探讨症状指数（SI）在胃食管反流引起的慢性咳嗽（GERC）中的诊断价值及最佳截断点。

方法

回顾性分析118例疑似GERC患者的多通道腔内食管阻抗和pH监测记录。通过分析检测到的反流与日记卡上记录的咳嗽之间的时间关联，分别计算所有反流、酸反流和非酸反流的SI。基于抗反流治疗的良好反应，评估SI对GERC的诊断价值，并与症状关联概率（SAP）进行比较。

结果

100例患者（84.7%）确诊为GERC。当使用所有反流的SI诊断GERC时，截断点≥45%具有最高的诊断效能，敏感性为56.0%，特异性为83.3%，约登指数为0.393。酸反流或非酸反流的SI具有相同的最佳截断点≥30%，在酸或非酸GERC的诊断中表现出相似的效能。与≥75%的SAP相比，≥45%的所有反流的SI敏感性较低（56.0%对75.0%，χ² = 7.988，P = 0.005），特异性较高（83.3%对44.4%，χ² = 5.900，P = 0.015），在GERC诊断中的阳性或阴性预测价值相当。将所有反流的SI与SAP结合时，GERC的诊断准确性进一步提高。