食管pH监测在诊断胃食管反流病相关慢性咳嗽中的应用

The utility of oesophageal pH monitoring in diagnosing gastroesophageal reflux disease-related chronic cough.

作者信息

Rybka Aleksandra, Malesa Kamila, Radlińska Olga, Krakowiak Karolina, Grabczak Elżbieta M, Dąbrowska Marta, Chazan Ryszarda

出版信息

Pneumonol Alergol Pol. 2014;82(6):489-94. doi: 10.5603/PiAP.2014.0065.

DOI:10.5603/PiAP.2014.0065

PMID:25339558

Abstract

INTRODUCTION

Chronic cough is a common medical complaint, which may deteriorate patients' quality of life and cause many complications. Gastroesophageal reflux disease (GERD) is one of the frequent reasons for chronic cough. Oesophageal pH monitoring is one of the diagnostic methods performed to confirm diagnosis of GERD-related cough. The aim of the study was to analyse the utility of oesophageal pH monitoring in diagnosing GERD-related cough and to identify the most sensitive pH monitoring parameters for diagnosing GERD-related cough.

MATERIAL AND METHODS

24-hour oesophageal pH monitoring was performed in 204 patients suffering from chronic cough. The group consisted of 65% females and the median age was 59 years. An acid reflux episode was defined as a rapid drop in pH to a value below 4 for at least 12 seconds. The diagnosis of GERD was based on total fraction time of pH < 4, upright or supine fraction time of pH < 4, or DeMeester score. The diagnosis of GERD-related cough was made if cough episodes, marked by the patients, appeared within 2 minutes after the reflux. The association between reflux episode and appearance of cough was analysed using two parameters: symptom index (SI ≥ 50%) and/or symptom association probability (SAP ≥ 95%).

RESULTS

Based on results of pH monitoring, 135 patients (135/204, 66%) were diagnosed with GERD. Among them, 117 patients (117/135, 87%) were diagnosed based on DeMeester score. Among patients with GERD, 61 patients met the criteria of GERD-related cough (61/135, 45%), i.e. 30% of the group as a whole. Thirty-six patients (36/61, 59%) were diagnosed based on SAP, 12 patients (20%) based on SI, and 13 (21%) based on both parameters. Spearman rank correlation coefficient for SAP ≥ 95% and SI ≥ 50% was 0.46 (p < 0.05).

CONCLUSIONS

Based on pH monitoring results, GERD was diagnosed twice as often as GERD-related cough. SAP index is more sensitive than SI for the diagnosis of GERD-related cough.

摘要

引言

慢性咳嗽是一种常见的医学病症，可能会降低患者的生活质量并引发许多并发症。胃食管反流病（GERD）是慢性咳嗽的常见原因之一。食管pH监测是用于确诊GERD相关性咳嗽的诊断方法之一。本研究的目的是分析食管pH监测在诊断GERD相关性咳嗽中的效用，并确定诊断GERD相关性咳嗽最敏感的pH监测参数。

材料与方法

对204例慢性咳嗽患者进行了24小时食管pH监测。该组患者中65%为女性，中位年龄为59岁。酸反流发作定义为pH值迅速降至4以下并持续至少12秒。GERD的诊断基于pH<4的总分数时间、直立或仰卧位pH<4的分数时间或DeMeester评分。如果患者标记的咳嗽发作在反流后2分钟内出现，则诊断为GERD相关性咳嗽。使用症状指数（SI≥50%）和/或症状关联概率（SAP≥95%）这两个参数分析反流发作与咳嗽出现之间的关联。

结果

根据pH监测结果，135例患者（135/204，66%）被诊断为GERD。其中，117例患者（117/135，87%）根据DeMeester评分被诊断。在GERD患者中，61例患者符合GERD相关性咳嗽的标准（61/135，45%），即占整个研究组的30%。36例患者（36/61，59%）根据SAP被诊断，12例患者（20%）根据SI被诊断，13例患者（21%）根据两个参数被诊断。SAP≥95%和SI≥50%的Spearman等级相关系数为0.46（p<0.05）。