Wang Lu, Tan Jia-Jie, Wu Ting, Zhang Rui, Wu Jia-Nuan, Zeng Fang-Fang, Liu You-Li, Han Xiao-Yan, Li Yan-Fei, Li Xiang-Ping
1 Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
2 Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Otolaryngol Head Neck Surg. 2017 Jan;156(1):144-151. doi: 10.1177/0194599816676471. Epub 2016 Nov 14.
Objective To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps' tissues. Study Design Cross-sectional study. Setting Nanfang Hospital of Southern Medical University. Subjects and Methods The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed. Results The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%). Conclusion Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.
目的 确定反流胃液的主要成分胃蛋白酶是否与声带息肉显著相关，并评估胃蛋白酶在声带息肉组织中的诊断价值。 研究设计 横断面研究。 研究地点 南方医科大学南方医院。 对象与方法 该研究纳入了2011年至2012年间的32例声带息肉患者和16例健康对照者。进行反流症状指数和反流发现评分评估、24小时联合多通道腔内阻抗和pH监测，以及对声带息肉组织或喉后黏膜（健康对照者）进行活检以进行胃蛋白酶免疫组化染色。 结果 声带息肉患者中胃蛋白酶的表达显著高于对照组（28/32，75% 对5/16，31.25%；P <.001）。胃蛋白酶水平与经年龄调整的直立位咽部酸反流和食管反流参数显著正相关。基于胃蛋白酶染色数据，24小时pH监测、反流症状指数和反流发现评分的敏感性和阴性预测值为70%至84.62%，而其特异性和阳性预测值相对较低（20% - 31.58%）。 结论 胃蛋白酶反流可能是声带息肉形成的危险因素。此外，在临床环境中，对息肉活检样本进行胃蛋白酶免疫组化分析似乎是一种比反流症状指数、反流发现评分和24小时pH监测更敏感、有效的喉咽反流诊断测试。
