Division of Allergy and Immunology, Scripps Green Hospital, La Jolla, Calif.
Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif.
J Allergy Clin Immunol Pract. 2018 Jan-Feb;6(1):132-138.e1. doi: 10.1016/j.jaip.2017.04.039. Epub 2017 Jun 9.
Laryngopharyngeal reflux (LPR) is associated with asthma, vocal cord dysfunction, cough, postnasal drainage, and throat irritation. The Reflux Symptom Index (RSI) is a clinical tool to predict the presence of LPR, but a threshold RSI score has never been validated for the diagnosis of LPR in an allergic patient population.
To identify the optimal threshold RSI score predictive of LPR in an allergy clinic population.
The 9-question RSI questionnaire was administered to 84 patients in the Kaiser Permanente San Diego Allergy Department. The patient's allergist (who was blinded to the patient's RSI responses) was asked to determine whether the patient had symptoms consistent with LPR. Each subject's RSI score was then compared with a corresponding physician-based diagnosis. After determining the correlation between the subject's RSI score and physician-diagnosed LPR/supraesophageal reflux, a cutoff level above which LPR/supraesophageal reflux would be highly suspected was calculated on the basis of most optimal balance of sensitivity and specificity determined via a receiver-operating curve analysis.
Thirty of the 84 patients (36%) were diagnosed with LPR. The mean RSI score for the group without LPR was 18.3 ± 9.8 (out of 45 possible), while the LPR group's mean was 25.0 ± 8.3 (P < .01). The optimal RSI score cutoff was determined to be 19. An abbreviated questionnaire was also generated using 6 of the RSI questions found to be significantly different between patients with and without LPR.
An RSI score of 19 appears to represent the best threshold for predicting LPR in an allergy clinic patient population.
喉咽反流（LPR）与哮喘、声带功能障碍、咳嗽、后鼻滴注和咽喉刺激有关。反流症状指数（RSI）是一种预测 LPR 存在的临床工具，但从未针对过敏患者人群中 LPR 的诊断验证过 RSI 评分的阈值。
确定在过敏诊所人群中预测 LPR 的最佳 RSI 评分阈值。
在 Kaiser Permanente San Diego Allergy Department，对 84 名患者进行了 9 个问题的 RSI 问卷。要求患者的过敏症专家（对患者的 RSI 反应不知情）确定患者是否有符合 LPR 的症状。然后将每个受试者的 RSI 评分与相应的医生基于诊断进行比较。在确定受试者的 RSI 评分与医生诊断的 LPR/食管上反流之间的相关性之后，基于通过接收者操作曲线分析确定的最佳灵敏度和特异性之间的平衡，计算出 LPR/食管上反流高度可疑的截断值。
84 名患者中有 30 名（36%）被诊断为 LPR。无 LPR 组的平均 RSI 评分为 18.3 ± 9.8（满分 45 分），而 LPR 组的平均 RSI 评分为 25.0 ± 8.3（P<.01）。确定最佳 RSI 评分截断值为 19。还使用在有和无 LPR 的患者之间存在显著差异的 RSI 问题中的 6 个问题生成了一个简化问卷。
RSI 评分 19 似乎代表了预测过敏诊所患者人群中 LPR 的最佳阈值。
