Wang Ching-Ping, Wang Chen-Chi, Lien Han-Chung, Lin Wen-Jiun, Wu Shang-Heng, Liang Kai-Li, Liu Shih-An
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan.
Laryngoscope. 2019 Mar;129(3):709-714. doi: 10.1002/lary.27502. Epub 2018 Sep 24.
OBJECTIVES/HYPOTHESIS: To evaluate the prediction value of saliva pepsin detection for an 8-week proton pump inhibitor (PPI) response in patients with a Reflux Symptoms Index (RSI) score ≥13, which indicates possible laryngopharyngeal reflux.
Prospective individual single-cohort study.
Patients were recruited who had experienced chronic laryngopharyngeal symptoms (RSI score ≥13) for more than 3 months after excluding other etiologies. The patients received PPI (40 mg of esomeprazole once daily) treatment for 8 weeks. Prior to treatment, the patients submitted saliva/sputum samples that were collected during the time symptoms were observed. The samples were taken for pepsin detection, and performed using the commercially available Peptest lateral flow device. The association of the Peptest results and PPI response were statistically analyzed with the χ test.
Seventy-four patients completed the study, and upon completion of PPI treatment, the mean RSI score was significantly reduced from 19.22 ± 5.18 to 8.99 ± 5.69. Forty-four (59.5%) patients exhibited a good response as defined by an RSI score reduction ≥50%. The results of the Peptest were semiquantitatively graded as 0, 1, 2, 3 (negative, weak positive, moderate positive and strong positive, respectively) based upon the visual intensity of the test sample line as compared to the control line. Twenty-four patients (32.4%) exhibited grade 3 strong positive results. The Peptest strong positive results (P < .05) were significantly associated with a good PPI response, with the positive predictive value being 79.2%.
Analysis of strong positive results for pepsin detection in saliva/sputum samples may be a useful, noninvasive method for predicting better PPI response in patients with suspected reflux induced chronic laryngopharyngeal symptoms.
2 Laryngoscope, 129:709-714, 2019.
目的/假设：评估唾液胃蛋白酶检测对反流症状指数（RSI）评分≥13（提示可能存在喉咽反流）的患者8周质子泵抑制剂（PPI）治疗反应的预测价值。
前瞻性个体单队列研究。
招募排除其他病因后有超过3个月慢性喉咽症状（RSI评分≥13）的患者。患者接受PPI（40 mg埃索美拉唑每日一次）治疗8周。治疗前，患者提交在观察症状期间采集的唾液/痰液样本。采集样本进行胃蛋白酶检测，使用市售的Peptest侧向流动装置进行检测。采用χ检验对Peptest结果与PPI治疗反应的相关性进行统计学分析。
74例患者完成研究，PPI治疗结束时，平均RSI评分从19.22±5.18显著降至8.99±5.69。44例（59.5%）患者表现出良好反应，定义为RSI评分降低≥50%。根据测试样本线与对照线的视觉强度，将Peptest结果半定量分级为0、1、2、3级（分别为阴性、弱阳性、中度阳性和强阳性）。24例患者（32.4%）表现为3级强阳性结果。Peptest强阳性结果（P<0.05）与良好的PPI治疗反应显著相关，阳性预测值为79.2%。
分析唾液/痰液样本中胃蛋白酶检测的强阳性结果可能是一种有用的非侵入性方法，用于预测疑似反流引起的慢性喉咽症状患者更好的PPI治疗反应。
2《喉镜》，2019年，第129卷，第709 - 714页
