一种新的喉咽反流疾病诊断模式：阻抗-pH 监测与数字反流闪烁显像结果的相关性。
A new diagnostic paradigm for laryngopharyngeal reflux disease: correlation of impedance-pH monitoring and digital reflux scintigraphy results.
机构信息
Department of Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia.
School of Medicine, University of Notre Dame, Sydney, NSW, Australia.
出版信息
Eur Arch Otorhinolaryngol. 2021 Jun;278(6):1917-1926. doi: 10.1007/s00405-021-06658-z. Epub 2021 Feb 13.
PURPOSE
No gold-standard investigation exists for laryngopharyngeal reflux (LPR). Multichannel intraluminal impedance (MII)-pH testing has uncertain utility in LPR. Meanwhile, reflux scintigraphy allows immediate and delayed visualisation of tracer reflux in the esophagus, pharynx, and lungs. The present study aimed to correlate MII-pH and scintigraphic reflux results in patients with primary LPR.
METHODS
Consecutive patients with LPR underwent MII-pH and scintigraphic reflux studies. Abnormal values for MII-pH results were defined from existing literature. MII-pH and scintigraphic data were correlated.
RESULTS
105 patients with LPR [31 males (29.5%), median age 60 years (range 20-87)] were studied. Immediate scintigraphic reflux was seen in the pharynx in 94 (90.4%), and in the proximal esophagus in 94 (90.4%). Delayed scintigraphic contamination of the pharynx was seen in 101 patients (96.2%) and in the lungs of 56 patients (53.3%). For MII-pH, abnormally frequent reflux was seen in the distal esophagus in 12.4%, proximal esophagus in 25.7%, and in the pharynx in 82.9%. Patients with poor scintigraphic clearance had higher Demeester scores (p = 0.043), more proximal reflux episodes (p = 0.046), more distal acid reflux episodes (p = 0.023), and more prolonged bolus clearance times (p = 0.002).
CONCLUSION
Reflux scintigraphy has a high yield in LPR patients. Scintigraphic time-activity curves correlated with validated MII-pH results. A high rate of pulmonary microaspiration was found in LPR patients. This study demonstrated a high level of pharyngeal contamination by scintigraphy and MII-pH, which supports the use of digital reflux scintigraphy in diagnosing LPR.
目的
目前尚无金标准方法用于检测喉咽反流（LPR）。多通道腔内阻抗-pH 监测（MII-pH）技术在 LPR 中的应用价值存在不确定性。与此同时，反流闪烁显像可即时和延迟显示示踪剂在食管、咽和肺中的反流情况。本研究旨在比较 MII-pH 与闪烁显像反流结果在原发性 LPR 患者中的相关性。
方法
连续入组的 LPR 患者同时接受 MII-pH 和闪烁显像反流检查。MII-pH 异常值定义来源于现有文献。分析 MII-pH 和闪烁显像数据之间的相关性。
结果
共纳入 105 例 LPR 患者[31 例男性（29.5%），中位年龄 60 岁（范围 20-87 岁）]。94 例（90.4%）即刻闪烁显像可见反流累及咽，94 例（90.4%）可见反流累及近端食管。101 例（96.2%）患者可见延迟性咽反流污染，56 例（53.3%）患者可见肺内反流污染。MII-pH 检测示，远端食管、近端食管和咽部异常反流的发生率分别为 12.4%、25.7%和 82.9%。闪烁显像清除不良的患者 Demeester 评分更高（p=0.043），近端反流事件更多（p=0.046），远端酸反流事件更多（p=0.023），且食团廓清时间延长（p=0.002）。
结论
反流闪烁显像在 LPR 患者中具有较高的检出率。闪烁显像时间-活性曲线与经验证的 MII-pH 结果相关。LPR 患者存在较高的肺部微吸入率。本研究显示，LPR 患者的咽部存在较高的反流污染，MII-pH 检测也有较高的反流污染率，这支持使用数字化反流闪烁显像来诊断 LPR。
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