在胃食管反流引起的咳嗽诊断中，酸暴露时间能否取代DeMeester评分？
Can acid exposure time replace the DeMeester score in the diagnosis of gastroesophageal reflux-induced cough?
作者信息
Zhu Yiqing, Tang Junjun, Shi Wenbo, Wang Shengyuan, Wu Mingyan, Lu Lihua, Zhang Mengru, Wen Siwan, Shi Cuiqin, Yu Li, Xu Xianghuai
机构信息
Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
出版信息
Ther Adv Chronic Dis. 2021 Nov 10;12:20406223211056719. doi: 10.1177/20406223211056719. eCollection 2021.
BACKGROUND
The objective of this study was to compare the predictive accuracy of the acid exposure time (AET) with the DeMeester score (DMS) for gastroesophageal reflux-induced cough (GERC).
METHODS
A total of 277 patients who underwent multichannel intraluminal impedance pH monitoring (MII-pH) were enrolled, and their clinical information and laboratory results were retrospectively analyzed. The diagnostic value of AET for GERC was compared with that of the DMS, symptom association probability (SAP), and symptom index (SI).
RESULTS
A total of 236 patients met the inclusion criteria, 150 patients (63.65%) were definitely diagnosed with GERC, including 111(74%) acid GERC and 39 (26%) nonacid GERC. The optimal cutoff value of AET for diagnosing GERC was AET > 4.8%, and its diagnostic value was equal to that of DMS > 14.7 (AUC = 0.827 0.818, = 0.519) and was superior to that of SAP (AUC = 0.827 0.689, = 0.000) and SI (AUC = 0.827 0.688, = 0.000). When using both DMS > 14.7 and AET > 4.8% or either of the two for the diagnosis of GERC, the diagnosis rate was not improved over using DMS > 14.7 alone. The diagnostic value of AET and DMS for acid GERC were both high and equivalent (AUC = 0.925 0.922, = 0.95). The optimal cutoff value of AET for diagnosing acid GERC was AET > 6.2%.
CONCLUSION
AET and DMS are both equal in discriminating GERC. A GERC diagnosis should be considered when AET > 4.8%, whereas an acid GERC diagnosis should be considered when AET > 6.2%.
背景
本研究的目的是比较酸暴露时间（AET）与DeMeester评分（DMS）对胃食管反流性咳嗽（GERC）的预测准确性。
方法
共纳入277例行多通道腔内阻抗pH监测（MII-pH）的患者，对其临床资料和实验室检查结果进行回顾性分析。将AET对GERC的诊断价值与DMS、症状关联概率（SAP）和症状指数（SI）的诊断价值进行比较。
结果
共有236例患者符合纳入标准，150例患者（63.65%）被明确诊断为GERC，其中111例（74%）为酸性GERC，39例（26%）为非酸性GERC。诊断GERC的AET最佳截断值为AET＞4.8%，其诊断价值与DMS＞14.7相当（AUC = 0.827对0.818，P = 0.519），且优于SAP（AUC = 0.827对0.689，P = 0.000）和SI（AUC = 0.827对0.688，P = 0.000）。当使用DMS＞14.7和AET＞4.8%两者或其中之一诊断GERC时，诊断率并未高于单独使用DMS＞14.7。AET和DMS对酸性GERC的诊断价值均较高且相当（AUC = 0.925对0.922，P = 0.95）。诊断酸性GERC的AET最佳截断值为AET＞6.2%。
结论
AET和DMS在鉴别GERC方面相当。当AET＞4.8%时应考虑诊断GERC，而当AET＞6.2%时应考虑诊断酸性GERC。
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