Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Voice. 2024 Nov;38(6):1412-1418. doi: 10.1016/j.jvoice.2022.05.013. Epub 2022 Jun 25.
OBJECTIVES/HYPOTHESIS: To investigate the predictive capability of pepsin level in the laryngeal mucosa to the therapeutic effect of proton-pump inhibitors in patients with suspected laryngopharyngeal reflux (LPR), so as to verify whether it can be referred to as a biomarker of LPR.
Prospective case study.
Sixty patients with clinical empiric LPR were enrolled, with an reflux symptom index (RSI) ≥ 13 and an reflux finding score (RFS) > 7 as screening criteria. Biopsy specimens from the interarytenoid mucosa were obtained under topical anesthesia for pepsin immunohistochemical staining. Two parameters were observed in these patients with different pepsin levels after the administration of esomeprazole for 12 weeks: the RSI and the RFS.
Among the 60 cases, 35 cases were negative or weakly positive for pepsin (Pepsin(-) group), and 25 cases were moderately positive or strongly positive for pepsin (Pepsin(+) group). After therapy, the RSI significantly decreased from 17.00 (15.00, 19.00) to 6.00 (5.00, 11.00) in the Pepsin(+) group (Z = -4.38, P < 0.01), but no difference was found in the RFS (T = 1.48, P > 0.05). No significant difference was observed in the RSI (T = 2.01, P > 0.05) or the RFS (T = 2.01, P > 0.05) in the Pepsin(-) group either before or after therapy. An improvement in the RSI ≥ 50% was taken as the standard of effective therapy. The effective rate in the Pepsin(+) group was 72.0% (18/25), while it was 14.3% (5/35) in the Pepsin(-) group. There was a significant difference in the effective rate between the two groups (χ = 20.55, P < 0.01).
Proton-pump inhibitors exhibited better effects in patients with higher pepsin levels in the laryngeal mucosa. Laryngeal mucosa pepsin may serve as an ideal indicator to screen patients suitable for proton-pump inhibitor therapy and a reliable biomarker to identify patients with LPR.
目的/假设：探讨喉黏膜胃蛋白酶水平对疑似喉咽反流（LPR）患者质子泵抑制剂治疗效果的预测能力，以验证其是否可作为 LPR 的生物标志物。
前瞻性病例研究。
纳入 60 例临床经验性 LPR 患者，以反流症状指数（RSI）≥13 和反流发现评分（RFS）>7 为筛选标准。在局部麻醉下获取杓状软骨间黏膜活检标本，进行胃蛋白酶免疫组化染色。观察 60 例患者在接受埃索美拉唑治疗 12 周后不同胃蛋白酶水平的 2 个参数：RSI 和 RFS。
60 例患者中，胃蛋白酶阴性或弱阳性 35 例（胃蛋白酶（-）组），胃蛋白酶中度或强阳性 25 例（胃蛋白酶（+）组）。治疗后，胃蛋白酶（+）组 RSI 从 17.00（15.00，19.00）显著下降至 6.00（5.00，11.00）（Z=-4.38，P<0.01），但 RFS 无差异（T=1.48，P>0.05）。治疗前后，胃蛋白酶（-）组的 RSI（T=2.01，P>0.05）或 RFS（T=2.01，P>0.05）无差异。以 RSI 改善≥50%为有效治疗标准，胃蛋白酶（+）组有效率为 72.0%（18/25），胃蛋白酶（-）组为 14.3%（5/35），两组有效率差异有统计学意义（χ=20.55，P<0.01）。
质子泵抑制剂在喉黏膜胃蛋白酶水平较高的患者中效果更好。喉黏膜胃蛋白酶可能作为筛选适合质子泵抑制剂治疗患者的理想指标，也是识别 LPR 患者的可靠生物标志物。
