Zhang Jinhong, Wang Xiaoyu, Wang Jiasen, Zhao Jing, Zhang Chun, Liu Zhi, Li Jinrang
Department of Otolaryngology, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, 100048, China.
Eur Arch Otorhinolaryngol. 2022 Nov;279(11):5323-5329. doi: 10.1007/s00405-022-07554-w. Epub 2022 Jul 21.
To investigate the diagnostic value of combined multi-timepoint salivary pepsin testing (MTPSPT) and hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) for laryngopharyngeal reflux (LPR) and whether an appropriate reduction in the duration of HEMII-pH would affect the accuracy of diagnosis of LPR.
Recruited patients were studied with both MTPSPT and HEMII-pH. The diagnosis of LPR was based on the occurrence of > 1 reflux event and/or positive results on any of the MTPSPT. The diagnostic value of combined diagnosis was studied through combining a breakdown of the 24-h HEMII-pH finding and the results of the MTPSPT. The diagnostic value was expressed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
Based on 24-h HEMII-pH and MTPSPT, the positive rate of LPR was 83.33% and 74.69%, respectively. According to the combined diagnosis, the positive rate of LPR was 90.74%. The sensitivity and specificity of the combined diagnosis both were 89.51% and 100%, when the HEMII-pH intervals were 7 a.m.-6 p.m. and 7 a.m.-7 p.m., respectively. However, when the monitoring time was extended to 8 p.m. and bedtime, the sensitivity, specificity, PPV and NPV of the combined diagnosis both were 100%.
The combination of MTPSPT and HEMII-pH increased the sensitivity and accuracy of diagnosis of LPR. For patients with positive MTPSPT results, the duration of HEMII-pH can be appropriately shortened to reduce patient sufferings.
探讨联合多时间点唾液胃蛋白酶检测（MTPSPT）和下咽-食管多通道腔内阻抗-pH监测（HEMII-pH）对喉咽反流（LPR）的诊断价值，以及适当缩短HEMII-pH监测时长是否会影响LPR的诊断准确性。
招募的患者同时接受MTPSPT和HEMII-pH检查。LPR的诊断基于>1次反流事件的发生和/或MTPSPT中任何一项的阳性结果。通过结合24小时HEMII-pH检查结果和MTPSPT结果，研究联合诊断的价值。诊断价值用敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）表示。
基于24小时HEMII-pH和MTPSPT，LPR的阳性率分别为83.33%和74.69%。根据联合诊断，LPR的阳性率为90.74%。当HEMII-pH监测时段分别为上午7点至下午6点和上午7点至晚上7点时，联合诊断的敏感性和特异性均为89.51%和100%。然而，当监测时间延长至晚上8点和就寝时间时，联合诊断的敏感性、特异性、PPV和NPV均为100%。
MTPSPT和HEMII-pH联合应用提高了LPR诊断的敏感性和准确性。对于MTPSPT结果为阳性的患者，可适当缩短HEMII-pH的监测时长以减轻患者痛苦。
