胃蛋白酶检测在喉咽反流病所致发声障碍中的诊断价值
Diagnostic Value of Pepsin Measurements in Dysphonia Attributed to Laryngopharyngeal Reflux Disease.
作者信息
Lechien Jerome R, Hamdan Abdul-Latif
机构信息
Division of Laryngology and Broncho-esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, Baudour, Belgium; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Polyclinique Elsan de Poitiers, Poitiers, France.
Department of Otolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
出版信息
J Voice. 2023 Aug 23. doi: 10.1016/j.jvoice.2023.07.020.
OBJECTIVE
To investigate the diagnostic value of pepsin test in detecting laryngopharyngeal reflux (LPR) in patients with suspected LPR-induced dysphonia.
METHODS
Dysphonic and non-dysphonic patients with LPR at the 24-hour hypopharyngeal-esophageal impedance-pH monitoring (HEMII-pH) were recruited from January 2019 to November 2022. Patients collected saliva/sputum samples to measure pepsin concentrations. Symptoms and findings were studied through reflux symptom score (RSS) and reflux sign assessment (RSA). Voice quality was assessed with maximum phonation time, GRBAS, voice handicap index (VHI), and acoustic parameters at baseline and 3-month post-treatment. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin tests for dysphonia-related to LPR were calculated at ≥16 ng/mL cutoff. The relationship between HEMII-pH, clinical features, voice quality outcomes, and pepsin measurement was investigated.
RESULTS
Sixty-seven patients with LPR at the HEMII-pH completed the evaluations accounting for 30 patients consulting for dysphonia. Dysphonic patients reported higher RSS than non-dysphonic patients. RSS, RSA, laryngeal findings, VHI, and grade of dysphonia significantly improved from baseline to 3-month posttreatment. Pepsin test detected LPR in 73% of dysphonic cases. The pepsin test was 73.3 sensitive and 18.9 specific when considering the highest pepsin level of morning, postlunch, and postdinner sputum collections. Sensitivity, specificity, PPV, and NPV varied regarding the time of sputum collections. There was a strong significant association between the concentration of the morning pepsin test and the severity of laryngeal RSA score (P = 0.018). The morning pepsin saliva test concentration was predictive of the 3-month otolaryngological RSS (P = 0.014).
CONCLUSION
Pepsin test is a sensitive but poorly specific diagnostic approach for patients with dysphonia attributed to LPR. Multiple pepsin measurements may increase the sensitivity and predictive value of pepsin test. Future large-cohort studies are needed to investigate the accuracy of pepsin test in this population.
目的
探讨胃蛋白酶检测在疑似喉咽反流（LPR）所致发音障碍患者中对检测喉咽反流的诊断价值。
方法
招募2019年1月至2022年11月期间在24小时下咽-食管阻抗-pH监测（HEMII-pH）中存在LPR的发音障碍和非发音障碍患者。患者采集唾液/痰液样本以测量胃蛋白酶浓度。通过反流症状评分（RSS）和反流体征评估（RSA）研究症状和检查结果。在基线和治疗后3个月，用最长发声时间、GRBAS、嗓音障碍指数（VHI）和声学参数评估嗓音质量。计算胃蛋白酶检测对与LPR相关的发音障碍的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），截断值≥16 ng/mL。研究HEMII-pH、临床特征、嗓音质量结果和胃蛋白酶测量之间的关系。
结果
67例在HEMII-pH检查中存在LPR的患者完成了评估，其中30例因发音障碍前来咨询。发音障碍患者的RSS高于非发音障碍患者。从基线到治疗后3个月，RSS、RSA、喉部检查结果、VHI和发音障碍分级均有显著改善。胃蛋白酶检测在73%的发音障碍病例中检测到LPR。考虑到早晨、午餐后和晚餐后痰液采集的最高胃蛋白酶水平，胃蛋白酶检测的敏感性为73.3%，特异性为18.9%。敏感性、特异性、PPV和NPV因痰液采集时间而异。早晨胃蛋白酶检测浓度与喉部RSA评分的严重程度之间存在强显著相关性（P = 0.018）。早晨胃蛋白酶唾液检测浓度可预测3个月时的耳鼻喉科RSS（P = 0.014）。
结论
胃蛋白酶检测对于LPR所致发音障碍患者是一种敏感但特异性较差的诊断方法。多次胃蛋白酶测量可能会提高胃蛋白酶检测的敏感性和预测价值。未来需要进行大型队列研究来调查胃蛋白酶检测在该人群中的准确性。
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