反流后吞咽诱发蠕动波指数：一种用于识别非酸性胃食管反流相关慢性咳嗽的新参数。
Post-reflux swallow-induced peristaltic wave index: a new parameter for the identification of non-acid gastroesophageal reflux-related chronic cough.
机构信息
Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, China.
出版信息
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666231220819. doi: 10.1177/17534666231220819.
BACKGROUND
The current available diagnostic criteria for gastroesophageal reflux-related chronic cough (GERC) dominated by non-acid reflux is imperfect. The post-reflux swallow-induced peristaltic wave index (PSPWI) is a parameter reflecting esophageal clearance function.
OBJECTIVES
This study aims to investigate its diagnostic value for non-acid GERC.
DESIGN
This study sought to compare the diagnostic value of PSPWI in different types of GERC, particularly non-acid GERC, and explore the clinical significance of PSPWI in the diagnosis of non-acid GERC through diagnostic experiments.
METHODS
A retrospective analysis was performed based on 223 patients with suspected GERC who underwent multichannel intraluminal impedance-pH monitoring (MII-pH) in the outpatient clinic of our department from August 2016 to June 2021. Their clinical information, laboratory test results, and treatment responses were assessed and the underlying etiologies of chronic cough were categorized. The predictive value of the PSPWI in diagnosing different types of GERC, especially non-acid GERC, was analyzed and compared.
RESULTS
A total of 195 patients with chronic cough who met the inclusion criteria underwent MII-pH monitoring. 143 patients had a definitive diagnosis of GERC, including 98 with acid GERC and 45 with non-acid GERC. The diagnostic value of PSPWI alone was moderate for GERC with an area under the working curve (AUC) 0.760, but poor for non-acid GERC with an AUC of 0.569. However, PSPWI < 39.8% combining with acid exposure time (AET) ⩽ 6.2% demonstrated a moderate diagnostic value for non-acid GERC, with an AUC of 0.722. When PSPWI < 39.8% combined with a non-acid reflux ratio >68.75%, the diagnostic value for non-acid GERC was improved (AUC = 0.80 AUC = 0.722, < 0.05), which was significantly superior to non-acid symptom index (AUC = 0.804 AUC = 0.550, < 0.05) and non-acid symptom association probability (AUC = 0.804 AUC = 0.571, < 0.05).
CONCLUSION
PSPWI < 39.8% and AET ⩽ 6.2% have demonstrated good diagnostic value for non-acid GERC. The diagnostic value was further improved when combined with non-acid reflux ratio >68.75%.
背景
目前以非酸反流为主的胃食管反流相关慢性咳嗽（GERC）的诊断标准并不完善。反流后吞咽诱发的蠕动波指数（PSPWI）是反映食管清除功能的参数。
目的
本研究旨在探讨其对非酸性 GERC 的诊断价值。
设计
本研究旨在比较 PSPWI 在不同类型 GERC 中的诊断价值，特别是非酸性 GERC，并通过诊断性试验探讨 PSPWI 在非酸性 GERC 诊断中的临床意义。
方法
回顾性分析 2016 年 8 月至 2021 年 6 月期间在我科门诊行多通道腔内阻抗-pH 监测（MII-pH）的 223 例疑似 GERC 患者的临床资料、实验室检查结果及治疗反应，对慢性咳嗽的潜在病因进行分类。分析和比较 PSPWI 对不同类型 GERC，特别是非酸性 GERC 的预测价值。
结果
共 195 例慢性咳嗽患者符合纳入标准，行 MII-pH 监测。其中 143 例确诊为 GERC，包括 98 例酸性 GERC 和 45 例非酸性 GERC。PSPWI 单独诊断 GERC 的价值中等，曲线下工作面积（AUC）为 0.760，但诊断非酸性 GERC 的价值较差，AUC 为 0.569。然而，PSPWI<39.8%结合酸暴露时间（AET）≤6.2%对非酸性 GERC 具有中等诊断价值，AUC 为 0.722。当 PSPWI<39.8%结合非酸性反流比>68.75%时，对非酸性 GERC 的诊断价值提高（AUC=0.80 AUC=0.722，<0.05），明显优于非酸性症状指数（AUC=0.804 AUC=0.550，<0.05）和非酸性症状关联概率（AUC=0.804 AUC=0.571，<0.05）。
结论
PSPWI<39.8%和 AET≤6.2%对非酸性 GERC 具有良好的诊断价值。当与非酸性反流比>68.75%结合时，诊断价值进一步提高。
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