Li Wanzhen, Sha Bingxian, Bai Haodong, Zhang Tongyangzi, Wang Shengyuan, Ambedkar Kumar Yadav, Zhu Yiqing, Yu Li, Xu Xianghuai
Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
W. Li, B. Sha and H. Bai contributed equally to this article as joint first authors.
ERJ Open Res. 2025 Jan 20;11(1). doi: 10.1183/23120541.00299-2024. eCollection 2025 Jan.
The results of empirical trials with proton pump inhibitors (PPIs) for management of gastro-oesophageal reflux-induced chronic cough (GERC) have resulted in considerable controversy, and the mechanism of PPI refractoriness remains unclear. Our study aims to identify the predictors of PPI refractoriness of GERC in a retrospective clinical study.
In total, 128 GERC patients were enrolled between March 2018 and October 2022. Regression analysis was utilised to create a model for predicting PPI-refractory of GERC using retrospective analysis of the general data and MII-pH indicators.
The post-reflux swallow induced peristaltic wave index (PSPWI) was lower in the PPI-refractory group than the PPI-responsive group (33.89±7.38 39.45±9.47, respectively, p<0.001), as were the mean nocturnal baseline impedance (MNBI) and proximal MNBI (2092.11 (IQR: 652.23)] 2426.52 (IQR: 917.39) Ω, respectively, p=0.012; 1599.50 (IQR: 1206.63) 2274.50 (IQR: 1775.29) Ω, respectively, p=0.001). Multivariate logistic regression analysis identified the PSPWI (odds ratio 0.919, p=0.001) as an independent predictor of PPI-refractory GERC.
The diagnostic value of both proximal MNBI ≤39.90% and MNBI ≤2233.58 Ω had moderate sensitivity (71.67%) and specificity (75.00%) to identify PPI-refractory GERC.
质子泵抑制剂（PPI）用于治疗胃食管反流引起的慢性咳嗽（GERC）的经验性试验结果引发了相当大的争议，PPI难治性的机制仍不清楚。我们的研究旨在通过一项回顾性临床研究确定GERC患者PPI难治性的预测因素。
2018年3月至2022年10月期间共纳入128例GERC患者。利用回归分析，通过对一般数据和MII-pH指标的回顾性分析，建立一个预测GERC患者PPI难治性的模型。
PPI难治组的反流后吞咽诱发蠕动波指数（PSPWI）低于PPI反应组（分别为33.89±7.38和39.45±9.47，p<0.001），夜间平均基线阻抗（MNBI）和近端MNBI也较低（分别为2092.11（IQR：652.23）Ω和2426.52（IQR：917.39）Ω，p=0.012；分别为1599.50（IQR：1206.63）Ω和2274.50（IQR：1775.29）Ω，p=0.001）。多因素逻辑回归分析确定PSPWI（比值比0.919，p=0.001）是GERC患者PPI难治性的独立预测因素。
近端MNBI≤39.90%和MNBI≤2233.58 Ω对识别GERC患者PPI难治性具有中等敏感性（71.67%）和特异性（75.00%）。
