摘要目的 探讨唾液中检测胃蛋白酶浓度在咽喉反流(laryngopharyngeal reflux,LPR)中的诊断价值.方法 根据反流症状指数(reflux symptom index,PSI)量表和反流检查计分(reflux finding score,RFS)量表得分,结合质子泵抑制剂奥美拉唑(20 mg每日2次)诊断性治疗结果,将56例长期有咽喉不适症状的患者,分为咽喉反流组(32例)和慢性咽喉炎组(24例),以健康志愿者为健康对照组(15例).留取3组人员深咳咽后部唾液,用酶联免疫方法 检测唾液中胃蛋白酶浓度.结果 唾液中胃蛋白酶阳性率在咽喉反流组、慢性咽喉炎组和健康组分别为93.8%(30/32),75.0%(18/24),20.0%(3/15).胃蛋白酶质量浓度中位数[25分位数;75分位数]为5.3[1.3;53.4]ng/ml、0.8[0.1;17.2]ns/ml、0.0[0.0;0.0]ns/ml,差异有统计学意义(H值=23.29,P=0.00).以PSI、RFS量表及诊断性治疗三者联合诊断结果 为诊断标准,单独应用PSI量表对于咽喉反流诊断的灵敏度为59.4%,特异度87.2%;单独应用RFS量表诊断灵敏度为84.4%,特异度61.5%;单独应用诊断性治疗的诊断灵敏度81.3%,特异度95.8%;而单独应用唾液中胃蛋白酶检测的诊断灵敏度为93.8%,特异度为46.2%.结论 唾液中胃蛋白酶质量浓度的检测可做为一项灵敏度高、元创、快速的客观的诊断方法 应用于咽喉反流的筛查.

abstractsObjective To study whether the presence of gastric pepsin in the sputum might be used as a reliable criteria of laryngopharyngeal reflux. Methods Fifty-six patients with the symptoms of laryngopharyngitis and fifteen healthy people were recruited. Fifty-six patients were divided into laryngopharyngeal reflux group and chronic laryngitis group by the reflux symptom index (RSI), by the reflux finding score (RFS) and by their treating experiment taking omeprazole 20 mg bid for 2 weeks. Sputum in all three groups was obtained in the morning. Pepsin in the sputum was measured by enzyme-linked immunoadsorbent assay. Results The positive rate of pepsin in sputum among LPR group, chronic laryngopharyngitis group and normal group were 93.8% (30/32), 75.0% (18/24), 20.0% (3/15) respectively, and the median concentration of pepsin were 5. 3 [1.3;53.4] ng/ml, 0.8 [0.1;17.2] ng/ml, 0.0 [0.0;0.0] ng/ml (H=23.29, P=0.000). Compared with co-diagnosis as gold standard, the sensitivity of RSI, RFS treating experiment and the pepsin immunoassay was 59.4%, 84.4%, 81.3% and 93.8%, and the specificity of those was 87.2%, 61.5%, 95. 8% and 46.2% respectively. Conclusions Detection of pepsin in sputum by immunoassay might provide a high sensitive, noninvasive method for laryngopharyngeal reflux.