摘要目的 探讨以Ryan指数作为判断标准的咽喉部pH监测(Dx-pH)在咽喉反流性疾病中的应用价值.方法 回顾性分析2016年2月至2017年3月在解放军第三○六医院耳鼻咽喉头颈外科就诊的有咽喉反流症状的590例患者临床资料.所有患者均行电子喉镜检查,反流症状指数量表(reflux symptom index,RSI)和反流体征评分量表(reflux finding score,RFS)及咽部pH监测.采用SPSS 19.0进行统计学分析.结果 所有患者监测过程顺利,患者接受度良好.590例患者中Ryan指数阳性率为15.93％(94/590),其中直立位阳性70例,平卧位阳性12例,直立位、平卧位均阳性12例.Ryan指数正常、但存在症状相关pH下降事件40例(6.78％).存在pH ＜6.5、pH ＜6.0、pH＜5.5及pH ＜5.0事件的患者分别为536例(90.85％),417例(70.68％),233例(39.49％)和117例(19.83％).单纯RSI评分阳性、单纯RFS评分阳性、RSI且RFS评分阳性、RSI或RFS评分阳性的Ryan指数阳性率分别为44.24％、16.78％、7.12％、53.90％.Ryan指数阳性组患者RFS评分高于Ryan指数阴性组患者[(8.2±2.4)分比(4.0±2.9)分,u=5.424,P＜0.05].;Ryan指数阳性组患者RSI评分与Ryan指数阴性组患者差异无统计学意义[(11.3±6.2)分比(12.7±5.8)分,t=1.247,P=0.167].结论 咽喉部pH监测是直接反映咽喉部反流客观、无创的检测方法,以Ryan指数作为咽喉反流性疾病的判断标准,可能会遗漏部分阳性病例,仍需进一步研究用于诊断咽喉反流性疾病的更准确、客观的咽喉部pH统计学指数.

abstractsObjective To explore the utility of pharyngeal pH monitoring which positive standard is Ryan index in diagnosis of laryngopharyngeal reflux disease.Methods In a retrospective study,clinical data of 590 patients who had symptoms laryngopharyngeal reflux disease from February 2016 to March 2017 were analyzed.All patients were received electronic laryngoscopy,assessment of reflux symptom index(RSI) and reflux finding score(RFS),and pharyngeal pH monitoring.SPSS 19.0 software was used to analyze the date.Results There were 94 patients whose Ryan index were positive(15.93％).Among the 94 patients,70 were positive during upright,12 during supine and 12 during both upright and supine.There were 40 patients(6.78％)with pH decline events related to symptoms,while those Ryan index were normal.There were 536 (90.85％),417 (70.68％),233 (39.49％) and 117 (19.83％) patients with pH ＜ 6.5,pH ＜ 6.0,pH ＜ 5.5 and pH ＜ 5.0 events respectively.The positive rate of RSI,RFS,RSI and RFS,RSI or RFS were 44.24％,16.78％,7.12％,53.90％ respectively.The RFS score in Ryan index positive group was higher than that in Ryan index negative group [(8.2 ± 2.4) vs (4.0 ± 2.9),u =5.424,P ＜ 0.05],while the RSI score in Ryan index positive group was not statistically different from that in Ryan index negative group[(11.3 ±6.2) vs (12.7 ±5.8),t =1.247,P =0.167].Conclusions Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly.However,with the Ryan index as a criterion for the diagnosis of laryngopharyngeal reflux disease,partial patients may be missed.Further studies are needed to obtain more accurate and objective laryngopharyngeal pH statistical index for diagnosis of laryngopharyngeal reflux disease.