窄带成像技术在诊断儿童咽喉反流中的应用

Application of narrow band imaging in the diagnosis of laryngopharyngeal reux disease in children

摘要:

目的 研究窄带成像（NBI）技术在诊断儿童咽喉反流性疾病（LPRD）的应用价值。方法 选取2021年1月—2021年7月因慢性扁桃体炎或扁桃体肥大在徐州医科大学附属医院耳鼻咽喉科施行扁桃体切除手术的4~14岁患儿60例，在耳鼻咽喉医师的指导下，患儿和其父母共同填写《反流症状指数评分量表（RSI）》，并由2名耳鼻咽喉科专业医生填写《反流体征评分量表（RFS）》，切除的扁桃体组织进行免疫组织化学分析，观察扁桃体组织中胃蛋白酶（Pepsin）的表达情况。结果 22例（36.7%）患儿RSI>13分，38例（63.3%）患儿RSI≤13分，35例（58.3%）患儿RFS>7分，25例（41.7%）患儿RFS≤7分，39例（65%）患儿Pepsin （+），21例（35%）患儿Pepsin （-）。RSI评分在有无咽喉反流症状中比较，两者差异无统计学意义（P>0.05），RFS评分在有无咽喉反流症状中比较，两者差异具有统计学意义（P<0.05）。普通白光和NBI两种模式下进行RFS评分的比较，差异具有统计学意义（P<0.05），其中在声带水肿、喉黏膜弥漫性水肿、充血和红斑方面差异较显著。结论 NBI视图比普通白光视图更容易识别声带水肿、喉黏膜弥漫性水肿、充血和红斑等RFS参数，能够提高儿童LPRD诊断的准确性。

Abstract:

Objective To study the accuracy of narrow band imaging (NBI) technique in the diagnosis of laryngopharyngeal reflux disease (LPRD) in children.Methods A total of 60 children aged 4 to 14 years old who underwent tonsillectomy for chronic tonsillitis or hypertrophy of tonsil in our hospital from Jan 2021 to July 2021 were recruited. Parents and children completed the reflux symptom index (RSI) questionnaires under doctor's guidance, and 2 otolaryngologists filled in the reflux finding score (RFS). The expression of pepsin in the resected tonsil was detected by immunohistochemistry.Results Of the 60 cases, RSI was more than 13 in 22 cases (36.7%) and equal to or less than 13 in 38 (63.3%), RFS was more than 7 in 35 cases (58.3%) and equal to or less than 7 in 25 (41.7%), pepsin was positive in 39 cases (65%) and negative in 21 (35%). The difference of RSI score between children with and without LPRD was statistically insignificant (P>0.05), while that of RFS score was significant (P<0.05). The comparison of RFS score between ordinary white light and NBI endoscopy showed statistically significant differences in vocal cord edema, diffuse edema, hyperemia and erythema of laryngeal mucosa (P<0.05).Conclusion NBI view is more liable than ordinary white light view to identify RFS parameters such as vocal cord edema, diffuse edema, hyperemia and erythema of laryngeal mucosa, which can improve the accuracy of LPRD diagnosis in children.