咽喉反流与下鼻甲肥大的相关性*

Correlation between laryngopharyngeal reflux and Inferiorturbinate hypertrophy*

摘要:

目的 探讨咽喉反流(LPR)与下鼻甲肥大(ITH)的相关性,揭示LPR在ITH发病中的潜在作用。方法 选取2023年10月至2024年06月中国人民解放军联勤保障部队第940医院收治的33例下鼻甲肥大住院患者和19例健康体检者作为研究对象。在入选的患者中,采用反流症状指数(RSI)和反流体征评分(RFS)对所有受试者进行评估。RSI≥13和/或RFS≥7的患者被诊断为LPR。用酶联免疫吸附试验检测清晨空腹时鼻腔灌洗液中胃蛋白酶的含量。用鼻内镜检查患者双侧下鼻甲肥大的分度。于空腹时行C13呼气试验检测幽门螺旋杆菌。结果 下鼻甲肥大组和对照组在性别、身高、体重、BMI及吸烟、饮酒方面无显著差异。幽门螺旋杆菌在下鼻甲肥大组和健康对照组的阳性率分别为54.5%和31.6%,P＞0.05,两组间无统计学意义。下鼻甲肥大组RSI和(或)RFS阳性率为为84.8%,明显高于对照组10.5％(P＜0.01)。鼻腔灌洗液胃蛋白酶检测结果与RSI评分之间呈显著正相关(r=0.505,P＜0.01),与RFS评分之间呈正相关(r=0.271, P ＞0.05),但无统计学意义。鼻腔灌洗液胃蛋白酶检测结果分别与左、右侧下鼻甲肥大分级呈显著正相关(左侧r=0.33, P ＜0.05；右侧r=0.40, P ＜0.01),RSI评分、RFS评分分别与左、右侧鼻甲肥大严重程度正相关。结论 在咽喉反流患者中,RSI和RFS评分与鼻腔灌洗液胃蛋白酶测定结果显著相关,RSI评分、RFS评分、鼻腔灌洗液胃蛋白酶测定结果分别与左、右侧鼻甲肥大严重程度正相关,对于鼻甲肥大患者有必要进行RSI、RFS评分和胃蛋白酶检测来筛查咽喉反流。

Abstract:

Objective To investigate the correlation between laryngopharyngeal reflux (LPR) and inferior turbinate hypertrophy (ITH), and to reveal the potential role of LPR in the pathogenesis of ITH. Methods Thirty-three hospitalized patients with inferior turbinate hypertrophy and 19 healthy patients admitted to the No. 940 Hospital of the People"s Liberation Army Joint Command and Security Forces from October 2023 to June 2024 were selected as study subjects. All subjects underwent evaluation using the Reflux Symptom Index (RSI) and Reflux Fluid Signs Score (RFS). Patients with RSI ≥13 and/or RFS ≥7 were diagnosed with Laryngopharyngeal reflux (LPR). The amount of pepsin in the nasal lavage fluid was detected by ELISA in the early morning before food consumption. Nasal endoscopy was performed to assess bilateral inferior turbinate hypertrophy, and a C13 breath test was conducted in the early morning without food to detect Helicobacter pylori. Results There were no significant differences between the inferior turbinate hypertrophy group and the control group in terms of gender, height, weight, BMI, smoking, or alcohol consumption. The positive rates of Hpylori in the inferior turbinate hypertrophy group and healthy control group were 54.5% and 31.6%, respectively (P＞0.05), showing no statistical significance between the two groups. The positive rate of RSI and/or RFS in the inferior turbinate hypertrophy group was significantly higher at 84.8% compared to that of the control group at 10.5% (P ＜0 .01).A significant positive correlation was found between pepsin test results and RSI scores (r=0 .505,p＜0.01) as well as RFS scores (r=0.271,p＞0.05), although it did not reach statistical significance. Furthermore, there was a significant positive correlation between pepsin test results and grading of left/right inferior turbinate hypertrophy (r=0.33,p＜0.05on left side; r=0.40,p＜0.01on right side), along with a positive correlation between RSI score/RFS score severity and the severity of the left/right turbinate hypertrophy. Conclusions In patients with pharyngeal reflux, the scores of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) showed a significant correlation with pepsin measurements. Additionally, RSI scores, RFS scores, and pepsin measurements were found to be positively correlated with the severity of left- and right-sided turbinate hypertrophy. Therefore, it is necessary to utilize RSI and RFS scores as well as pepsin assays in order to screen for pharyngeal reflux disease in patients with hypertrophied turbinate.