咽喉反流与慢性肥厚性鼻炎的相关性分析

Correlation analysis of laryngopharyngeal reflux and chronic hyperplastic rhinitis

摘要:

目的 探讨咽喉反流(LPR)与慢性肥厚性鼻炎下鼻甲肥大之间的相关性，揭示LPR对慢性肥厚性鼻炎下鼻甲肥大发病机制的影响。方法 选取2023年10月—2024年11月中国人民解放军联勤保障部队第九四〇医院收治的48例慢性肥厚性鼻炎住院患者，另同期选取25例健康体检者作为对照组。在入选的患者中，采用反流症状指数(RSI)和反流体征量表(RFS)对所有受试者进行评估。RSI≥13分和/或RFS≥7分的患者被诊断为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。用鼻内镜检查并对慢性肥厚性鼻炎患者的双侧下鼻甲肥大进行分度。空腹行C13呼气试验检测患者幽门螺旋杆菌(Hp)。结果 慢性肥厚性鼻炎组和对照组在性别、身高、体重、体质指数(BMI)及吸烟、饮酒方面差异均无统计学意义。Hp在慢性肥厚性鼻炎组和对照组的阳性率分别为54.2%和32.0%，两组间差异无统计学意义(P＞0.05)。慢性肥厚性鼻炎组RSI和/或RFS阳性率为89.6%，明显高于对照组的8.0％(P＜0.01)。两组间鼻腔灌洗液中胃蛋白酶含量比较差异具有统计学意义(t=2.665, P=0.01)。鼻腔灌洗液胃蛋白酶检测结果与RSI评分之间呈正相关(r=0.579 7, P＜0.01)，与RFS评分之间呈正相关(r=0.2996,P＜0.05)。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正相关(左侧r=0.323,P=0.05；右侧r=0.387,P＜0.01)，RSI和RFS评分分别与左、右侧下鼻甲肥大严重程度呈正相关。结论 伴LPR的慢性肥厚性鼻炎患者，RSI和RFS评分与鼻腔灌洗液胃蛋白酶测定结果具有相关性，RSI、RFS评分、鼻腔灌洗液胃蛋白酶测定结果分别与左、右侧下鼻甲肥大严重程度呈正相关，对于慢性肥厚性鼻炎患者有必要进行RSI、RFS评分和胃蛋白酶检测来筛查LPR。

Abstract:

Objective To investigate the correlation between laryngopharyngeal reflux (LPR) and inferior turbinate hypertrophy in chronic hypertrophic rhinitis, and to reveal the influence of LPR on the pathogenesis of the inferior turbinate hypertrophy.Methods A total of 48 patients with inferior turbinate hypertrophy who were admitted to the 940th Hospital of the Joint Support Force of the Chinese People’s Liberation Army from October 2023 to November 2024 were selected as the inferior turbinate hypertrophy group. Meanwhile, 25 healthy individuals undergoing physical examinations during the same period were selected as the control group. All subjects underwent evaluation using the reflux symptom index (RSI) and reflux finding score (RFS), and those with RSI ≥13 and/or RFS ≥7 were diagnosed as LPR. The amount of pepsin in the nasal lavage fluid in the early morning before food consumption was detected by enzyme-linked immunosorbent assay. Nasal endoscopy was performed to assess bilateral inferior turbinate hypertrophy, and a fasting C13 breath test was conducted to detect helicobacter pylori (Hp).Results There were no significant differences between the inferior turbinate hypertrophy group and the control group in terms of gender, height, weight, body mass index, smoking, and alcohol consumption. The positive rates of Hp infection in the inferior turbinate hypertrophy group and the control group were 54.2% and 32.0%, respectively, showing statistically insignificant difference between the two groups (P＞0.05). The positive rate of RSI and/or RFS in the inferior turbinate hypertrophy group was 89.6%, significantly higher than 8.0% in the control group (P<0.01). There was a statistically significant difference in the amount of pepsin in nasal lavage fluid between the two groups (t=2.665,P=0.01). The amount of pepsin in nasal lavage fluid showed a significant positive correlation with the RSI score (r=0.579 7, P<0.01), and a positive correlation with the RFS score (r=0.299 6, P<0.05). The amount of pepsin in nasal lavage fluid were significantly positively correlated with the grading of left and right inferior turbinate hypertrophy (left r=0.323, P=0.05; right r=0.387, P<0.01), and the RSI score and RFS score were positively correlated with the severity of turbinate hypertrophy on the left and right sides.Conclusion In patients with LPR, the RSI and RFS scores are significantly correlated with the amount of pepsin in nasal lavage fluid. The RSI score, RFS score, and the amount of pepsin in nasal lavage fluid are respectively positively correlated with the severity of left and right inferior turbinate hypertrophy. For patients with chronic hypertrophic rhinitis, it is necessary to conduct RSI, RFS score, and pepsin detection to screen for LPR.