疑似咽喉逆流患者咽部胃酸逆流之預測因子

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Title:	疑似咽喉逆流患者咽部胃酸逆流之預測因子 Predictors of Pharyngeal Acid Reflux in Patients with Suspected Laryngopharyngeal Reflux Disease
Authors:	連漢仲;Han-Chung Lien
Contributors:	公共衛生學院環境醫學研究所碩士班
Keywords:	咽喉逆流疾病;風險因子;預測模式;Laryngopharyngeal Reflux Disease;Risk Factors;Prediction Model
Date:	2010
Issue Date:	2010-09-29 12:03:34 (UTC+8)
Abstract:	背景：咽喉逆流疾病是指胃液倒流導致的喉部不適症狀和徵候，其致病機轉被認為與胃食道逆流疾病不同。目的：從疑似咽喉逆流患者中，找出異常咽部胃酸逆流之風險因子，並建立臨床診斷異常咽部胃酸逆流之預測模式。方法：九十九位耳鼻喉科門診中，疑似咽喉逆流患者，填寫咽喉逆流症狀問卷，同時接受二十四小時咽部及食道胃酸檢查，檢查結果以任何有咽部胃酸暴露者為異常，其餘受試者為對照組。結果：總共84位患者完成二十四小時咽部及食道胃酸檢查，其中19% (16/84) 咽部胃酸暴露為陽性，這些患者中50% (8/16) 同時合併異常食道胃酸逆流。根據鑑別分析及羅吉斯迴歸分析，有三個因子與異常咽部胃酸暴露相關：分別是胃食道逆流症狀 (調整後勝算比8.0，95%信賴區間1.5-44.3)、橫隔疝氣 (8.5; 1.3-53.6)，及身體質量指數大於23.5 kg/m2 (4.5; 1.1-19.0) 。胃食道逆流症狀的敏感度為0.86，橫隔疝氣的特異性為0.96，同時有三種的風險因子陽性預測率及特異性分別為0.75 和0.99。結論：本研究初步發現，胃食道逆流症狀、橫隔疝氣、高身體質量指數為異常咽部胃酸暴露之獨立風險因子；胃食道逆流症狀與橫隔疝氣，分別有好的敏感度與特異性。以上結果顯示，咽喉逆流疾病的風險因子與胃食道逆流疾病有共同之處；意謂兩者在致病機轉上，至少有部分相似。 Introduction: The pathophysiology of laryngopharyngeal reflux disease (LPRD) was proposed to be different from that of gastroesophageal reflux disease (GERD). This study was performed to find the risk factors and to establish clinical prediction model for pharyngeal acid reflux (PAR) in patients with suspected LPRD. Materials and Methods: A total of 99 patients referred from ENT physicians with suspected LPRD were enrolled. Each underwent ambulatory 24-hour pH test with 3 probes located at hypopharynx, proximal, and distal esophagus and filled out a validated questionnaire for symptoms of LPRD. Any pharyngeal acid event(s) was (were) considered as abnormality. The remaining subjects without PAR were considered as controls. Results: Eight-four 84 subjects (84.8%) completed 24-hour pH test. There were 19% (16/84) of subjects with PAR, of whom, 50% (8/16) also had abnormal esophageal acid exposure. According to the discriminant analysis and the logistic regression analysis, 3 factors were independently associated with PAR: gastroesophageal-related reflux symptoms (heartburn, chest pain, indigestion, or acid coming up) (adjusted odds ratio, 8.0; 95% confidence interval:1.5-44.3), hiatus hernia (8.5; 1.3-53.6), and BMI (body mass index) ≧ 23.5 kg/m2 (4.5; 1.1-19.0). The sensitivity of gastroesophageal-related reflux symptoms and the specificity of hiatus hernia were 0.86 and 0.96, respectively. With concurrent 3 factors, the positive predictive value and specificity were 0.75 and 0.99, respectively. Conclusions: Gastroesophageal-related reflux symptoms, hiatus hernia, and high BMI are 3 independent risk factors of PAR in patients with suspected LPRD, which are all in common with GERD. Our preliminary data supports that GERD and LPRD, at least, in part, share common pathophysiology.
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