Comparative study of three methods in the diagnosis of laryngopharyngeal reflux in children
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摘要: 目的 探讨RSI和RFS量表评分、胃蛋白酶检测、pH监测在诊断儿童咽喉反流(LPR)的一致性、灵敏度及特异度。方法 门诊诊断可疑LPR的患儿76例，最后确诊为LPR的患儿65例，对其同时进行RSI和RFS量表评分、胃蛋白酶检测及Dx-pH监测，检验3种方法的诊断一致性，并计算其灵敏度和特异度。结果 76例可疑LPR患者中胃蛋白酶检测、24 h Dx-pH监测、RSI和RFS量表诊断LPR灵敏度分别为95.31%、66.15%和84.62%，特异度分别为100%、81.82%和72.73%。胃蛋白酶检测与RSI和RFS量表诊断结果一致性良好(Kappa>0.75)，胃蛋白酶检测与24 h Dx-pH监测诊断结果一致性一般(Kappa=0.467)，24 h Dx-pH监测与RSI和RFS量表诊断结果一致性一般(Kappa=0.446)。结论 胃蛋白酶检测客观、经济无创、患儿无不适感，可作为诊断儿童LPR的可靠指标，易于临床推广。Abstract: Objective To compare the consistency of RSI and RFS, pepsin detection and 24 h Dx-pH monitoring in the diagnosis of laryngopharyngeal reflux (LPR) in children.Method A retrospective analysis was made of 76 children with suspicious LPR. A total of 65 children with suspicious LPR were finally diagnosed. RSI and RFS scales, pepsin detection and Dx-pH monitoring were performed simultaneously. The diagnostic consistency of the three methods was tested, and the sensitivity and specificity were calculated.Result The sensitivity of pepsin detection, 24 h Dx-pH monitoring, RSI and RFS in the diagnosis of LPR in 76 suspected LPR patients were 95.31%, 66.15% and 84.62%, and the specificity were 100%, 81.82% and 72.73%. The pepsin detection was well consistent with the scale(Kappa>0.75), pepsin detection and 24 h Dx-pH monitoring were in medium consistency(Kappa=0.467), and 24 h Dx-pH monitoring and scale were in medium consistency(Kappa=0.446).Conclusion Pepsin detection can be used as a reliable index for the diagnosis of LPR in children. It is objective, economical, non-invasive, comfortable and easy to spread.
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Key words:
- laryngeal reflux /
- pepsin /
- pH monitoring /
- reflux symptom index /
- reflux finding score
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表 1 量表评分与胃蛋白酶检测和Dx-pH监测结果一致性分析(n=76)
例(%) 量表 胃蛋白酶检测 24h Dx-pH监测 阳性 阴性 阳性 阴性 阳性 57(75.00) 1(1.32) 42(55.26) 16(21.05) 阴性 4(5.26) 14(18.42) 3(3.95) 15(19.74) k值 0.807 0.446 
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表 2 可疑LPR患儿3种方法诊断的灵敏度和特异度
例(%) 可疑LPR RSI、RFS量表 胃蛋白酶检测 24 h Dx-pH监测 阳性 阴性 阳性 阴性 阳性 阴性 确诊 55(72.37) 10(13.16) 61(80.26) 4(5.26) 43(56.58) 22(28.95) 排除 3(3.95) 8(10.53) 0 11(14.47) 2(2.63) 9(11.84)
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