平均夜间基线阻抗预测喉咽症状患者下咽-食管pH阻抗监测中咽反流增加

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中文摘要

喉咽症状（LPS）因缺乏明确的诊断金标准以及传统食管反流标准与咽反流事件之间相关性欠佳而构成诊断挑战。平均夜间基线阻抗（MNBI）是一种与反流负荷相关的黏膜完整性指标，但其在诊断喉咽反流病中的作用证据仍有限。我们旨在描述MNBI与客观反流监测中咽反流之间的相关性。这是一项回顾性研究，纳入接受下咽-食管多通道腔内阻抗和pH反流监测的LPS成人患者。MNBI通过取远端电极对（食管上括约肌下方9-11 cm/11-13 cm）在静息状态下三个10分钟时间段（凌晨1点、2点、3点）的平均基线阻抗计算。根据既定标准，咽反流增加定义为24小时内≥2次事件。进行了单变量、多变量和受试者工作特征（ROC）曲线分析。共纳入119例患者（平均年龄=55.5±1.4岁，71.4%为女性）。MNBI与咽反流事件呈负相关（r=-0.25，P=0.009），并且在咽反流增加的患者中较低（1867±124 Ω vs. 2540±177 Ω，P=0.0027）。在多变量分析中，MNBI仍独立预测咽反流增加（每增加100 Ω的OR：0.94，95% CI：0.90-0.98，P=0.008）。在ROC分析中，咽反流增加的ROC曲线下面积为0.65，MNBI阈值1017 Ω和3474 Ω分别达到>90%的特异度和敏感度。较低的MNBI独立预测LPS患者咽反流增加，在客观检测中对喉咽反流病诊断具有潜在的辅助价值。

英文摘要

Laryngopharyngeal symptoms (LPS) present a diagnostic challenge due to the lack of clear diagnostic gold standard, and suboptimal correlation between traditional esophageal reflux criteria and pharyngeal reflux events. Mean nocturnal baseline impedance (MNBI) is a measure of mucosal integrity that correlates with reflux burden, but evidence for its role in diagnosing laryngopharyngeal reflux disease remains limited. We aimed to characterize the correlation between MNBI and pharyngeal reflux on objective reflux monitoring. This was a retrospective study of adults with LPS undergoing reflux monitoring with hypopharyngeal-esophageal multichannel intraluminal impedance and pH. MNBI was calculated by taking the mean baseline impedance of three 10-minute time periods at rest (1 AM, 2 AM, 3 AM) from the distal electrode pairs (9-11 cm/11-13 cm below the upper esophageal sphincter). Increased pharyngeal reflux was defined as ≥2 events in 24 hours per established criteria. Univariate, multivariable, and receiver-operating characteristic (ROC) curve analyses were performed. One hundred nineteen patients were included (mean age = 55.5 ± 1.4 years, 71.4% female). MNBI inversely correlated with pharyngeal reflux events (r = -0.25, P = 0.009) and was lower in patients with increased pharyngeal reflux (1867 ± 124 Ω vs. 2540 ± 177 Ω, P = 0.0027). On multivariable analysis, MNBI remained independently predictive of increased pharyngeal reflux (OR: 0.94 per 100 Ω increase, 95% CI:0.90-0.98, P = 0.008). On ROC analysis, the area under ROC curve for increased pharyngeal reflux was 0.65, with MNBI thresholds of 1017 Ω and 3474 Ω achieving >90% specificity and sensitivity, respectively. Lower MNBI independently predicts increased pharyngeal reflux in patients with LPS, with potential adjunctive value for laryngopharyngeal reflux disease diagnosis on objective testing.