鼻咽和喉咽塌陷：评分者内和评分者间一致性支持马的新型内镜评分分类。

文献信息

中文摘要

目的： 吸气压力增高或主动肌肉收缩导致的气道通畅性降低在咽塌陷病理生理学中的作用尚不清楚。现有分类涉及整个咽部区域；然而，吻侧和尾侧塌陷之间存在明显的解剖学差异。提出了新的分类和分级系统以区分2种病理：鼻咽塌陷（NPC；会厌尖端吻侧≥1个咽壁塌陷；0至4级）和喉咽塌陷（LPC；会厌尖端尾侧≥1个咽壁塌陷；0至3级）。
方法： 回顾性分析加拿大南部艾伯塔省99匹先前通过地面以上内镜（2015年至2025年）诊断为咽塌陷的绕桶赛马匹的临床报告。马匹因呼吸系统症状和/或表现不佳而被转诊。两名评分者以盲法和随机方式独立评估高速运动期间获得的静态图像。报告了描述性统计以及分类（McNemar检验）和评分（加权κ）的评分者内/评分者间一致性。
结果： 观察到NPC（64.6%）和LPC（67.6%）的频率相似（32%两者均有）。NPC的评分者内一致性为χ2 = 7.0（评分者1）和χ2 = 1.0（评分者2），LPC为χ2 = 2.0（评分者1）和χ2 = 1.6（评分者2）。NPC的评分一致性为良好至非常好（κ = 0.69至0.81），LPC为中等至良好（κ = 0.56至0.80），表明性能可靠。NPC的评分者间一致性为χ2 = 4.6（评分者1）和χ2 = 0.7（评分者2），LPC为χ2 = 0.2（评分者1）和2.0（评分者2）。
结论： 评分者内和评分者间一致性支持区分NPC与LPC的可行性和实用性。
临床相关性： 反映功能解剖学的新分类可能有助于深入了解咽塌陷的病理生理学。

英文摘要

OBJECTIVE: The contribution of reduced airway patency from heightened inspiratory pressure or active muscular contraction to the pathophysiology of pharyngeal collapse is unknown. Existing classifications refer to the entire pharyngeal region; however, anatomical differences are evident between rostral and caudal collapse. Novel classifications and grading systems are proposed to differentiate 2 pathologies: nasopharyngeal collapse (NPC; collapse of ≥ 1 pharyngeal wall rostral to the tip of the epiglottis; grades 0 through 4), and laryngopharyngeal collapse (LPC; collapse of ≥ 1 pharyngeal wall caudal to the tip of the epiglottis; grades 0 through 3).
METHODS: Clinical reports from 99 barrel racing horses in Southern Alberta previously diagnosed with pharyngeal collapse via overground endoscopy (2015 through 2025) were retrospectively analyzed. Horses were referred for respiratory signs and/or poor performance. Two raters independently assessed still images obtained during high-speed exercise in a blinded and randomized fashion. Descriptive statistics and intrarater/interrater agreement for classification (McNemar test) and scoring (weighted κ) were reported.
RESULTS: Similar frequencies of NPC (64.6%) and LPC (67.6%) were observed (32% had both). Intrarater agreement for NPC was χ2 = 7.0 (rater 1) and χ2 = 1.0 (rater 2) for NPC and χ2 = 2.0 (rater 1) and χ2 = 1.6 (rater 2) for LPC. Scoring agreement was good to very good for NPC (κ = 0.69 to 0.81) and moderate to good for LPC (κ = 0.56 to 0.80), indicating reliable performance. Interrater agreement was χ2 = 4.6 (rater 1) and χ2 = 0.7 (rater 2) for NPC and χ2 = 0.2 (rater 1) and 2.0 (rater 2) for LPC.
CONCLUSIONS: Intra- and interrater agreement supports the feasibility and practicality of distinguishing NPC from LPC.
CLINICAL RELEVANCE: Novel classifications reflecting functional anatomy may provide insight into the pathophysiology of pharyngeal collapse.