儿童咽喉反流病与分泌性中耳炎：系统综述与荟萃分析
Pediatric Laryngopharyngeal Reflux Disease and Otitis Media With Effusion: A Systematic Review and Meta-Analysis.
文献信息
| PMID | 42867255 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jérôme R Lechien |
| 作者单位 | Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium. |
| 期刊 | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 探讨儿童人群中复发性中耳炎（ROM）、慢性分泌性中耳炎（COM）与咽喉反流病（LPRD）之间的关系。
数据来源： PubMed、Scopus和Cochrane数据库。
综述方法： 两名研究者依据PRISMA指南独立筛选文献，考虑以下主要结局：儿童ROM和COM中LPRD的患病率、所使用的诊断方法，以及中耳积液中胃十二指肠标志物的检出率。进行了两项随机效应荟萃分析，以估计中耳积液中胃蛋白酶/胃蛋白酶原检出的合并患病率，并使用标准化均数差（Hedges' g）比较COM/ROM患者与对照组之间的胃蛋白酶浓度。
结果： 共纳入28项研究（2070名儿童患者）。COM儿童中累积的胃食管反流病患病率估计为50.7%，而27.6%的儿童报告有咽反流事件。15项研究测量了积液中的胃蛋白酶，报告的合并检出患病率为72.5%（95% CI：53.7%-88.0%），基于ELISA的方法升至85.6%，而酶学测定为17.9%。OME患者与对照组之间胃蛋白酶浓度的合并标准化均数差较大且显著（Hedges' g = 1.92，95% CI：0.58-3.25，P = .005）。3项研究评估了碱性激活的胃十二指肠介质，胰蛋白酶的检出率范围为39.6%至100%，胆盐为32%至42%。在COM/ROM和反流病的诊断标准、胃十二指肠生物标志物测量及结局方面发现了显著异质性。
结论： 胃十二指肠生物标志物存在于COM和ROM儿童的中耳积液中。未来需要开展前瞻性横向研究，探索有明确咽反流事件儿童积液中的碱性激活酶和胆盐。
英文摘要
OBJECTIVES: To explore the relationship between recurrent otitis media (ROM), chronic media otitis with effusion (COM), and laryngopharyngeal reflux disease (LPRD) in pediatric populations.
DATA SOURCES: PubMed, Scopus, and Cochrane databases.
REVIEW METHODS: Two investigators independently screened papers with PRISMA guidelines considering the following primary outcomes: LPRD prevalence in pediatric ROM and COM, diagnostic methods used, and detection rates of gastroduodenal markers in middle ear effusions. Two random-effects meta-analyses were performed to estimate the pooled prevalence of pepsin/pepsinogen detection in middle ear effusions and to compare pepsin concentrations between COM/ROM patients and controls using standardized mean differences (Hedges' g).
RESULTS: Twenty-eight studies were included (2070 pediatric patients). The cumulated gastroesophageal reflux disease prevalence in COM children was estimated to 50.7%, while 27.6% of children reported pharyngeal reflux events. Fifteen studies measured pepsin in effusions, reporting a pooled detection prevalence of 72.5% (95% CI: 53.7%-88.0%), rising to 85.6% with ELISA-based methods versus 17.9% with enzymatic assays. The pooled standardized mean difference in pepsin concentration between OME patients and controls was large and significant (Hedges' g = 1.92, 95% CI: 0.58-3.25, P = .005). Alkaline-activated gastroduodenal mediators were assessed in 3 studies, with detection rates ranging from 39.6% to 100% for trypsin and from 32% to 42% for bile salts. Substantial heterogeneity was found for COM/ROM and reflux disease diagnostic criteria, gastroduodenal biomarker measurements, and outcomes.
CONCLUSION: Gastroduodenal biomarkers are present in middle ear effusions of children with COM and ROM. Future prospective transversal studies exploring alkaline-activated enzymes and bile salts in effusion of children with documented pharyngeal reflux events are needed.