气道pH值监测在儿童慢性咳嗽与咽喉反流相关性判断中的价值

doi:10.7499/j.issn.1008-8830.2102022

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摘要

目的探讨气道pH值监测在儿童慢性咳嗽与咽喉反流（laryngopharyngeal reflux，LPR）相关性判断中的价值。方法对2016年1月至2019年12月274例慢性咳嗽患儿，采用DX-pH监测仪进行24 h气道pH值监测，分析儿童慢性咳嗽与LPR的相关性。结果 274例患儿中，男168例，女106例，中位年龄62.8个月，中位气道pH值为7.3，存在LPR患儿99例（36.1%），其中男孩LPR发生率为36.9%（62/168），女孩为34.9%（37/106），差异无统计学意义（P=0.737）；婴儿期（< 1岁）、幼儿及学龄前期（1~6岁）、学龄期（> 6岁）患儿LPR发生率比较显示，低年龄LPR患儿发生率明显高于高年龄患儿（P=0.003）。慢性咳嗽病因明确与否并不影响LPR发生率（P=0.992），慢性咳嗽与LPR的发生呈正相关（r_s=0.861，P < 0.01），RYAN指数阳性患儿中单纯LPR有65例，占比66%（65/99），临床应予以重视。结论 LPR与慢性咳嗽的发生高度相关，气道pH值监测是诊断LPR安全有效的方法。

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	姜允丽
	李丹
	李田田
	吴蓓蓉
	尹冰如
	李爱求

关键词 ：慢性咳嗽, 咽喉反流, 气道pH值监测, 儿童

Abstract：Objective To study the value of airway pH monitoring in determining the association between chronic cough and laryngopharyngeal reflux (LPR) in children. Methods A total of 274 children with chronic cough who were treated from January 2016 to December 2019 were enrolled. The DX-pH detection system was used to conduct 24-hour airway pH monitoring. The association between chronic cough and LPR was analyzed. Results Among the 274 children, there were 168 boys and 106 girls, with a median age of 62.8 months and a median airway pH value of 7.3. Of all the 274 children, 99 (36.1%) had LPR, and the incidence rate of LPR was 36.9% (62/168) in boys and 34.9% (37/106) in girls (P=0.737). The comparison of the incidence rate of LPR among children aged < 1 year, 1-6 years, and > 6 years showed that the younger children had a significantly higher incidence rate of LPR than the older ones (P=0.003). There was no significant difference in the incidence of LPR between the two groups with chronic cough of unknown etiology and definite etiology. The incidence of chronic cough was positively correlated with that of LPR (rs=0.861, P < 0.01). Among the 99 children with positive RYAN index, 65 (66%) suffered from simple LPR. Conclusions LPR is highly associated with the development of chronic cough, and airway pH monitoring may be a safe and effective method for the diagnosis of LPR.

收稿日期: 2021-02-03

PACS:

null

通讯作者: 李爱求,女,主任护师,教授。Email:liaiqiu817@hotmail.com。 E-mail: liaiqiu817@hotmail.com

作者简介: 姜允丽,女,本科,主管护师。

引用本文:

姜允丽,李丹,李田田等. 气道pH值监测在儿童慢性咳嗽与咽喉反流相关性判断中的价值[J]. 中国当代儿科杂志, 2021, 23(7): 713-717.

JIANG Yun-Li,LI Dan,LI Tian-Tian et al. null[J]. CJCP, 2021, 23(7): 713-717.

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http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2102022 或 http://www.zgddek.com/CN/Y2021/V23/I7/713

[1]	中华医学会儿科学分会呼吸学组慢性咳嗽协作组, «中华儿科杂志»编辑委员会. 中国儿童慢性咳嗽诊断与治疗指南(2013年修订)[J]. 中华儿科杂志, 2014, 52(3):184-188. DOI:10.3760/cma.j.issn.0578-1310.2014.03.005. PMID:24824387.
[2]	Michaudet C, Malaty J. Chronic cough:evaluation and management[J]. Am Fam Physician, 2017, 96(9):575-580. PMID:29094873.
[3]	Chang AB, Oppenheimer JJ, Weinberger M, et al. Etiologies of chronic cough in pediatric cohorts:CHEST guideline and expert panel report[J]. Chest, 2017, 152(3):607-617. DOI:10.1016/j.chest.2017.06.006. PMID:28645463. PMCID:PMC6026225.
[4]	徐幼, 谢友奇, 李离. 耳鼻咽喉科疾病与儿童咳嗽相关性分析[J]. 中国耳鼻咽喉颅底外科杂志, 2015, 21(5):399-401. DOI:10.11798/j.issn.1007-1520.201505013.
[5]	中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 咽喉反流性疾病诊断与治疗专家共识(2015年)[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(5):324-326. DOI:10.3760/cma.j.issn.1673-0860.2016.05.002. PMID:27220289.
[6]	Weber B, Portnoy JE, Castellanos A, et al. Efficacy of anti-reflux surgery on refractory laryngopharyngeal reflux disease in professional voice users:a pilot study[J]. J Voice, 2014, 28(4):492-500. DOI:10.1016/j.jvoice.2013.12.009. PMID:24629640.
[7]	Lee JS, Lee YC, Kim SW, et al. Changes in the quality of life of patients with laryngopharyngeal reflux after treatment[J]. J Voice, 2014, 28(4):487-491. DOI:10.1016/j.jvoice.2013.12.015. PMID:24598356.
[8]	Andrews TM, Orobello N. Histologic versus pH probe results in pediatric laryngopharyngeal reflux[J]. Int J Pediatr Otorhinolaryngol, 2013, 77(5):813-816. DOI:10.1016/j.ijporl.2013.02.017. PMID:23489887.
[9]	Galluzzi F, Schindler A, Gaini RM, et al. The assessment of children with suspected laryngopharyngeal reflux:an otorhinolaringological perspective[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(10):1613-1619. DOI:10.1016/j.ijporl.2015.07.037. PMID:26279249.
[10]	Banaszkiewicz A, Dembinski L, Zawadzka-Krajewska A, et al. Evaluation of laryngopharyngeal reflux in pediatric patients with asthma using a new technique of pharyngeal pH-monitoring[J]. Adv Exp Med Biol, 2013, 755:89-95. DOI:10.1007/978-94-007-4546-9_12. PMID:22826054.
[11]	Gibson PG, Chang AB, Glasgow NJ, et al. CICADA:cough in children and adults:diagnosis and assessment. Australian cough guidelines summary statement[J]. Med J Aust, 2010, 192(5):265-271. DOI:10.5694/j.1326-5377.2010.tb03504.x. PMID:20201760.
[12]	李晓雨, 王嘉森, 李进让. 口咽pH监测技术在咽喉反流性疾病诊断中的应用[J]. 国际耳鼻咽喉头颈外科杂志, 2016, 40(5):291-294. DOI:10.3760/cma.j.issn.1673-4106.2016.05.008.
[13]	Wiener GJ, Tsukashima R, Kelly C, et al. Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux[J]. J Voice, 2009, 23(4):498-504. DOI:10.1016/j.jvoice.2007.12.005. PMID:18468849.
[14]	李进让, 肖水芳, 李湘平, 等. 咽喉反流性疾病诊断与治疗专家共识(2015年)解读[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(5):327-332. DOI:10.3760/cma.j.issn.1673-0860.2016.05.003. PMID:27220290.
[15]	Ayazi S, Lipham JC, Hagen JA, et al. A new technique for measurement of pharyngeal pH:normal values and discriminating pH threshold[J]. J Gastrointest Surg, 2009, 13(8):1422-1429. DOI:10.1007/s11605-009-0915-6. PMID:19421822.
[16]	Yuksel ES, Slaughter JC, Mukhtar N, et al. An oropharyngeal pH monitoring device to evaluate patients with chronic laryngitis[J]. Neurogastroenterol Motil, 2013, 25(5):e315-e323. DOI:10.1111/nmo.12109. PMID:23495894.
[17]	Beaver ME, Karow CM. Clinical utility of 24 hour pharyngeal pH monitoring for hoarseness[J]. J Laryngol Voice, 2012, 2(2):60-63. DOI:10.4103/2230-9748.106979.
[18]	Friedman M, Hamilton C, Samuelson CG, et al. The value of routine pH monitoring in the diagnosis and treatment of laryngopharyngeal reflux[J]. Otolaryngol Head Neck Surg, 2012, 146(6):952-958. DOI:10.1177/0194599812436952. PMID:22301104.
[19]	Vailati C, Mazzoleni G, Bondi S, et al. Oropharyngeal pH monitoring for laryngopharyngeal reflux:is it a reliable test before therapy?[J]. J Voice, 2013, 27(1):84-89. DOI:10.1016/j.jvoice.2012.08.006. PMID:23159026.
[20]	毕战胜, 吕瑞, 高守波, 等. 慢性咳嗽患儿咽喉反流状况分析[J]. 当代医学, 2020, 26(12):141-142. DOI:10.3969/j.issn.1009-4393.2020.12.060.
[21]	Patel DA, Blanco M, Vaezi MF. Laryngopharyngeal reflux and functional laryngeal disorder:perspective and common practice of the general gastroenterologist[J]. Gastroenterol Hepatol (N Y), 2018, 14(9):512-520. PMID:30364386. PMCID:PMC6194652.
[22]	Chang AB, Robertson CF, van Asperen PP, et al. A cough algorithm for chronic cough in children:a multicenter, randomized controlled study[J]. Pediatrics, 2013, 131(5):e1576-e1583. DOI:10.1542/peds.2012-3318. PMID:23610200.
[23]	韩红蕾, 赵建辉, 张艳丽, 等. Dx-pH检测系统在咽喉反流性疾病中的初步应用[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(9):666-670. DOI:10.3760/cma.j.issn.1673-0860.2016.09.006. PMID:27666704.
[24]	王嘉森, 李进让. 24小时多通道腔内阻抗-pH监测和Dx-pH监测诊断咽喉反流的比较研究[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(4):270-275. DOI:10.3760/cma.j.issn.1673-0860.2018.04.006. PMID:29747251.
[25]	Gupta N, Green RW, Megwalu UC. Evaluation of a laryngopharyngeal reflux management protocol[J]. Am J Otolaryngol, 2016, 37(3):245-250. DOI:10.1016/j.amjoto.2016.01.008. PMID:27178517.