摘要: |
目的对慢性鼻-鼻窦炎(CRS)患者进行咽喉反流量表评估,并探讨鼻腔-鼻窦结局测试22条(the sino-nasal outcome test-22,SNOT-22)与反流症状指数量表(the reflux symptom index,RSI)之间的相关性,以及RSI、反流体征指数量表(the reflux finding score,RFS)在慢性鼻-鼻窦炎人群中的应用价值。方法选取我院2014年11月至2015年6月住院治疗的CRS患者共96例,其中鼻窦炎伴息肉者44例(即CRSw NP组),鼻窦炎不伴息肉者52例(CRSs NP组),另于体检中心随机选取53例无鼻炎/鼻窦炎病史的体检居民作为正常对照组,对受试者进行视觉模拟评分(VAS)、SNOT-22、Lund-Mackay CT评分、RSI以及RFS评分。分析三组间各项得分有无统计学差异;并利用直线相关统计学方法分析SNOT-22量表中的流脓涕、必须擤鼻涕、涕后漏、打喷嚏以及流清涕这五项与RSI量表中的声嘶/发声疲劳、反复咽部异物感、持续清嗓、咽干/分泌物多、反酸/烧心/胃部不适这五项指标之间的相关性。结果所有受试者RFS得分仅1例≥7分。RSI≥13分的结果为CRSw NP组有15.91%(7/44),CRSs NP组有23.08%(12/52),对照组有3.77%(2/53),其中CRSw NP组与CRSs NP组之间差异无统计学意义(P>0.05),且CRSw NP组和CRSs NP组均明显大于对照组(ZCRSw NP=1.99>Z0.975,ZCRSs NP=3.02>Z0.975)。RSI≥10分的结果为:CRSw NP组有18.18%(8/44),CRSs NP组有34.62%(18/52),对照组有3.77%(2/53),其中CRSw NP组与CRSs NP组之间差异无统计学意义(P>0.05),CRSw NP组和CRSs NP组均明显大于对照组(ZCRSw NP=2.26>Z0.975,ZCRSs NP=4.35>Z0.975)。SNOT-22的前10项症状总分(脓鼻涕、需要擤涕、头昏、面痛及压迫感、涕后漏、喷嚏、流清涕、咳嗽、耳胀、耳痛)与RSI总分之间的相关性如下(P<0.01):CRSw NP组正相关(r=0.461);CRSs NP组正相关(r=0.67);对照组无相关性。SNOT-20量表中的部分指标与RSI中的部分指标相关性如下(P<0.05):CRSw NP组中流脓涕与反酸(r=-0.37,P<0.05)成负相关;涕后漏与声嘶/发声疲劳(r=0.3)、咽异物感(r=0.42)成正相关。CRSs NP组流脓涕与咽异物感(r=0.362)、清嗓(r=0.418)成正相关;涕后漏与咽异物感(r=0.36)、清嗓(r=0.47)、咳嗽(r=0.455)、咽干/分泌物多(r=0.559)、反酸/烧心/胃不适(r=0.47)成正相关;喷嚏与声嘶/发声疲劳(r=0.306)、咽异物感(r=0.392)正相关。VAS量表中的鼻分泌物/涕后漏与RSI中的咳嗽成正相关(r=0.351)。结论CRS(伴/不伴息肉)患者咽喉反流症状得分高于对照组人群,且鼻部症状总分越高,咽喉部症状总分也越高,二者之间存在正相关性。这两个量表在鼻部及咽部症状之间存在一定的交叉影响,或存在着潜在的因果关系,将RSI量表应用于调查CRS患者的咽喉反流情况可能会得到不准确的结果。 |
关键词: SNOT-22 RSI 咽喉反流 慢性鼻-鼻窦炎 症状量表 |
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基金项目:四川省科技厅应用基础计划项目(编号:2015JY0256) |
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Analysis of Whether the Laryngopharyngeal Reflux Symptom Scale Can be Used to Evaluate Reflux in Chronic Rhinosinusitis |
Huang Shi;Zhu Li;Ren Jianjun1,2
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1.Department of Otorhinolaryngology and Head and Neck Surgery,The First Affiliated Hospital of Chengdu Medical College;2.Department of Otorhinolaryngology and Head and Neck Surgery,West China Hospital,Sichuan University
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Abstract: |
ObjectiveTo evaluate the chronic rhinosinusitis(CRS)patients using Laryngopharyngeal Reflux Symptom Scale and to discuss the correlation between the sino-nasal outcome test-22(SNOT-22)and the reflux symptom index(RSI)and the application value of RSI and the reflux finding score(RFS)in CRS population.Methods 96 CRS patients received and treated in our hospiotal November 2014 to June 2015,were selected,including 44 patients with sinusitis and polyps(CRSw NP group),52 patients with sinusitis but not polyps(CRSs NP),and 53 randomly selected healthy residents in the physical examination center with no history of rhinitis/sinusitis as normal control group.Visual analogue score(VAS),SNOT-22,Lund-Mackay CT score,RSI and RFS were performed among them.Each scores were compared among groups,and correlation between purulent snot,necessity to blow nose,postnasal drips of snot,sneeze as well as clear snot of SNOT-22 and hoarseness/phonation fatigue,repeated foreign body sensation in pharynx,continual clearing throat,dry throat/much secretion as well as acid regurgitation/heartburn/stomach discomfort of RSI were analyzed by rectilinear correlation.Results As for all subjects in this study,only 1 person scored≥7 in RFS.As for persons who scored≥13 in RSI,they covered 15.91%(7/44)in CRSw NP group,23.08%(12/52)in CRSs NP group and3.77%(2/53)in control group,the difference between CRSw NP group and CRSs NP group being not statistically significant(P>0.05),but scores of both CRSw NP group and CRSs NP group being significantly higher than control group(ZCRSw NP=1.99>Z0.975,ZCRSs NP=3.02>Z0.975).As for persons who scored≥10 in RSI,they covered 18.18%(8/44)in CRSw NP group,34.62%(18/52)in CRSs NP group and 3.77%(2/53),the difference between CRSw NP group and CRSs NP group being not statistically significant(P>0.05),but scores of both CRSw NP group and CRSs NP group being significantly higher than control group(ZCRSw NP=2.26>Z0.975,ZCRSs NP=4.35>Z0.975).Correlation analysis between total score of the top 10 symptoms of SNOT-22(purulent nose,necessity to blow nose,dizziness,facial pain and compression,postnasal drips of snot,sneeze,clear snot,cough,ear fullness and otalgia)and total score of RSI(P<0.002)showed that there was positive correlation in CRSw NP(r=0.461),positive correlation in CRSs NP group(r=0.67)and no correlation in control group.Correlation analysis between some indexes in SNOT-22 and some indexes in RSI(P<0.05)showed that in CRSw NP group,purulent snot had negative correlation with acid regurgitation(r=-0.37,P<0.05),postnasal drips of snot had positive correlation with hoarseness/phonation fatigue(r=0.3)and foreign body sensation in pharynx(r=0.42)and in CRSs NP group,purulent snot had positive correlation with foreign body sensation in pharynx(r=0.362)and clearing throat(r=0.418),postnasal drips of snot had positive correlation with foreign body sensation in pharynx(r=0.36),clearing throat(r=0.47),cough(r=0.455),dry throat/much secretion(r=0.559)and acid regurgitation/heartburn/stomach discomfort(r=0.47),and sneeze had positive correlation with hoarseness/phonation fatigue(r=0.306)and foreign body sensation in pharynx(r=0.392).Nasal secretion/postnasal drips of snot in VAS had positive correlation with cough in RSI(r=0.351).Conclusion CRS patients with or without polyps scored higher in laryngopharyngeal reflux symptom scale than persons in control group,and there is a positive correlation between nasal symptoms and laryngopharyngeal symptoms,that is the higher nasal symptoms scored,the higher laryngopharyngeal symptoms scored.There is cross impact or potential causality between RSI and SNOT-22 as for nasal symptoms and laryngopharyngeal symptoms,so applying RSI to investigating laryngopharyngeal reflux in CRS patients may lead to inaccurate results. 更多 |
Key words: SNOT-22 RSI laryngopharyngealreflux chronicrhinosinusitis symptomscale |