Objective: To investigate the correlation between gastric bubble size and laryngopharyngeal reflux pattern in patients with laryngopharyngeal reflux disease(LPRD). Methods: A total of 52 LPRD patients who underwent Dx-pH monitoring and anteroposterior chest radiography at the same time from February 2016 to November 2018 were retrospectively studied. Patients were devided into three position-related groups according to the Ryan score of upright and supine: isolated upright reflux(IUR), isolated supine reflux(ISR) and bipositional reflux(BR) groups. In addition, 13 healthy volunteers with negative pH monitoring were selected as the control group. Gastric bubble size and pH monitoring data among the four groups were compared. SPSS 24.0 was used for statistical analysis. Results: In all the 52 patients, 35 cases (67.3%) were classified as IUR, 9 cases (17.3%) as ISR, and 8 cases (15.4%) as BR. The height of gastric bubbles in the four groups were: IUR (26±14) mm, ISR (9±8) mm, BR (20±13) mm, control (17±15) mm, and statistical difference was found among the four groups(P=0.004). Post Hoc Multiple Comparisons found that IUR group had statistical difference between ISR group and control group (P=0.001, P=0.034 respectively). There was no statistical difference of gastric bubble width and area among the four groups(P=0.340, P=0.186 respectively). The ROC curve of the gastric bubble height with isolated upright and supine reflux patterns was obtained, and the optimal cutoff value of the gastric bubble height was 11 mm. Accordingly, we divided the patiens into two groups with high and low gastric bubble. LPRD reflux pattern distribution was significantly different between the two groups(P<0.001). The comparison of reflux parameters in pH monitoring also showed that the supine reflux parameters in the lower group were significantly higher than those in the higher group, and the upright reflux parameters in the higher group were significantly higher than those in the lower group(P<0.001). Conclusions: The height of gastric bubble is significantly correlated with the reflux patterns in LPRD patients. The gastric bubble of patients with IUR is significantly higher than that of patients with ISR. Taking 11 mm as the cutoff value, patients with higher gastric bubble are more prone to upright laryngopharyngeal reflux, while those with lower gastric bubble are more prone to supine laryngopharyngeal reflux.
目的： 探究胃泡大小与咽喉反流性疾病（LPRD）患者的反流模式的相关性。 方法： 回顾性研究2016年2月至2018年11月间，在战略支援部队特色医学中心就诊，有咽喉反流（LPR）症状且同时接受Dx-pH监测和立位胸片检查的患者，纳入Dx-pH监测阳性且胸片上胃泡可判读的52例作为病例组，然后根据pH监测将病例组分为单纯立位阳性组、单纯卧位阳性组和双体位阳性组。选取pH监测阴性的13名健康志愿者作为对照组，比较组间一般状况、胃泡测量数据及pH监测数据。 结果： 共52例患者纳入研究，其中单纯立位阳性35例（67.3%）、单纯卧位阳性9例（17.3%）、双体位阳性8例（15.4%）。四组胃泡高度分别为：单纯立位阳性组（26±14）mm、单纯卧位阳性组（9±8）mm、双阳性组（20±13）mm、对照组（17±15）mm，四组间比较差异有统计学意义（均P=0.004），单纯立位阳性组、双体位阳性组和单纯卧位阳性组呈递减趋势，两两比较显示单纯立位组与单纯卧位组间差异有统计学意义（P=0.001），单纯立位组与对照组间差异有统计学意义（P=0.034）。胃泡宽度和胃泡面积比较呈现同样趋势，但差异无统计学意义（P=0.340，P=0.186）。以LPRD单纯立位和单纯卧位反流模式与胃泡高度做ROC曲线，得出胃泡高度的最佳分类界值为11 mm，依此将病例组分为高、低胃泡两组，两组间LPRD反流模式分布比较差异有统计学意义（P<0.001），其中高胃泡组单纯立位反流比例显著高于低胃泡组，低胃泡组单纯卧位反流比例显著高于高胃泡组。pH监测的反流参数比较同样显示：低胃泡组的卧位反流参数均高于高胃泡组，高胃泡组的立位反流参数均高于低胃泡组，差异均有统计学意义（均P<0.001）。 结论： 胃泡高度与LPRD患者反流模式存在显著相关性。单纯立位反流患者的胃泡显著高于单纯卧位反流患者，以11 mm为界值，高胃泡较易发生立位LPR，低胃泡较易发生卧位LPR。.
Keywords: Laryngopharyngeal reflux; Posture; Radiography, thoracic; pH monitoring.