Objective: To investigate the daily variation of LPR and the significance of 48-hour oropharyngeal pH monitoring in the diagnosis of LPRD. Methods: 72 subjects with suspected LPRD who were treated in our department from June 2018 to June 2021 were included. All patients were hospitalized to complete continuous 48-hour oropharyngeal Dx-pH monitoring. The consistency of Ryan index and W index and the correlation of various reflux parameters between the first and second 24-hour were compared. SPSS 24.0 was used for statistical analysis. Results: All 72 subjects successfully completed 48-hour oropharyngeal Dx-pH monitoring. Ryan index was positive in 11 cases (15.2%) in the first 24-hour, in 17 cases (23.6%) in the second 24-hour, in 5 cases (6.9%) both first and second, and in 23 cases (31.9%) in either 24-hour, Kappa=0.211 (P=0.064), 18 cases (25%) had inconsistent results of the first 24-hour and the second 24-hour, and there was no significant difference in the positive rate between the first and second (P=0.234). The number of positive cases in 48-hour monitoring increased by 109.1% compared with 24-hour monitoring.For W index, 49 cases (68.1%) were positive in the first 24-hourf 53 cases (73.6%) were positive in the second 24-hour, 42 cases (58.3%) were positive both first and second, and 58 cases (80.6%) were positive in either 24-hour, Kappa=0.477 (P<0.001), 16 cases (22.2%) had inconsistent results of the first and second, and there was no significant difference in the positive rate between the first and second (P=0.804). The number of positive cases in 48-hour monitoring increased by 18.4% compared with 24-hour monitoring. There was no significant difference in all the reflux parameters of first and second (P>0.05). The correlation comparison showed that the correlation of various reflux parameters in the upright position was lower than that in the supine position. Conclusion: Laryngeal reflux has daily variability. Extending the monitoring time of Dx-pH to 48-hour can help reduce the missed diagnosis caused by daily variability; the use of W index can reduce the influence of daily variability on the diagnostic results of LPRD.
目的： 探索咽喉反流日变异来源及48 h口咽动态pH监测（Dx-pH监测）在咽喉反流性疾病（LPRD）诊断中的价值。 方法： 回顾性分析2018年6月至2021年6月在战略支援部队特色医学中心耳鼻咽喉头颈外科就诊的72例疑似LPRD患者资料，男43例，女29例，年龄19~74（50.4±15.1）岁。所有患者均住院完成连续48 h口咽Dx-pH监测，比较前后2个24 h的Ryan指数、W指数的一致性及各项反流参数的相关性，使用SPSS 24.0软件进行统计学分析。 结果： 72例研究对象均顺利完成48 h Dx-pH监测，Ryan指数前24 h阳性11例（15.2%），后24 h阳性17例（23.6%），前后均阳性5例（6.9%），任一个24 h阳性23例（31.9%），Kappa=0.211，P=0.064，前后结果不一致的有18例（25%），前后阳性率差异无统计学意义（P=0.234），48 h监测较24 h监测阳性例数增加109.1%。W指数前24 h阳性49例（68.1%），后24 h阳性53例（73.6%），前后均阳性42例（58.3%），任一个24 h阳性58例（80.6%），Kappa=0.477，P<0.001，前后结果不一致的有16例（22.2%），前后阳性率差异无统计学意义（P=0.804），48 h监测较24 h监测阳性例数增加18.4%。前后各项反流参数差异均无统计学意义（P>0.05）。相关性比较显示，立位各项反流参数相关性较低，卧位各项反流参数相关性较高。 结论： 咽喉反流有日变异性，将Dx-pH监测时间延长至48 h有助于减少日变异性导致的漏诊。.