本文選題：分泌性中耳炎 + 胃食管反流病��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:胃食管反流病(gastro-esophageal reflux disease,GERD)常引起許食管外癥狀,如呼吸道癥狀、咽部癥狀,甚至導(dǎo)致哮喘癥狀。隨著分泌性中耳炎患者中耳積液中胃內(nèi)容物(胃蛋白酶、胃蛋白酶原、HP、膽汁酸等)的檢出,有人提出GERD與分泌性中耳炎(secretory otitis media,SOM)發(fā)病有關(guān)。GERD與分泌性中耳炎是否相關(guān)及其相互作用機制成為近年研究熱點。本研究的目的是比較GERD在SOM及非SOM中的患病率,明確SOM與GERD的相互關(guān)系及GERD相關(guān)性中耳炎與年齡關(guān)系,GERD是否為SOM發(fā)病原因,二者的關(guān)系尚不明確,明確其相互關(guān)系可為臨床耳鼻咽喉科醫(yī)生提高SOM的診治率提供新的理論依據(jù)。方法:對2013年9月至2016年9月在天津醫(yī)科大學(xué)第一中心醫(yī)院耳鼻喉科門診及住院確診的52例(59耳)初發(fā)或復(fù)發(fā)SOM患者的臨床資料進行分析,患者病程2月-4年不等,除外胃腸腫瘤、鼻咽部腫瘤患者、腺樣體肥大、扁桃體肥大≥II°者,除外合并先天性胃腸道畸形、免疫功能低下、腦癱、腦外傷合并腦積液漏者等疾病者。并以52例非SOM的健康體檢人群作為對照組。對所有入組者進行電子耳鏡、聲阻抗、電測聽、24h食管pH監(jiān)測或胃鏡檢查或GerdQ評分進行GERD診斷。將SOM組伴有GERD的患者人數(shù)與對照組GERD的人數(shù)比較,分析GERD與SOM相關(guān)性。采用酶聯(lián)反應(yīng)免疫吸附法(ELISA法)對SOM組中耳積液進行胃蛋白酶檢測,酶標(biāo)儀測定其含量。根據(jù)比較SOM組GERD患者與無GERD患者胃蛋白酶陽性率,并對GERD相關(guān)SOM可能發(fā)病機制進行討論。最后對SOM組患者年齡與GERD的相關(guān)性進行分析。全部數(shù)據(jù)采用SPSS19.0進行分析。結(jié)果:52例SOM患者中有35例患有GERD,無GERD 17例SOM中GERD陽性率為67.3%。52例對照組中共診斷出GERD患者6名,其陽性率為11.54%。SOM組與對照組GERD陽性率比較差異有統(tǒng)計學(xué)意義(p0.05)。GERD患者鼓室積液中檢出胃蛋白酶陽性者19例,平均濃度為246.6±229.4 ng/mL,陽性率為54.29%;無GERD患者鼓室積液中檢出胃蛋白酶陽性者1例,濃度為195.2 ng/mL,陽性率為5.88%。采用卡方檢驗對兩組胃蛋白酶陽性率進行比較,差異有統(tǒng)計學(xué)意義(x2=11.33,P㩳0.05)。SOM組患者年齡與GERD的關(guān)系進行分析,發(fā)現(xiàn)其發(fā)病率在青年、老年、學(xué)齡期及學(xué)齡前中的患病比例依次增加。結(jié)論:GERD在SOM患者的發(fā)病率高于非SOM患者,從而推測GERD可能是分泌性中耳炎發(fā)病因素之一,且SOM患者鼓室積液中可檢出胃蛋白酶,GERD組胃蛋白酶的陽性率和絕對數(shù)值都較高說明胃蛋白酶在SOM的發(fā)病及病理過程中發(fā)揮了重要的作用。這對于臨床診治GERD引起的分泌性中耳炎提供了理論依據(jù)。年齡因素影響GERD相關(guān)性SOM的發(fā)病,由此可推測解剖機能發(fā)育、機體的免疫等在其發(fā)病中發(fā)揮了作用。
[Abstract]:Objective: gastroesophageal reflux disease (GERD) often causes extraesophageal symptoms, such as respiratory symptoms, pharyngeal symptoms, and even asthma symptoms. With the detection of gastric contents (pepsin, pepsinogen, bile acid, etc.) in the middle ear effusion of patients with secretory otitis media, It has been suggested that the relationship between GERD and secretory otitis mediaSom (Som) and the relationship between GERD and secretory otitis media and its interaction mechanism have become a hot topic in recent years. The purpose of this study was to compare the prevalence of GERD in SOM and non-SOM, and to determine the relationship between SOM and GERD and whether GERD-associated otitis media and age were the causes of SOM. The relationship between GERD and GERD was not clear. Clarifying their relationship can provide a new theoretical basis for clinical otolaryngologist to improve the diagnosis and treatment rate of SOM. Methods: from September 2013 to September 2016, the clinical data of 52 patients with initial or recurrent SOM in Otolaryngology Department, first Central Hospital of Tianjin Medical University were analyzed. The course of disease ranged from 2 months to 4 years. Patients with gastrointestinal neoplasms, nasopharyngeal neoplasms, adenoid hypertrophy and tonsil hypertrophy 鈮，

本文編號：2020909