Correlation Of Refractory LPRD With Anxiety,depression And Autonomic Nervous Function

Objective: To investigate the correlation between laryngopharyngeal reflux disease(LPRD)with anxiety and depression status and autonomic nervous function.Methods:(1)Choose the patients who admitted to the Department of Otolaryngology of our hospital who were diagnosed with LPRD and had been given proton pump inhibitor(PPI)standard treatment for at least 2 months without significant improvement of symptoms.Twenty-eight eligible patients were enrolled.Fill in the reflux symptom index(RSI)based on symptoms,and fill in the reflux finding score(RFS)based on electronic laryngoscopy signs.(2)All the enrolled patients went to the Mental Health Department to finish the self-rating anxiety scale(SAS)and the self-rating depression scale(SDS)in order to evaluate the status of anxiety and depression.(3)The enrolled patients were sent to the department of electrocardiography to detect 24-hour dynamic electrocardiogram examination and 24-hour long-duration heart rate variability(HRV)analysis.HRV was used to evaluate whether there were autonomic nervous dysfunction.The heart rate variability was measured in time domain,including the mean standard deviation of 24 h sinus interval(SDNN),the mean standard deviation of every 5min sinus interval(SDANN),and the mean root division of the difference between adjacent sinus intervals(RMSSD).Frequency domain indicators: low frequency power(LF)and high frequency power(HF),low frequency power to high frequency power ratio(LF/HF).(4)All the enrolled patients were treated with PPI(esomeprazole 20 mg,bid)combined with Delixin(1 tablet,qd),and the treatment effect was evaluated after 1 month of standard medication.Results: Among the 28 patients with refractory laryngopharyngeal reflux disease,about 67.9% were female patients,with an average age of about 45.3±8.4years.About 32.1% of the patients were male,with a mean age of about 40.0±10.4years.There were no significant differences in gender,age and degree of anxiety and depression among refractory LPRD patients(all P > 0.05).2.Among the 28 refractory LPRD patients,moderate and severe pharyngeal foreign body sensation(96.4%)and persistent throat clearing(69.7%)were the main symptoms;The reflux signs were moderate to severe mucous attachment in the larynx(100%)and laryngeal mucosal erythema/congestion confined to arytenoid cartilage(100%).3.RSI was positively correlated with SAS and SDS scores(r = 0.733,P < 0.05;R= 0.797,P < 0.05),there was no significant correlation between RFS and SAS and SDS scores(r =-0.066,P > 0.05;R =-0.029,P > 0.05).4.Among the 28 patients with refractory LPRD,17 patients(60.7%)were SAS/SDS positive,and 11patients(39.3%)were SAS/SDS negative.The RSI score was 16.76±1.64 in SAS/SDS positive group and 14.82±1.08 in SAS/SDS negative group,and the difference was statistically significant(P < 0.05).RFS score of SAS/SDS positive group(8.24±1.03)and SAS/SDS negative group(8.45±1.57)was not statistically significant(P > 0.05).5.There were 8 cases of abnormal SDNN,accounting for about 28.6%;There were 7 cases of SNANN abnormality,accounting for about25.0%.8 cases of RMSSD were abnormal,accounting for 28.6%.There were 22 abnormal cases of LF,accounting for 78.6%.There were 26 abnormal HF cases,accounting for about 92.3;There were 16 cases of LF/HF abnormality,accounting for 57.1%.6.In comparison of HRV indexes between SAS/SDS(+)group and SAS/SDS(-)group,SDNN were(120.65±26.95)ms and(151.00±40.24)ms,and SDANN were(110.06±27.06)ms and(140.73±36.44)ms,respectively.There were statistically significant differences in indexes(P < 0.05).The remaining RMSSD were(23.47±6.97)ms,(29.00±12.98)ms,and the LF were(396.89±209.23)ms2,(584.87±416.82)ms2,respectively.HF were(251.21±135.99)MS2,(357.09±303.09)MS2,and LF/HF were(1.70±0.53)and(2.11±0.98),respectively,with no statistically significant difference(P > 0.05).7.The RSI scores before treatment were 16.76±1.64 in SAS/SDS positive group and14.82±1.08 in SAS/SDS negative group,and the difference was statistically significant(P < 0.05).RFS score of SAS/SDS positive group(8.24±1.03)and SAS/SDS negative group(8.45±1.57)was not statistically significant(P > 0.05).After treatment,the RSI scores of SAS/SDS positive group(8.18±0.81)and SAS/SDS negative group(8.45±1.57)were not statistically significant(P > 0.05).RFS score of SAS/SDS positive group(3.82±0.73)and SAS/SDS negative group(3.64±0.67)was not statistically significant(P > 0.05).Conclusion: 1.The symptoms and signs of laryngopharyngeal reflux were characteristic,and the main symptoms were pharyngeal foreign body sensation and continuous throat clearing.The main signs were sticky mucus in the larynx and erythema and congestion in the larynx mucosa.2.The severity of reflux symptoms is closely related to the state of anxiety and depression.The more severe the anxiety and depression symptoms are,the more serious the reflux symptoms are.3.Patients with refractory LPRD had a higher incidence of anxiety and depression symptoms;Most of the patients had autonomic nervous dysfunction.4.Anxiety and depression affect the balance of autonomic nervous function.5.Delexin combined with PPI can effectively treat refractory LPRD.