Correlation Of The Expression Of Pepsin In Vocal Fold Lesions With Laryngopharyngeal Reflux

Background and Objective :Vocal fold lesions vary from benign to malignant.Recently,the role of 1aryngopharyngeal reflux(LPR) in the pathogenesis of laryngeal disorders has been emphasized.Despite years of research into this topic,it remains unclear whether reflux laryngitis is a independent risk factor for laryngeal disease.Papers have reported that the incidence of LPR is between 10% and 15% among the outpatients.In LPR,gastric contentsmanily acid and pepsin-pass through the upper oesophageal sphincter and damage the pharyngeal and the laryngeal mucosa.Pepsin taken up by epithelial cells by receptor mediated endocytosis can be used as a specific maker to detect whether there is LPR.In clinical work, the main methods we used to check laryngopharyngeal reflux are 24-hour p H monitoring,reflux symptom index( RSI) and reflux finding score(RFS). 24-hour p H monitoring is recognized as the "standard", but this way is invasion,costy and some patients can not tolerate.It’s hard to be widly used.RSI and RFS are convenient, noninvasive, relatively high rate way to detect LPR. Doctors can make a diagnose according to whether patients with symptoms and signs. And this paper using RSI and RFS as the standard of diagnosis of laryngopharyngeal reflux.Objective:Results of reflux symptom index(RSI) and reflux finding score(RFS) were used as the standard for diagnosis of LPR.To investigate the expression of the pepsin immunohistochemical(IHC) staining in laryngeal mucosa;the relationship between pepsin and LPR in the laryngeal musoca;the ability of pepsin immunohistochemistry in laryngeal mucosa to diagnose laryngopharyngeal reflux;and the correlation between the results of RSI and RFS and the expression of pepsin. Methods:Patients:the complains of patients were hoarseness, patients with vocal fold lesionsons by fiber laryngoscopy were checked in the ENT department of Second affiliated hospital of Jilin university from September 2014 to January 2016.Surgical indications were applied to each patient and the patients agreed with surgery to remove the lesions.After surgery,tissues were send to have pathological diagnosis.Method: a. patients were asked to finish the RSI questionnaire by the direction of doctors,and were examined by laryngoscope to expose laryngeal mucosal abnormalities.According to the laryngoscopy,RFS were filled in by otolaryngologists. Subjects comprising the 1aryngopharyngeal reflux were individuals who had an RSI>13 or RFS≥7,and the Non-laryngopharyngeal reflux were patients who had an RSI≤13 and RFS<7.b.Tissues were cut off to examine the expression of pepsin by immunohistochemistry(IHC). Results:70 cases(45 males and 25 females,age range: 21-76 years;mean age:49.27±11.25 years)were included to this study.LPR:28 persons and Non-LPR:42 persons.LPR patients demonstrated much higher levels of pepsin in their laryngeal mucosa compared with the non-LPR patients.Significant difference in pepsin expression level was found between two groups.ROC curve for parameters, with AUC of 0.702(P=0.004).when positivity was used as a cutpoint, the positive pepsin IHC reaction in the laryngeal mucosa had a sensitivity of 64.3% and specificity of 78.6% in diagnosis of LPR.RSI and RFS scale scores of and immunohistochemical results show weakly positive correlation(r = 0.347, P = 0.003; r = 0.361, P = 0.002). Conclusion:Generally speaking,patients with LPR are found high level expression of pepsin in laryngeal mucosa.Finding pepsin by IHC is a sensitive and specific way to diagnose LPR,and it can be served as a rapid,effective and simple method to diagnose LPR.