Association Between Laryngopharyngeal Reflux Disease And Autonomic Nerve Dysfunction

Objective:To investigate the autonomic nervous function state of patients with laryngopharyngeal reflux disease(LPRD),and to clarify the association between laryngopharyngeal reflux disease and autonomic nerve dysfunction.Methods:The patients who were likely to be LPRD in the outpatient department were scored by the reflux symptom index scale(RSI)and the reflux finding score(RFS).A 5minute short-term heart rate variability(HRV)tests were performed for 81 patients suspected of LPRD with RSI>13 and RFS>7 points.The detection indicators include:frequency domain:low-frequency power(LF,0.04-0.15 Hz),and high-frequency power(HF,0.15-0.40Hz),the ratio of low frequency power and high frequency power(LF/HF),total power(TP),the ratio of low frequency power to total power(LF%),the ratio of high frequency power to total power(HF%),normalized low-frequency power(LFnu),normalized high-frequency power(HFnu);time domain:standard deviation of the NN intervals(SDNN),the root mean square of difference between adjacent NN intervals(RMSSD).All the patients were treated with proton pump inhibitors.Patients with effective treatment were diagnosed as LPRD and were finally included in the LPRD group,a total of 53 cases.Compared with 55 healthy volunteers,we further analyzed the relationship between the degree of autonomic nerve dysfunction and reflux symptom index score and reflux finding score,according to the results of autonomic nervous function evaluation.Results:1.RMSSD(41.10±10.90)ms,HF(638.25±283.10)ms~2,HFnu(36.98±10.72)nu,HF%(23.04±9.32)in the LPRD group were lower than the RMSSD(45.91±12.97)ms and HF(803.15±218.09)ms~2,HFnu(42.68±11.87)nu,HF%(28.18±8.27)in the control group,and the difference was statistically significant(P<0.05);2.SDNN(57.83±10.41)ms,TP(2773.13±997.26)ms~2,LF(1197.47±776.53)ms~2 in the LPRD group was lower than SDNN(59.05±13.37)ms,TP(3005.16±1039.46)ms~2,LF(1289.62)±901.37)ms~2 in the control group,the difference was not statistically significant(P>0.05);3.LFnu(63.02±10.72)nu and LF/HF(1.99±1.08)in the LPRD group were significantly higher than those in the control group(57.30±11.87)nu and LF/HF(1.57±0.93),and the difference was statistically significant(P<0.05).LF%(40.34±15.67)in the LPRD group was higher than in the control group(39.81±14.53),the difference was not statistically significant(P>0.05);4.The RSI score,RFS,and the course of disease were all in negative linear correlation with HF value(r=-0.89,-0.77,-0.315,P<0.05);there was a positive linear correlation between the course of disease and LF/HF value(r=0.315,P<0.05).Conclusion:Patients with LPRD have autonomic nerve dysfunction,which is mainly associated with the reduction of vagal activity.The severity of LPRD was significantly correlated with autonomic nerve dysfunction,especially negatively correlated with vagal activity.