| Objectives Laryngeal cancer is a common malignant tumor in otolaryngology and it is a kind of multi-factor pathogenic tumor.It is important to make clear the cause of laryngeal cancer.As the medical community continues to explore the causes of laryngeal cancer,some scholars have proposed that laryngeal reflux may be one of the important factors in the pathogenesis of laryngeal cancer.High resolution esophageal pressure measurement(HREM)was performed on the subjects.The 24-hour multichannel intraluminal impedance-pH monitoring results were used as the determination criteria for laryngeal reflux,to explore the value of RSI scale for laryngeal reflux.Through the comparative analysis of the detection results of pepsin concentration in laryngeal sputum of the vocal cord cancer group,vocal cord polyp group and the normal control group,the laryngeal reflux of the three groups was investigated.In this way,we explore the value of detection of pepsin concentration in saliva or sputum in diagnosing LPR.The correlation between laryngeal reflux and laryngeal cancer was investigated by analyzing the expression intensity of pepsin in tumor tissue samples of vocal cord cancer and benign lesion tissue samples of vocal cord polyps.Methods Patients who were first diagnosed with squamous cell carcinoma of the vocal cords by pathological examination in the otolaryngology department of Tangshan People's Hospital affiliated to North China University of Science and Technology between June 2018 and June 2019 were collected as the vocal cord cancer group.Meanwhile,the patients who were first diagnosed as vocal polyps in the otolaryngology department of the hospital and confirmed as vocal polyps by pathological examination were collected as vocal polyps group,and healthy volunteers were recruited as normal controls.All patients completed the Chinese RSI scale in combination with their symptoms and severity for self-scoring,then high resolution esophageal pressure measurement(HREM)monitoring was completed to them and underwent 24-hour MII-pH monitoring.Sputum samples from the larynx of patients and healthy group were collected and the concentration of pepsin was monitored according to the uniform method.Immunohistochemical staining was used to monitor the expression level of pepsin in the lesion tissues of the vocal cord carcinoma group and the vocal cord polyp group,and the chromogenic intensity of pepsin in the immunohistochemical staining tissues was determined by referring to the Formwitz scoring method.Results 1 RSI score of the three groups was significantly different(P<0.05),and RSI score of the vocal cord cancer group was higher than that of the vocal cord polyp group and the normal control group,with statistically significant difference(P<0.05).RSI score of vocal cord polyp group was not significantly different from that of normal control group(P>0.05).RSI score ?13.0 was used as the diagnostic index of laryngopharyngeal reflux positive,with a sensitivity of 59.5% and specificity of 71.4%.The Youden index was 0.309.2 Analysis of results of high resolution usion manometry(HREM),The UESP value of vocal cord cancer group was lower than that of vocal cord polyp group,and the difference was statistically significant(P<0.05);The vocal cord cancer group was lower than the control group,and the difference was also statistically significant(P<0.05);There was no significant difference in UESP value between vocal cord polyp group and control group(P>0.05);There was no significant difference in LESP,DCI and DL between the three groups(P>0.05).3 Analysis of 24-hour MII-pH monitoring data showed that the frequency of laryngopharyngeal acid reflux was significantly different among the three groups(P<0.05),and this index was higher in the group of vocal cord carcinoma than in the group of vocal cord polyp and control group and the difference was statistically significant(P<0.05),and there was no significant difference between the vocal cord polyp group and the control group(P>0.05).The number of laryngeal acid reflux ?2 was used as the criterion for the determination of positive laryngeal reflux,and the positive rate of laryngeal reflux was compared among the three groups with statistically significant difference(P<0.05).The positive rate of laryngopharyngeal reflux in the vocal cord cancer group was higher than that in the vocal cord polyp group and control group,the difference was statistically significant(P<0.01),and the positive rate of laryngopharyngeal reflux in the vocal polyp group was not significantly different from that in the control group(P>0.05).4 There was a statistically significant difference in the concentration of pepsin in saliva between the three groups(P<0.05),and the concentration of pepsin in saliva of the vocal cord cancer group was higher than that of the vocal cord polyp group and the control group(P<0.05).There was no significant difference in the concentration of pepsin in saliva between the vocal cord polyp group and the control group(P>0.05).The concentration of pepsin in 98 saliva samples collected was measured as the subject(ROC curve).The cut-off point(out-off)was 23.57ng/ml.The concentration of pepsin in saliva > 23.57ng/ml was used as positive determination for laryngopharyngeal reflux,with a sensitivity of 88.1% and specificity of 85.7%.The Youden index was 0.738,and the area under ROC curve(AUC)was 0.792(95%CI: 0.651~0.934,P=0.002).5 Pepsin in the immunohistochemical staining tissues was higher than that in the polyp group,with a statistically significant difference(P<0.05).The positive rate of pepsin expression in the vocal cord cancer group was significantly higher than that in the vocal cord polyp group(P < 0.05).6 Pepsin immunohistochemical scores were positively correlated with the number of laryngeal acid reflux(r=0.533,P < 0.005).Conclusions 1 laryngopharyngeal reflux is associated with vocal cord cancer,and pepsin may be one of the risk factors for the development of vocal cord cancer.2 The positive rate of laryngopharyngeal reflux,the times of laryngeal acid reflux and the concentration of pepsin in saliva of the patients with vocal cord polyps were not significantly different from the control group.3 The monitoring of pepsin concentration in saliva can be used as an objective and effective indicator for the diagnosis of laryngeal reflux.4 The reflux symptom index(RSI)scale score was used for the positive diagnosis of laryngopharyngeal reflux,with a low sensitivity in this study.5 Abnormal function of esophageal sphincter may be one of the causes of laryngeal reflux.Figure 13;Table 15;Reference 78... |
PDF Full Text Request