一种bstract
唾液百辛(Peptest)的检测可以是诊断气道回流的有用附件http://ow.ly/t7b0l.
到编辑:
诊断测试Peptest(RD Biomed Ltd,Cottingham,UK)检测到患者唾液中的胃蛋白酶,并建立为胃内容物的回流简单,无侵入性。它已被用于检测胃肠 - 食管回流疾病(GORD)和外膜反流的患者中的胃蛋白酶A进入喉咽和气道[1-5.]。
回流具有实质性,但尚未缺乏的组分在咳嗽超敏反综合征的缓解过程中[6.]。目前评估是由主观船体流回流问卷(HARQ)[7.或客观,但昂贵和侵入性,措施如24小时ph-metry,阻抗[8.]和高分辨率测量[8.那9.]。这些目前的诊断途径具有检测可能足以引起慢性咳嗽的低水平回流的局限性。我们假设Peptest可以在未选择的慢性咳嗽患者中提供简单的客观性能。
Peptest was used in routine clinical practice in out-patients attending the Hull Cough Clinic at Castle Hill Hospital (Hull, UK), a secondary and tertiary referral centre. Verbal consent was obtained at the time of attendance. Chronic cough was defined as cough lasting >8 weeks.
患者被指示在日常活动中向样品收集管(含有0.01M柠檬酸)的样品收集管(含有0.01M柠檬酸)中,并在三次自发咳嗽发作后立即提供三个咳出唾液样品。通过提供患者传单和视频来优化样品集合。使用培训的分析师使用Peptest测量胃蛋白酶的存在和浓度,并用已知浓度的胃蛋白酶校准横向流动测试读取器。检测的下限为16 ng·mL-1和量化的上限为500 ng·ml-1。Peptest是胃蛋白酶A(同种型1,3a,3b和3c)的特异性,并且不检测胃蛋白酶c / gastricsin(同种型5)表明在肺部表达[10.那11.]。由于胃蛋白酶浓度不遵循正常分布,进行非参数统计分析。
我们测试了93名(55例女性)慢性咳嗽患者的意思±SD.2014年8月至2014年8月至12月年龄58.4±13.8岁。吸烟状况为:吸烟者n = 5,Nonsmoker n = 55,出吸烟者n = 24且未知n = 9。平均值SD.H一种R.Q score (upper limit of normal 13) was 31.9±13.1 and cough duration was 5.6±7.0 years. Over a period of 4 months the 93 patients provided 262 evaluable samples for testing. 80 patients had at least one pepsin positive sample (86.0%). Pepsin concentrations ranged from 0 to 500 ng·mL-131 ng·ml的中位数(四分位数范围(IQR))-1(0–113.5) ng·mL-1。
我们以前[1] used a similar triple sampling strategy in a thoroughly investigated normal asymptomatic healthy volunteer population. The absence of gastro-oesophageal reflux was confirmed by pH-impedance testing. In contrast to this chronic cough study these control samples were provided first thing in the morning, 1 h after lunch and 1 h after the evening meal. Of the 87 control subjects only 33 were found to have at least one positive sample (37.9%) but the pepsin concentration in those that were Peptest positive was very low, median (IQR) of 0 (0–0) ng·mL-1胃蛋白酶,代表生理回流。
我们研究中慢性咳嗽的患者显着增加了胃蛋白酶检测的患病率(P <0.0001 Fisher的确切测试; 86%相对38%)和胃蛋白酶浓度增加(P <0.0001 Mann-Whitney U-Test,31 ng·mL-1相对0 ng·ml-1)与对照组相比。对于对照群体,有一个重要的接收器操作特征(ROC)曲线(ROC曲线下的0.7244,ROC曲线下的P <0.0001面积)(图1A)。
![FIGURE 1](http://www.qdcxjkg.com/content/erj/47/1/339/F1.medium.gif)
其他原发性肺病理学,例如COPD或IPF,仅占患者的6%,并且不会影响胃蛋白酶检测率(肺病理学的患病率83%相对86%没有肺部病理学)。
一世nterestingly, the mean pepsin concentration in this chronic cough population is comparable to the mean pepsin concentration seen in 59 symptomatic GORD patients [12.]在症状性发作时,胃蛋白酶检测的患病率(80%)。因此表明,在慢性咳嗽患者中观察到的胃蛋白酶的水平可能是病理相关的(图1B.)。
酸性抑制药物,通常是质子泵抑制剂(PPI),已在介绍中规定了30%的患者。酸性抑制没有影响回流胃蛋白蛋白的检测或浓度(81%,37 ng·ml-1在PPI上相对89%,28.5 ng·ml-1关闭ppi;P> 0.05 Fisher的确切测试)。我们之前在随机的双盲安慰剂对照研究中显示为eSomeprazole [13.酸抑制在气道回流相关慢性咳嗽中没有显着效益。对于患有气道超敏反应的患者,少量回流(通常是非酸)可能足以诱导咳嗽[14.]和亲动力医疗策略(例如应考虑Baclofen,MetaClopramide或二十霉素)。
This prospective cohort study in a real-life setting has demonstrated Peptest has a high sensitivity to detect pepsin in the overwhelming majority of chronic cough patients during symptomatic episodes. Since some reflux is physiological a lack of specificity must be considered. In conjunction with subjective assessment this assay may aid in diagnosis, leading to more appropriate management strategies in chronic cough.
致谢
我们非常感谢RD Biomed Ltd Jeanine Fisher(英国Cottingham,英国),NHS患者管理的Karen Welburn和NHS秘书援助(Hanka Remblance)(心血管和均布骨架研究中心,Hull Yrought Medical School,Hull大学,Castle Hill Hospital,Cottingham)。
Footnotes
支持声明:该项目部分由约克郡和亨伯欧洲区域发展基金计划2007 - 2013年约克郡创新基金部分供资。
Conflict of interest: Disclosures can be found alongside the online version of this article atwww.qdcxjkg.com.
- 已收到2015年5月26日。
- 公认2015年9月11日。
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