| Objective（s）:Laryngopharyngeal reflux disease（LPRD）has attracted widespread attention as a risk factor for oral-pharyngeal and larynx cancer such as laryngeal,nasopharyngeal,and hypopharyngeal cancers and oral cancer in recent years[1-3].In this study,we analyzed the concentration of salivary pepsin in the oral cavity of patients with malignant tumors in the pharynx and oral cavity,and used the reflux symptom index（RSI）and reflux finding score（RFS）to comprehensively evaluate the correlation between salivary pepsin and the occurrence of pharyngeal and oral tumors in LPRD patients.Method:Patient Selection and Sample Collection From January 2022 to December 2022,patients with pharyngeal and oral malignant tumors who underwent surgery were enrolled as the experimental group;patients with typical reflux symptoms such as cough,throat foreign body sensation,hoarseness,and other symptoms were selected as the reflux symptom-free group;and healthy individuals without any self-reported symptoms were selected as the control group.A total of 70 individuals were included,ranging in age from 21 to 86 years old,with an average age of46.6 years.The enrolled patients were divided into the experimental group（tumor group）consisting of 17 individuals,the experimental control group（reflux symptom-free group）consisting of 47 individuals,and the control group（healthy group）consisting of 6 individuals.Oral saliva samples were obtained from patients before breakfast and tooth brushing,or 1 hour after lunch or dinner for each participant.The concentration of pepsin in the saliva samples was detected using the Peptest kit provided by RD Biomed Ltd,and the values obtained were recorded.Clinical data of the patients were collected,and all procedures were approved by the hospital ethics committee and conducted with informed consent from the patients or their families.Prior to testing,patients with confirmed pharyngeal and oral malignant tumors completed the reflux symptom index（RSI）based on their symptoms.For patients who self-reported reflux symptoms at the outpatient or inpatient department,RSI evaluation was performed first.Then,electronic laryngoscopy was performed on all three groups of patients,and the reflux finding score（RFS）was assessed by clinical doctors based on the electronic laryngoscopy report.The RSI and RFS scores were combined to comprehensively evaluate the correlation between laryngopharyngeal reflux disease and the occurrence of pharyngeal and oral malignant tumors.Additionally,the clinical information of patients with laryngeal cancer including age,sex,smoking and drinking history were collected for further clinical correlation analysis.All patients’basic information,laboratory indicators,adverse events,etc.were recorded throughout the research process.A pepsin detection value of≥75 ng/m L was considered positive,while 16 ng/m L to 75 ng/m L was weakly positive,and≤16 ng/m L was negative.For RSI,a symptom score of≥13 was considered positive,while scores<13 were negative.For RFS,a score of≥7 was considered positive,while scores<7 were negative.All results were analyzed using SPSS25.0 software,and data were statistically analyzed usingχ2 tests to further analyze the correlation between laryngopharyngeal reflux disease and head and neck tumors.Fisher’s exact test was used for tests that did not meetχ2criteria.Results:In the test results,there were 4 positive cases（0 RSI positive,4 RSI negative,0RFS positive,4 RFS negative）among tumor group patients with positive gastric protease test,12weakly positive cases（3 RSI positive,9 RSI negative,10 RFS positive,2 RFS negative）,and 1negative case（0 RSI positive,1 RSI negative,1 RFS positive,0 RFS negative）.In the control group without tumor or laryngopharyngeal reflux disease,there were 29 positive cases（18 RSI positive,11 RSI negative,20 RFS positive,9 RFS negative）,2 weakly positive cases（2 RSI negative,2 RFS negative）,and 16 negative cases（1 RSI positive,15 RSI negative,0 RFS positive,16 RFS negative）among patients with positive gastric protease test.Among the blank control group with a total of 6 cases,0 were positive and 6 were negative for gastric protease test,and both RFS and RSI scales were negative.Three patient groups were compared using gastric protease detection,RSI symptom scores,and RFS physical signs.Data were analyzed using SSPSS25.0 software.The positive rate of patients with reflux in tumor group was 20.52%（4/17）,weakly positive 70.58%（12/17）and negative5.88%（1/17）,while that of patients with reflux in control group（pharyngeal reflux group）was61.7%（26/47）and weakly positive 25%（2/47）negative（16/47）.Statistical analysis comparing the gastric protease ratios in the tumor group and control group resulted in a P value less than 0.05,meaning that the difference was statistically significant.The blank control group was completely negative,and the statistical analysis of the gastric protease ratio in tumor group,control group and blank control group yielded a P value less than 0.05,indicating a statistically significant difference.RSI assessment yielded a positive rate of 17.64（3/17）in the tumor group and 61.70%（29/47）in the control group（throat reflux group）.The blank control group was completely negative,and the P value was less than 0.05,indicating a statistically significant difference.RFS assessment yielded a positive rate of 88.23%（15/17）in the tumor group and 46.80%（22/47）in the normal group（throat reflux group）.The blank control group was completely negative,and the P value was less than 0.05,indicating a statistically significant difference.Conclusion:1.The detection rate of pepsin in the malignant tumor group was significantly higher than that in the laryngopharyngeal reflux group and the blank control group（P<0.05）,suggesting a certain correlation between pepsin in laryngopharyngeal reflux and the pathogenesis of head and neck malignancies.2.The blank group of subjects detected a concentration of pepsin,indicating that a concentration of pepsin≤16ng/ml is insufficient to cause symptoms and signs related to pharyngolaryngeal reflux. |
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