何金年 班正锋

[摘要] 针对鼻部炎性疾病的基础及临床研究常集中于鼻腔及鼻窦的局部因素，因其病因复杂，所以具体发病机制仍不十分明确，其临床治疗仍有诸多困难。近年来对喉咽返流的认识逐渐深入，研究显示其与多种疾病密切相关。喉咽返流在鼻部炎性疾病发生及发展中的作用逐步受到临床关注，新近研究就其二者内在联系及具体机制在疾病基础与临床方面进行全面探讨。本文综合最新研究文献对喉咽返流与鼻部炎性疾病相关性进行综述。结合喉咽返流的发病机制、临床诊断、治疗方案等，从整体医学的角度出发，为鼻部炎性疾病及喉咽反流的诊治提供新的临床思路。

[关键词] 喉咽反流;慢性鼻窦炎;变应性鼻炎;胃蛋白酶

[中图分类号] R766          [文献标识码] A          [文章编号] 1673-9701（2021）31-0188-05

[Abstract] Basic and clinical research on nasal inflammatory diseases often focuses on the local factors of the nasal cavity and sinuses. There are still many difficulties in clinical treatment， due to their complex etiology and unclear specific pathogenesis. In recent years， the understanding of laryngopharyngeal reflux has gradually deepened. Research has shown that it is closely related to a variety of diseases. The role of laryngopharyngeal reflux in the occurrence and development of nasal inflammatory diseases has gradually attracted clinical attention. Recent studies have fully explored the basic and clinical aspects of the underlying relationship and specific mechanisms of the two. This article summarizes the latest research literature on the relationship between laryngopharyngeal reflux and nasal inflammatory diseases. It provides new clinical ideas for the diagnosis and treatment of nasal inflammatory diseases and laryngopharyngeal reflux from the perspective of holistic medicine， combining the pathogenesis， clinical diagnosis， and treatment plan of laryngopharyngeal reflux.

[Key words] Laryngopharyngeal reflux; Chronic sinusitis; Allergic rhinitis; Pepsin

喉咽返流（Laryngopharyngeal reflux，LPR）最初是由Cherry和Marguies于1968年報道，近年来逐渐受到临床重视，临床证实其与临床多种疾病相关，特别是喉、咽、口腔、鼻、耳、气管、睡眠障碍等疾病。调查显示，10%的耳鼻喉科门诊患者的症状归因于LPR，55%的声音嘶哑患者存在有LPR因素[1]。美国耳鼻喉学会（AAO-HNSF）将LPR定义为胃内酸性物质（H+）及胃蛋白酶原经松弛的食道下括约肌进入食道，进而经食道返流至食管上段及以上区域而引起的一系列临床症状。研究认为LPR是不同于胃食管反流（Gastroesophageal reflux，GERD）的一类疾病，二者在疾病的发生机制、临床表现有明显区别。食管上区域范围广泛，涉及多个学科，而返流程度及黏膜组织对酸性物质耐受程度也不尽相同，故临床表现呈现多样性特点。……