慢性阻塞性肺病与胃食道反流的相关性研究  

Association between chronic obstructive pulmonary disease and gastroesophageal reflux

作　　者：翁俊良[1] 郑义珊 马琼凤[1] 

机构地区：[1]汕头大学医学院第一附属医院,广东汕头515041 [2]汕头市龙湖人民医院,广东汕头515000

出　　处：《医师进修杂志》2004年第11期22-24,共3页Journal of Postgraduates of Medicine

摘　　要：目的　通过抗反流治疗探讨慢性阻塞性肺病 (COPD)与胃食道反流 (GER)的相关性。方法　对 6 4例临床确诊COPD患者及 30例健康者进行消化道症状 (反酸、反食、烧心、咽部异物感和腹胀等 1 8种症状 )发病情况问卷调查 ,以总分≥ 6分为症状性GER的诊断标准。当至少符合以下其中之一时 ,异常GER诊断成立。 (1 ) 2 4h食道pH监测远端电极Demeester总积分≥ 1 4 .72分。 (2 )远端电极Demeester总积分虽小于 1 4 .72分 ,但食道上、下电极至少有 1个咳喘症状相关概率 (SAP)大于 75 %。 (3)酸反流试验阳性。胃肠钡餐透视作为辅助诊断。GER诊断确立后以多潘立酮和麦滋林抗反流治疗 6周。结果　 (1 )治疗前 6 4例COPD患者中有 5 2例GER ,4 8例为异常GER ;健康组GER只有 8例 ,两组GER有显著性差异 (P <0 .0 1 )。对 4 8例异常GER抗反流治疗后发现各项观察指标均有明显改善。 (2 ) 1 1例轻型COPD患者咳嗽气促症状完全消失 ;9例中度COPD患者症状有明显减轻 ,SAP >90 %;2 0例患者临床症状完全控制。 (3)酸反流阳性试验全部阴转 ,肺功能检查发现治疗前后有显著性差异 ,P <0 .0 1。结论　对症状性GER的抗反流治疗 ,可以有效减轻部分COPD患者长期咳嗽气促症状 ,证实了COPD与GER之间的密切相关性。Objectives To explore association between chronic obstructive pulmonary disease (COPD) and gastroesophageal reflux (GER) by anti-reflux therapy. Methods Prospective question naire-based survey of digestive tract symptoms (18 symptoms such as acid reflux, regurgitation, heartburn, swallowing abnormalities and windy etc.) was performed on 64 patients with COPD as well as 30 healthy subjects, score≥6 as the diagnostic criteria of symptomatic GER. The unusual GER was defined subsequently if one of the following index was found.(1) Total score of far electrode Demeester ≥14.72 with 24 hours surveillance of esophageal pH value.(2) Total score of far electrode Demeester <14.72, but with one electrode of which symptom associated probability (SAP) was ≥75%. (3) Positive reaction of acid reflux was found. The diagnosis was assisted with the examination of barium meal. Once the diagnosis of unusual GER was established, anti-reflux medications of doperidone and marzulenes were utilized to the patients for consecutive 6 weeks. Results (1) There were 52 cases of symptomatic GER and 48 cases of unusual GER among 64 cases of COPD patients,8 cases of symptomatic GER among healthy subjects. The various index were significantly improved after the antsireflux therapy,P<0.01.(2) Cough and short breath in 11 patients with mild COPD were disappeared completely;Symptoms in 9 patients with moderate COPD were lightened obviously,SAP>90%;Symptoms in 20 patients were controlled completely. (3) In acid reflux positive reaction, pulmonary function tests (PFTs) showed a significant difference was found after the treatment, P<0.01. Conclusion The anti-reflux treatment to symptomatic GER may effectively alleviate long term cough and short breath in COPD patient,it demonstrate that GER is closely associated with COPD.

关 键 词：慢性阻塞性肺病 胃食道反流 消化道症状 

分 类 号：R563[医药卫生—呼吸系统]