非糜烂性反流病放大内镜下微小变化的临床研究  

Clinical Study on Minimal Changes of Nonerosive Reflux Disease Using Magnifying Endoscope

作　　者：刘建军[1] 周丽雅[1] 林三仁[1] 夏志伟[1] 

机构地区：[1]北京大学第三医院消化内科,100083

出　　处：《胃肠病学》2005年第5期281-285,共5页Chinese Journal of Gastroenterology

摘　　要：背景:研究显示胃食管反流病(GERD)大部分为非糜烂性反流病(NERD),目前NERD尚无内镜诊断标准。目的:应用放大内镜观察NERD的微小变化,探讨其特征性内镜表现。方法:58例GERD患者(NERD47例,糜烂性食管炎11例)和6例健康志愿者行24h食管pH监测和放大内镜检查,于食管、胃不同部位取活检行组织病理学检查。结果:内镜下,NERD组贲门口松弛,23.4%的患者食管黏膜水肿、血管网模糊;10.6%食管下段可见点状血管,27.2%可见隐性红斑;25.5%齿状线上有白色结节样变;29.8%齿状线模糊或部分模糊,形态与正常对照组相比有显著差异(P<0.05);齿状线下黏膜不平程度亦显著高于正常对照组(P<0.05)。根据齿状线形态诊断NERD,锯齿型、三角型和半岛型的阳性率均为100%,宽大锯齿型为83.3%;根据齿状线下黏膜不平程度,斑块状凹凸不平和绒毛状不平阳性率均为100%,粗糙不平为91.7%。NERD组的食管上皮组织学表现与正常对照组相比无显著差异。结论:放大内镜下可以观察到NERD的齿状线形态和齿状线下黏膜不平程度,其特征性表现对完善NERD的诊断具有重要意义。Background： It has been demonstrated that most of the gastroesophageal reflux disease （GERD） is nonerosive reflux disease （NERD）, but so far there is no endoscopic criteria for the diagnosis of NERD. Aims： To observe the minimal changes of NERD with magnifying endoscope, and to explore its main endoscopic characteristics. Methods： Fifty-eight consecutive outpatients with GERD （47 NERD and 11 erosive esophagitis） were enrolled in this study, 6 healthy volunteers served as controls. All the subjects were assessed with 24-hour ambulatory esophageal pH monitoring and magnifying endoscope. Biopsy specimens were taken from esophagus and stomach for histopathological examination. Results： The orifice of cardia was loosened in all NERD patients endoscopically. Mucosal edema and obscure vascular net, pinpoint vessels and indistinct erythema in lower esophagus, and white nodular changes above Z-line were shown in 23.4%, 10.6%, 27.2% and 25.5% of the NERD patients, respectively. The appearance of Z-line was blurred in 29.8% of the NERD patients, its shape was significantly different from that of the controls （P〈0.05）; and roughness of the mueosa below Z-line in NERD patients was more severe as compared with that of the controls （P〈0.05）. When the two characteristics mentioned above were used for diagnosis of NERD, the accuracy rate of serrated-, triangular-, semi-island-shaped Z-line and concavo-convex or villous mucosa below Z-line were 100%, that of sparsely serrated-shaped Z-line was 83.3%, and rough mucosa below Z-line 91.7%. Histopathological examination showed no difference between the esophageal mucosa of NERD patients and that of the controls. Conclusions： Z-line shapes and roughness of mucosa below Z-line are the main characteristics of NERD under magnifying endoscope, which are important for the precise diagnosis of NERD.

关 键 词：胃食管反流 非糜烂性反流病 食管胃接合处 放大内镜检查 微小变化 诊断 非糜烂性反流病 内镜下 临床研究 胃食管反流病 正常对照组 组织病理学检查 NERD 黏膜水肿 糜烂性食管炎 

分 类 号：R571[医药卫生—消化系统]