无效食管动力对伴呼吸道症状胃食管反流病发病机制及临床意义的研究  

Ineffective esophageal motility in GERD with respiratory symptom

作　　者：高岩[1] 尚占民[1] 

机构地区：[1]首都医科大学附属北京朝阳医院消化科,北京100020

出　　处：《中国实用内科杂志》2008年第3期205-207,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的观察伴有呼吸道症状的胃食管反流病(GERD)患者食管动力异常的类型及发生率,探讨无效食管动力(IEM)在其发病机制中的作用及临床意义。方法应用多功能胃肠动力仪对首都医科大学附属北京朝阳医院2005年1月至2007年1月收治的34例伴有哮喘、慢性咳嗽和咽喉部不适等呼吸道症状的GERD患者进行食管压力测定及24h食管动态pH监测,测定下食管括约肌(LES)压力、食管体部蠕动波幅、蠕动时限及蠕动速度,计算pH<4的时间百分比,卧位及立位pH<4的时间百分比,平均食管酸清除时间(pH<4的时间/酸反流次数),算出DeMeester评分。结果伴有呼吸道症状GERD组LES压力及食管近端、远端蠕动波幅与典型反流症状GERD组及正常对照组比差异无统计学意义;伴有呼吸道症状GERD组的食管动力异常类型主要表现为IEM,IEM发生率为41.2%,明显高于典型反流症状GERD组(18.5%)及正常对照组(0);在伴有呼吸道症状GERD患者中,存在IEM组患者食管pH<4的总时间百分比及立、卧位食管pH<4的时间百分比均明显高于食管动力正常组;IEM组患者卧位食管酸清除时间(pH<4的时间/酸反流次数)较食管动力正常组明显延长。结论在伴有呼吸道症状GERD患者中,IEM是其最常见的动力异常类型;IEM与食管内酸暴露总时间及立、卧位时间,卧位食管酸清除时间均密切相关,因此,IEM在伴有呼吸道症状GERD患者的发病机制中起重要作用。Objective To observe the type and prevalence of esophageal motility abnormality in patients with respiratory symptom. And to investigate the effect and clinical significance of ineffective esophageal motility （IEM）in the pathogenesis of GERD with respiratory symptom. Methods In the thirty-four GERD patients with respiratory symptoms of asthma, chronic cough,complaint of laryngeal pharynges,the esophageal manometry and 24 hour esophageal pH monitoring were performed by Multiple Functional Gastrointestinal Motility Monitor made by MMS, Holland. The peristaltic velocity ,ampli- tude and duration of esophageal body and lower esophageal sphincter（LES） pressure was detected. Computer software was used to analyze pH monitoring result,including the percentage of pH 〈4 ,percentage of pH 〈4 in upright and supine position, average esophageal acid clearance time（ the time of pH 〈 4/peroid of acid reflex）, and calculate DeMeester score. Results The LES and peristaltic amplitudes of proximal and distal esophagus had no statistic difference （ P 〉 0. 05 ） between GERD patients with respiratory symptom group and normal control group. In the group of GERD patients with respiratory symptom, main abnormal esophageal motility type was IEM, the prevalance of IEM （41.2%）being significantly higher than that in group of typical reflux symptom GERD（ 18.5% ）and normal control group（O）. In 34 GERD patients with respiratory symptom ,24 hour esophageal pH monitoring result of IEM group and normal esophageal motility group was analyzed ： the total percentage of pH 〈 4 and percentage of pH 〈 4 in upright and supine position in the group of patient with IEM was much higher than the group of normal esophageal motility. Esophageal acid clearance time in supine position in the group of IEM was much longer than the group of normal esophageal motility. Conclusion In GERD patients with respiratory symptom, there is no significant difference in the LES pressure and distal esophagus peristaltic amplitude, compar

关 键 词：胃食管反流 无效食管动力 呼吸道症状 

分 类 号：R5[医药卫生—内科学]