症状量表、食管24hpH及阻抗监测对Barrett食管、反流性食管炎和非糜烂性反流病的诊断价值  

Diagnostic values of GerdQ, 24-h ambulatory oesophageal pH and impedance-pH monioring in Barrett＇s esophagus, reflux esophagitis and non-erosive reflux disease

作　　者：王琨[1] 段丽萍[1] 葛颖[1] 徐志洁[1] 夏志伟[1] 

机构地区：[1]北京大学第三医院消化科,北京100191

出　　处：《中华医学杂志》2011年第18期1228-1232,共5页National Medical Journal of China

基　　金：国家“863”高技术研究发展计划基金（2007AA022423）

摘　　要：目的比较GerdQ量表、24hpH-DeMeester（pH-DeM）及阻抗．pH联合监测3种方法在Barrett食管（BE）、反流性食管炎（RE）和非糜烂性反流病（NERD）的阳性诊断率以及胃食管反流事件特点。方法参考蒙特利尔共识意见纳入2009年6月1日至2010年9月30日于北京大学第三医院就诊的胃食管反流病（GERD）患者205例，胃镜检查将患者分为BE、RE和NERD3组。患者均接受GerdQ量表调查、食管24hpH及阻抗监测。结果共纳入GERD患者205例。其中BE患者10例，RE28例，NERD167例。（1）24h阻抗-pH法对GERD患者的阳性诊断率为74．1％，显著高于GerdQ（51．7％）和24hpH-DeM法（29．2％）（P〈0．05）。（2）GerdQ及24hpH-DeM法对BE及RE患者阳性诊断率高于NERD患者，而24h阻抗-pH法在3种类型GERD的阳性诊断率均在较高水平（70．0％、82．1％及73．1％）。（3）GerdQ量表得分值与pH-DeM积分及阻抗．pH酸反流分值呈正相关（r=0．242，P=0．000及r：0．182，P=0．009）；pH-DeM积分与阻抗-pH酸反流分值呈显著正相关（r=0．632，P=0．000）。（4）阻抗-pH监测对GerdQ问卷及pH-DeM积分法具有较强的补充诊断能力：GerdQ问卷阴性者，阻抗-pH的阳性诊断率为58．4％（59／101）；pH-DeM积分法阴性者，阻抗-pH监测的阳性诊断率为74．5％（108／145）。GerdQ问卷及pH—DeM积分法漏诊的患者均以弱酸反流为主。（5）RE患者酸反流事件检出率及积分均显著高于NERD[53．6％比23．4％，45．6（35．0～67．5）比23．1（9．3～35．0），均P〈O．05]，而NERD患者弱酸反流比例及气体反流积分均显著高于RE[弱酸：57．4％比28．6％，气体：17（0～194）比30（0～500），均P〈0．05]。结论RE患者以酸反流事件为主，GerdQ量表、24hpH．DeM积分法及24h阻抗-pH联合监测对其阳性诊断率差异无统计学意义；BE及NERD患者弱酸反流事件显著，GerdQ量表和单纯食管酸反流监测对其的Objective To compare the diagnostic values of GerdQ questionnaire, 24-h pH monitoring and 24-h impedance-pH monitoring for gastroesophageal reflux disease （GERD） and to analyze the reflux patterns of Barrett＇s esophagus （ BE）, reflux esophagitis （RE） and non-erosive disease （NERD）. Methods From June 1, 2009 to September 30, 2010, 205 GERD patients were included according to the Montreal consensus. All were surveyed by a GerdQ questionnaire and underwent 24-h impedance-pH monitoring. The diagnostic sensitivities of GerdQ, 24-h pH-DeM and 24-h IMP-pH were compared and the reflux pattern of BE, RE and NERD analyzed. Results A total of 205 GERD patients including 10 BE, 28 RE and 167 NERD were recruited. （ 1 ） The diagnostic rate of24-h IMP-pH was 74. 1%. It was significantly higher than that of GerdQ （51.7%） and 24-h pH-DeM （29. 2% ）. （2） The diagnostic sensitivities of GerdQ and 24-h pH-DeM for BE and RE were higher than that for NERD. But there were no significant differences of 24-h IMP-pH for three types of GERD（70.0%, 82. 1% and 73.1% ）. （3）There were positivecorrelations among the scores of GerdQ, pH-DeM scores and acid scores in IMP-pH （r = 0. 242, P = 0. 000; r =0. 182., P =0. 009 and r =0. 632, P =0. 000）. （4） Added diagnostic values of IMP-pH were 58. 5% and 74.5% respectively in patients who would have been missed by GerdQ and pH-DeM. （5） The detection rate and score of acid reflux in RE patients were higher than that of NERD [ 53.6% vs 23.4% , P 〈 0. 05 ; 45.6 （35.0 - 67.5 ） vs 23.1 （9. 3 - 35.0）, P 〈 0. 05 ]. But gas score and separate acid reflux were lower than that in NERD [ 17 （0 - 194） vs 30 （0 - 500）, P 〈 0. 05 ; 57.4% vs 28.6%, P 〈 0. 05 ]. Conclusions Acid reflux plays an important role in RE. The value of GerdQ and 24-h pH-DeM and 24-h IMP-pH monitoring were similar for the diagnosis of RE. Weak acid may be more important for BE and NERD patients than separate acid reflux. And 24-h IMP-pH monitoring has a distinct adv

关 键 词：食管PH监测 胃食管反流 诊断 症状量表 

分 类 号：R571[医药卫生—消化系统]