机构地区:[1]首都医科大学附属北京同仁医院消化内科,北京100730
出 处:《胃肠病学和肝病学杂志》2011年第6期557-560,共4页Chinese Journal of Gastroenterology and Hepatology
摘 要:目的比较非糜烂性反流病(NERD)与反流性食管炎(RE)的临床症状及食管酸暴露情况。方法具有反流症状的患者155例,进行胃镜检查和食管24 h pH动态监测。结果 155例患者中诊断RE 76例(49.0%),其中A、B、C、D级分别为40、24、8和4例;诊断NERD 79例(51.0%);RE组中pH监测阳性57例(75.0%),NERD组26例(32.9%),差异有统计学意义(P<0.05);NERD组食管外症状发生率较RE组高,差异有统计学意义(P<0.05),而典型的反流症状发生率两组比较差异无统计学意义(P>0.05);RE组各项酸反流指标均大于NERD组,差异有统计学意义(P<0.05);轻度RE(LA-A)组各项酸反流指标低于中度RE(LA-B)和重度RE(LA-C+D),差异有统计学意义(P<0.05),但中度RE(LA-B)与重度RE(LA-C+D)之间的差异无统计学意义(P>0.05);79例NERD中,依据监测当日症状计算SI值,pH阴性SI阳性(NERD pH-SI+)15例,pH阴性SI阴性(NERD pH-SI-)28例,NERD pH-SI+组的pH<4.0(%)和酸反流次数明显高于NERD pH-SI-组,差异有统计学意义(P<0.05)。结论胃酸反流是RE形成的重要因素,其中胃酸的浓度及长反流与食管黏膜接触的次数是直接造成食管黏膜损伤的重要因素;酸反流的程度与RE的严重程度之间可能相关;NERD根据酸反流与症状的关系可分为不同的亚型,病理性酸反流所占比例相对较低,酸反流的强弱在其发病机制中可能未起到决定性作用。Objective To compare the clinical symptoms and characteristics of esophageal acid exposure between non-erosive reflux disease (NERD) and reflux esophagitis (RE). Methods Gastroscopy and 24 h esophageal pH monitoring were performed in 155 patients suffered from acid regurgitation. Results Seventy-six of the 155 patients were confirmed as RE by endoscopy. Among them, the number of cases with grades A, B, C, D according to the diagnostic criteria by endoscopy were 40, 24, 8, and 4 cases, respectively, while the other 79 cases were diagnosed as NERD. Fifty-seven (75.0%) cases of RE and 26 (32.9%) cases of NERD had an abnormal pH monitoring (P 〈 0.05). The incidence of extra-esophageal manifestations in the NERD group was higher than that in the RE (P 〈 0.05). No difference of typical reflux symptoms was found between the two groups. All parameters of acid reflux in RE group were significantly higher than those in NERD group (P 〈 0.05). The parameters of acid reflux of RE (LA-A) were lower than those in RE (LA-B) and RE ( LA-C + D) (P 〈 0.05 ). However, the difference in acid reflux parameter between RE (LA-B) and RE ( LA-C + D) had no statistical significance. In the 79 cases of NERD patients, according to the symptom of the monitoring day, there were 15 patients with pH negative SI positive, 28 patients with pH negative SI negative, the pH 〈 4.0 ( % ) and reflux episodes reflux of the NERD pH - SI + was higher than that of the NERD pH - SI-. Conclusion Gastric acid reflux may be an important factor, in which the concentration of acid reflux and the long contacting with the esophageal mucosa may be the direct and important factors of esophageal mucosal injury. The degree of acid reflux may be correlated with the severity of RE. NERD may be divided into different subtypes according to the relationship between acid reflux and symptoms, the proportion of pathologic acid reflux may be lower, the acid reflux may not play the decisive role.
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