以慢性咳嗽为主要表现的胃食管反流病患者的食管功能及反流特点  

A study of esophageal function and reflux characteristics of gastroesophageal reflux disease in patients presenting with chronic cough

作　　者：高岩[1] 尚占民[1] 黄皖农[1] 郝建宇[1] 

机构地区：[1]首都医科大学附属北京朝阳医院消化科,100020

出　　处：《中华内科杂志》2011年第11期931-934,共4页Chinese Journal of Internal Medicine

摘　　要：目的通过对以慢性咳嗽为主要表现的胃食管反流病（GERD）患者行高分辨食管内压力一阻抗联合测定（MII—HRM）及24h联合多通道腔内阻抗-pH（MII—pH）监测的结果分析，探讨此类患者食管运动功能及胃食管反流的特点。方法选取2010年3—11月在首都医科大学附属北京朝阳医院就诊的19例GERD伴慢性咳嗽患者为研究对象。应用MII—HRM及24hMII—pH监测系统测定上食管括约肌（UES）和下食管括约肌压力、食管体部蠕动功能、对液体和黏液性物质的传输功能、立位及卧位酸及非酸反流的次数、近端反流的次数、酸暴露时间、酸清除时间以及食团清除时间。以同期仅表现为典型胃食管反流症状的17例GERD患者作为对照，比较两组间食管运动功能以及胃食管反流参数的差异。结果与仅表现为典型胃食管反流症状的GERD患者相比，以慢性咳嗽为主要表现的GERD患者的UES静息压力明显更低[（122．55±60．48）mmHg比（86．37±41．35）mmHg（1mmHg=0．133kPa），P〈0．05]，食管体部异常蠕动的比例更高[（9．47±15．63）％比（22．16±17．45）％，P〈0．05]，食管体部对液体物质传输能力减低[（88．82±12．23）％比（71．68±23．06）％，P〈0．05]，卧位时酸及非酸反流次数及卧位近端非酸反流次数明显增多（P〈0．05），卧位食团清除时间延长（P〈0．05）。结论以慢性咳嗽为主要表现的GERD发病机制可能与单纯典型GERD不同，其与UES静息压力减低、卧位酸及非酸反流、近端反流的增多以及食管清除功能障碍密切相关。Objective To investigate the characteristics of gastroesophageal reflux disease （GERD） with chronic cough by the results of combined muhiehannel intraluminal impedance and high-resolution manometry （MII-HRM） procedure and 24-hour multichannel intraluminal impedance combined pH （MII- pH） monitoring. Methods From March 2010 to November 2010, consecutive patients of GERD with chronic cough （more than 8 weeks） admitted to Beijing Chaoyang Hospital of Capital Medical University underwent 24-hour MII-pH monitoring and MII-HRM procedure with symptom association probability（SAP） over 95%. Data of lower esophageal sphincter （LES） pressure, LES relaxation, LES residual pressure, esophageal body peristalsis function and swallow bolus transit （liquid/viscous） was collected and the result of 24-hour MII-pH monitoring was analysed by the computer software containing reflux episode activity （acid/nonacid, upright/recumbent）, proximal extent, acid exposure and mean acid/bolus clearance time. Seventeen patients of GERD with typical reflux symptom were selected as the control group. Results Comparing with patients of GERD with typical reflux symptom, patients of GERD with chronic cough showed decreased upper esophageal sphincter pressure （UESP） [ （ 122. 55 ± 60. 48 ） mm Hg vs （ 86. 37 ± 41.35 ） mm Hg,P 〈 0. 05,1 mm Hg = 0. 133 kPa ], higher percentage of abnormality peristalsis [ （9.47 ± 15.63 ）% vs （ 22. 16 ± 17.45 ） %, P 〈 0. 05 ）, degraded esophagus transmittability of liquid substance [ （ 88.82 ± 12. 23 ） % vs （ 71.68 ± 23.06 ） %, P 〈 0. 05 ], more reflux episode activity （ acid /nonacid） in supine position and proximal reflux episode （nonacid） in supine position （P 〈 0. 05 ）and longer mean bolus clearance time（ P 〈 0. 05 ）. Conclusion Decrease of the UESP, increase of the reflux episode activity （acid/nonacid） in supine position and proximal reflux episode （nonacid） in supine position, lengthened mean bolus clearance time in

关 键 词：胃食管反流 咳嗽 慢性 食管功能 反流特点 

分 类 号：R571[医药卫生—消化系统]