食管远端鳞状上皮细胞间隙增宽对非糜烂性反流病诊断的价值  

Evaluation of dilation of intercellular spaces of squamous epithelium in the lower esophagus in the diagnosis of non-erosive reflux disease

作　　者：陈文科[1] 周丽雅[1] 陆京京[1] 薛艳[1] 崔荣丽[1] 

机构地区：[1]北京大学第三医院消化科,北京市100191

出　　处：《世界华人消化杂志》2012年第13期1142-1147,共6页World Chinese Journal of Digestology

摘　　要：目的:研究非糜烂性反流病(NERD)食管远端鳞状上皮细胞间隙变化及与食管酸暴露、反流症状严重程度的关系,探讨细胞间隙增宽对NERD诊断的价值.方法:纳入NERD患者(66例)和正常对照者(38例).所有受试者行GerdQ调查、食管24hpH值监测、胃镜检查并在食管齿状线(Z线)和Z上2cm线位置取活检,透射电镜测量鳞状上皮细胞间隙;pH监测阴性NERD患者行质子泵抑制剂诊断试验确诊.结果:(1)NERD组Z线和Z线上2cm的平均细胞间隙分别为(0.90±0.11)μm、(0.92±0.16)μm,正常对照组分别为(0.65±0.08)μm、(0.67±0.08)μm,两组间差异有统计学意义(P<0.05),组内差异无统计学意义(P>0.05);(2)NERD患者Z线和Z线上2cm两部位pH(+)亚组与pH(-)亚组的细胞间隙比较,差异均无统计学意义(P>0.05);GerdQ(+)亚组与GerdQ(-)亚组的细胞间隙比较,差异也均无统计学意义(P>0.05);(3)Z线和Z线上2cm两部位的平均细胞间隙与DeMeester积分均呈正相关性,r分别为0.33(P=0.001)、0.35(P=0.001);与GerdQ评分也均呈正相关性,r分别为0.32(P=0.006)、0.45(P<0.001);(4)Z线平均细胞间隙的cut-off值为0.81μm时,约登指数最大(0.808),诊断的敏感度为80.8%,特异度为100.0%.Z线上2cm平均细胞间隙的cut-off值为0.81μm时,约登指数最大(0.731),诊断的敏感度为75.8%,特异度为97.4%.结论:NERD食管远端鳞状上皮细胞间隙明显增宽,细胞间隙与食管远端胃酸暴露和反流症状的严重程度呈正相关.细胞间隙增宽可作为NERD诊断的一种敏感客观结构指标.AIM：To evaluate the diagnostic value of dilation of intercellular spaces（DIS） of squamous epithelium in the lower esophagus for non-erosive reflux disease（NERD）.METHODS：Sixty-six NERD patients and thirtyeight healthy volunteers were enrolled.All participants underwent evaluation using the gastroesophageal reflux disease questionnaire（GerdQ）,24 h esophageal pH monitoring,gastroscopy,and biopsy of mucosa in the lower esophagus at the Z-line and 2 cm above the Z-line for measurement of diameter of intercellular spaces by transmission electron microscopy（TEM）.NERD patients with negative pH monitoring resultsunderwent proton pump inhibitor test to confirm the diagnosis.RESULTS：The mean diameter of intercellular spaces of squamous epithelium at the Z-line and 2 cm above the Z-line were（0.90 ± 0.11） μm and（0.92 ± 0.16） μm in the NERD group,and were（0.65 ± 0.08） μm and（0.67 ± 0.08） μm in the control group,without significant differences within the groups（both P 0.05）,but with significant differences between the two groups（both P 0.05）.No significant differences in the mean diameter of intercellular spaces of squamous epithelium at the Z-line and 2 cm above the Z-line in NERD patients were observed between pH（＋） and pH（-） groups and between GerdQ（＋） and GerdQ（-） groups.Positive correlations were found between the DeMeester scores and mean intercellular space diameters either at the Z-line（r = 0.33,P = 0.001） or 2 cm above the Z-line（r = 0.35,P = 0.001）,and between the GerdQ scores and mean intercellular space diameters either at the Z-line（r = 0.32,P = 0.006） or 2 cm above the Z-line（r = 0.45,P 0.001）.The best cut-off values for mean intercellular space diameter were both 0.81 μm at the Z-line and 2 cm above the Z-line,with a highest Youden index of 0.808 at the Z-line（sensitivity 80.8%,specificity 100%） and 0.731 2 cm above the Z-line（sensitivity 78.8%,specificity 97.4%）.CONCLUSION：The diameter of intercellular spaces of

关 键 词：非糜烂性反流病 细胞间隙 透射电镜 

分 类 号：R571[医药卫生—消化系统]