36例难治性胃食管反流病患者阻抗-pH监测结果分析  

Analysis of 36 Cases of Refractory Gastroesophageal Reflux Disease with Impedance-pH Monitoring

作　　者：虞阳[1] 于晓峰[1] 姚健凤[1] 邹健[1] 王一倩[1] 项丹妮[1] 陈洁[1] 

机构地区：[1]复旦大学附属华东医院消化内科,200040

出　　处：《胃肠病学》2012年第6期347-350,共4页Chinese Journal of Gastroenterology

基　　金：上海市卫生局科研基金(No.2008061)资助

摘　　要：背景:质子泵抑制剂(PPIs)广泛用于治疗胃食管反流病(GERD),但部分患者对抑酸治疗的疗效不佳,称为难治性GERD。目的:研究难治性GERD患者食管内反流的严重程度和反流物性质,以探讨难治性GERD症状形成的因素。方法:选取2009年1月～2010年12月华东医院确诊的难治性GERD患者36例,以PPIs治疗后症状得到缓解的12例GERD患者作为对照。行24 h阻抗-pH监测,根据反流物pH值和阻抗值,分析比较两组的反流情况。结果:难治性GERD组24 h总反流和弱酸反流次数的中位数(第25百分位数,第75了百分位数)分别为98(58,136)和62(40,86),均显著高于对照组(P<0.001);两组酸反流次数均控制在较低水平,且组间差异无统计学意义(P=0.423)。难治性GERD组的气体反流和液气混合反流次数分别为48(31,61)和41(22,58),均显著高于对照组(P<0.0)01,P=0.002);液体反流次数无明显差异(P=0.757)。结论:弱酸反流在难治性GERD患者症状形成中起一定的作用,气体反流可能加重反流症状的感知。Proton pump inhibitors （PPIs） are widely used in the treatment of gastroesophageal reflux disease （GERD） , but some GERD patients have poor response to PPIs, which are called refractory GERD. Aims： To study the severity and character of esophageal reflux in refractory GERD patients and in order to explore the factors of refractory GERD symptoms. Methods： Thirty-six refractory GERD patients at Huadong Hospital from Jan. 2009 to Dee. 2010 were enrolled, and 12 GERD patients whose symptoms had been alleviated after PPIs treatment were served as controls. 24-hour impedance-pH monitoring was performed, and reflux were compared between the two groups according to pH and impedance of the reflux. Results： The median （25th percentile, 75th percentile） of total reflux times and weak-acid reflux times in refractory GERD patients were 98 （58,136） and 62 （40,86）, respectively, which were significantly higher than those in control group （ P 〈 0. 001 ）. Acid-reflux were well controlled after PPIs treatment in both groups, and no significant difference was found between the two groups （ P = 0. 423 ）. The median （ 25th percentile, 75th percentile） of gas and liquid-gas reflux times in refractory GERD patients were 48 （31,61） and 41 （22,58）, respectively, which were significantly higher than those in control group （ P 〈 0.001, P = 0. 002 ）. No significant difference of liquid reflux times was found between the two groups （ P = 0.757 ）. Conclusions ： The symptoms of refractory GERD may be associated with weak-acid reflux. Gas reflux may aggravate the reflux symptom perception.

关 键 词：难治性胃食管反流病 诊断 电阻抗 食管PH监测 

分 类 号：R571[医药卫生—消化系统]