24h食管pH-阻抗联合监测诊断胃食管反流病的价值评估  

The value of 24 h ambulatory impedance-pH in diagnosis of gastroesophageal reflux disease

作　　者：易丽莎[1] 陈莹[1] 孙会会[1] 姜元喜[1] 许树长[1] 

机构地区：[1]同济大学附属同济医院消化内科,上海200065

出　　处：《同济大学学报（医学版）》2013年第3期40-43,48,共5页Journal of Tongji University(Medical Science)

基　　金：上海市科委临床引导类项目(10411968100)

摘　　要：目的评估24 h食管pH-阻抗联合监测在诊断胃食管反流病(GERD)中的价值。方法纳入具有典型症状(反酸、烧心)或具有不典型症状(咽喉炎、咳嗽、胸痛等)但怀疑与胃食管反流相关的患者,共计142例,均进行上消化道内镜、24 h食管pH-阻抗联合监测。其中以内镜下发现反流性食管炎、DeMeester积分≥14.72及SI≥50%者定义为GERD组(59例),余83例为非GERD组,比较两组的24 h食管pH-阻抗联合监测结果。结果 (1)24 h食管pH监测的各指标中,DeMeester积分、pH<4的总时间(%)、pH<4长于5 min反流次数对诊断GERD有较好的敏感性和特异性。(2)腔内阻抗监测的各项指标单独诊断GERD的敏感性一般(均在45%以下),但酸反流合计(97.59%)、液体反流合计(97.59%)、食团清除时间(98.80%)、近端反流百分比(98.80%)等指标特异性较好。(3)与24 h食管pH监测比较,24 h食管pH-阻抗联合监测可发现更多异常反流情况(χ2=14.65,P<0.000)。结论 pH<4的总时间(%)、pH<4长于5 min反流次数这两个参数指标结合DeM eester积分是判断GERD的重要指标。单独腔内阻抗监测的各项指标对诊断GERD的敏感性一般,但24 h食管pH-阻抗联合监测可弥补单纯pH监测的不足,识别更多异常反流情况。内镜+24 h食管pH-阻抗联合监测是诊断GERD的选择。Objective To investigate the value of 24h ambulatory impedance-pH in diagnosis of gastroesophageal reflux disease（GERD）.Methods One hundred and forty two patients with typical reflux symptoms or suggestive of gastroesophageal reflux were included.All patients underwent endoscopy and 24 h ambulatory impedance-pH monitoring.Among them,those with reflux esophagitis or DeMeester score ≥14.72 and SI ≥50% were defined as GERD＋ group;others were defined as GERD-group.The parameters of 24h ambulatory impedance-pH were compared between two groups.Results Among all parameters of 24h esophageal pH monitoring,DeMeester score,the total time of pH 4 and time of reflux with pH 4 for 5min had better sensitivity and specificity for diagnosis of GERD.The single parameter of multichannel intraluminal impedance had a low sensitivity（ 45%） in diagnosis of GERD.Compared to 24h esophageal pH monitoring,24h ambulatory impedance-pH detected more abnormal reflux episodes（χ2=14.65,P0.000）.Conclusion The results suggest that endoscopy combined with 24h ambulatory impedance-pH may be a better choice for diagnosis of gastroesophageal reflux disease.

关 键 词：胃食管反流病 多通道阻抗监测 24hpH监测 Demeester评分 

分 类 号：R571[医药卫生—消化系统]