胃食管反流病患者食管动力异常及其对食管酸暴露的影响  

Esophageal motility abnormalities and their impact on esophageal acid exposure in patients with gastroesophageal reflux disease

作　　者：侯渊涛[1,2] 孙晓红[1] 李晓青[1] 王智凤[1] 朱丽明[1] 舒慧君[1] 费贵军[1] 柯美云[1] 方秀才[1] 

机构地区：[1]北京大学人民医院麻醉科,100044 [2]中国医学科学院北京协和医学院北京协和医院消化内科,100730

出　　处：《中华内科杂志》2015年第10期865-869,共5页Chinese Journal of Internal Medicine

基　　金：国家高技术研究发展计划课题（2010AA023007）

摘　　要：目的 研究胃食管反流病（GERD）患者下食管括约肌和食管体部动力异常的特点及其对食管酸暴露的影响.方法 应用前瞻性对照研究的方法,纳入有典型反流症状的反流性食管炎（RE）和非糜烂性反流病（NERD）患者和健康对照者.受试者接受食管压力测定和食管26 h pH监测.根据食管测压结果将GERD患者的动力异常进一步分为：单纯下食管括约肌压力（LESP）降低组、单纯食管体部无效收缩（IEM）组、IEM＋ LESP降低组.比较各组患者的食管酸暴露情况.结果 共纳入GERD患者27例（RE 15例,NERD 12例）和健康对照10例.GERD患者食管动力异常主要表现为LESP降低、食管体部远端压力降低.在RE和NERD患者中,3种食管动力异常情况的分布差异有统计学意义（P=0.017）.IEM＋ LESP降低组中7例患者均为RE,其26 h总的食管酸暴露次数和时间百分比、空腹时酸暴露时间百分比均高于单纯LESP降低组[98.0（63.3,282.8）次比41.0（25.0,82.0）次,P=0.029;11.7％ （4.1％,30.0％）比2.2％（1.4％,9.6％）,P=0.045;2.6％（0.9％,4.9％）比0.0（0.0,1.2％）,P=0.015].结论 GERD患者食管动力异常以LESP降低和/或食管体部远端IEM为主.同时存在LESP降低和IEM将导致食管酸暴露加重,是食管黏膜损伤的主要机制。Objective To identify the characteristics of esophageal motility abnormalities in patients with gastroesophageal reflux disease （GERD） and its influence on esophageal acid exposure.Methods Patients with typical reflux symptoms and diagnosis of reflux esophagitis （RE） or non-erosive reflux disease （NERD）,and healthy subject were enrolled in this prospective controlled study.The esophageal manometry and esophageal 26 hours pH monitoring were performed.GERD patients were divided into 3 groups according to their esophageal motility abnormalities：①low lower esophageal sphincter pressure （LESP） group,② ineffective esophageal motivation（IEM）group,③IEM and low LESP group.Esophageal acid exposure was analyzed among different groups.Results A total of 27 GERD patients （15 RE,12 NERD） and 10 healthy subjects were enrolled in this study.The esophageal motility abnormalities in GERD patients mainly presented as the decrease of LESP and distal esophageal body pressure.The proportion of 3 kinds of esophageal motility abnormalities has significant difference between RE and NERD patients （P =0.017）.In IEM and low LESP group,all patients suffered from RE,with the total number of acid exposure,the total acid exposure time and the acid exposure time in fasting higher than those in low LESP group [98.0（63.3,282.8）times vs 41.0（25.0,82.0）times,P=0.029;11.7% （4.1%,30.0%）vs 2.2% （1.4%,9.6%）,P=0.045;2.6%（0.9%,4.9%）vs0.0（0.0,1.2%）,P=0.015].Conclusions Esophageal motility abnormalities in GERD patients are characterized as low LESP and IEM in distal esophagus.The coexistence of low LESP and IEM exacerbates esophageal acid exposure,which might explain the mechanism of esophageal mucosal injury in RE patients.

关 键 词：胃食管反流 食管括约肌 下段 食管体部无效收缩 食管酸暴露 

分 类 号：R571[医药卫生—消化系统]