不同类型的食管动力异常对胃食管反流病的影响  

Influence of Different Esophageal Motor Abnormalities on Gastro-Esophageal Reflux Disease

作　　者：牛小羽[1] 张玫[1] 佘静[1] 

机构地区：[1]首都医科大学宣武医院消化科,北京100053

出　　处：《南昌大学学报（医学版）》2015年第4期33-35,39,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的通过分析下食管括约肌压力(LESP)下降和无效食管运动(IEM)的发生率及其与食管远端pH<4的>5min反流次数、食管酸清除(EAC)时间的关系,探讨LESP低下及IEM在胃食管反流病(GERD)中的作用。方法将272例GERD患者根据标准食管压力测定的结果分为3组:正常组(57例)、LESP降低组(73例)和IEM组(142例)。3组患者均行食管测压、24h食管动态pH检查。观察3组患者食管远端pH<4的总时间百分比和立位、卧位食管远端pH<4的时间百分比、食管远端pH<4的>5min反流次数及EAC时间(总EAC时间和立、卧位EAC时间)。结果正常组、LESP降低组患者食管远端pH<4的总时间百分比、立位食管远端pH<4的时间百分比均明显低于IEM组,LESP降低组、IEM组患者卧位食管远端pH<4的时间百分比则均明显高于正常组(均P<0.01);IEM组患者立位EAC时间明显高于正常组,食管远端pH<4的>5min反流次数则明显高于正常组和LESP降低组(P<0.05或P<0.01)。结论由IEM和LESP降低所引起的食管动力异常是GERD的主要诱因,其中前者尤为重要。Objective To evaluate the roles of decreased lower esophageal sphincter pressure（LESP）and invalid esophageal movement（IEM）in gastro-esophageal reflux disease（GERD）through analyzing the incidences of low LESP and IEM and their relationships to number of distal esophageal reflux episodes with pH〈4 that lasted longer than 5 min and esophageal acid clearance（EAC）time.Methods According to the results of standard esophageal pressure measurement,272 GERD patients were divided into three groups：normal group（57cases）,low LESP group（73cases）,and IEM group（142cases）.All patients underwent esophageal pressure measurement and 24-h dynamic esophageal pH monitoring.The percentage of time of pH4in the distal esophagus（upright,supine and total）,number of distal esophageal reflux episodes with pH〈4that lasted longer than 5min,and EAC time（upright,supine and total）were observed in all the three groups.Results Compared with IEM group,percentages of total and upright time of pH〈4in the distal esophagus and number of distal esophageal reflux episodes with pH〈4that lasted longer than 5min were decreased in normal group and low LESP group,and upright EAC time was shortened in normal group（P〈0.05 or P〈0.01）.Compared with normal group,percentage of supine time of pH4in the distal esophagus was increased in low LESP group and IEM group（P〈0.01）.Conclusion Esophageal motor abnormalities induced by IEM and low LESP,especially IEM,are the main causes of GERD.

关 键 词：胃食管反流病 食管动力障碍 下食管括约肌压力 无效食管运动 

分 类 号：R57[医药卫生—消化系统]