贲门失弛缓症患者食管上下括约肌压力变化与年龄的关系  

Dynamic analysis of upper and lower esophageal sphincter in achalasia patients at different ages

作　　者：马欣[1] 彭丽华[1] 王潇潇[1] 艾洁[1] 杨云生[1] 

机构地区：[1]解放军总医院消化科,北京100853

出　　处：《解放军医学院学报》2016年第6期603-606,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨不同年龄段贲门失弛缓症（achalasia,AC）患者食管上下括约肌压力的变化特点,为其病理生理机制和诊疗提供新的依据。方法回顾性分析2014年11月—2015年11月在我院消化动力中心行高分辨率食管测压（high resolution esophageal manometry,HRM）后根据2014年新版芝加哥分型诊断为贲门失弛缓症患者146例,根据年龄分组为青年组85例（≤44岁）、中年组41例（45～59岁）、老年组20例（≥60岁）,并对各组患者的临床资料和HRM数据进行分析。结果随着年龄的增加,男性患AC的比例显著下降,青年组男性患病率显著高于老年组（50.6%vs 20.0%,P=0.013）。青年组下食管括约肌（lower esophageal sphincter,LES）综合松弛压显著高于老年组[（29.78±9.72）mm Hg vs（24.75±7.11）mm Hg（1 mm Hg=0.133 k Pa）,P=0.032],老年组LES静息压异常的发生率显著低于青年组（10.0%vs 32.9%,P=0.041）。青年组上食管括约肌（upper esophageal sphincter,UES）静息压显著高于老年组[（75.92±32.45）mm Hg vs（53.27±22.17）mm Hg,P=0.004]。老年组UES静息压低压的发生率显著高于青年组（30.0%vs 5.9%,P=0.006）,而青年组UES静息压高压的发生率显著高于老年组（18.8%vs 0,P=0.006）。结论贲门失弛缓症好发于青中年患者,男性患AC的比例随年龄增长呈下降趋势。相比老年患者,中青年患者LES综合松弛压增高更显著、UES静息压更高。Objective To investigate the esophageal sphincter pressure changes of achalasia（AC） patients at various ages using high resolution esophageal manometry（HRM） and provide evidences for its physiopathologic mechanism and treatment.Methods Clinical data about 146 patients with achalasia who had undergone HRM at our Digestive Endoscopic Center from November 2014 to November 2015 were retrospectively analyzed. All patients were divided into three groups： group A（young group： ≤44 years, n=85）, group B（middle-aged group： 45-59 years, n=41） and group C（older group：≥60 years, n=20）. Clinical characteristics and HRM data were compared between three groups. Results The prevalence of AC in male patients declined significantly with the increase of age（group A vs group C： 50.6% vs 20.0%, P=0.013）. Integrated relaxation pressure（IRP） of lower esophageal sphincter in young group was significant higher than older group [（29.78±9.72） mm Hg vs（24.75±7.11） mm Hg（1 mm Hg=0.133 k Pa）, P=0.032], while, the incidence of abnormal LES resting pressure was significantly higher in young group than older group（32.9% vs 10.0%, P=0.041）. Furthermore, upper esophageal sphincter（UES） resting pressure in young group was significant higher than older group [（75.92±32.45） mm Hg vs（53.27±22.17） mm Hg, P=0.004]. The incidence of low UES resting pressure was significantly higher in older group than young group（30.0% vs 5.9%, P=0.006）. Conversely, the incidence of high UES resting pressure were significantly higher in young group than older group（18.8% vs 0, P=0.006）. Conclusion Achalasia mostly occurs in young and middle-aged person. The prevalence in male declines significantly with the increase of age. Compared with older group, patients in young group show higher LES integrated relaxation pressure and higher UES resting pressure.

关 键 词：贲门失弛缓症 食管上括约肌 食管下括约肌 高分辨率食管测压 

分 类 号：R573.7[医药卫生—消化系统]