非糜烂性反流病与反流性食管炎症状特点的比较  

A comparison of clinical characteristics between non-erosive reflux disease and reflux esophagitis

作　　者：潘红艳[1] 向雪莲[1] 吕尚泽 谢小平[1] 侯晓华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院消化内科,武汉430022 [2]华中科技大学同济医学院附属荆州医院消化内科

出　　处：《中华内科杂志》2016年第7期510-514,共5页Chinese Journal of Internal Medicine

摘　　要：目的全面比较非糜烂性反流病（NERD）和反流性食管炎（RE）的临床症状特点，明确两者症状的差异。方法对2010--2014年华中科技大学同济医学院附属协和医院消化科门诊符合蒙特利尔诊断标准的NERD、RE患者进行问卷调查。从发生率、严重程度和发作频率层面全面分析和比较NERD、RE患者食管症状、食管外症状的差异，并对两组患者合并功能性消化不良（FD）、肠易激综合征（IBS）相关症状的发生率进行比较。结果225例NERD和221例RE患者纳入研究。（1）食管症状：NERD组烧心、反酸的发生率高于RE组[76，0％（171／225）比52．0％（115／221），74．7％（168／225）比54．3％（120／221），P值均〈0．01]，且症状更严重（P〈0．05），发作更频繁（P〈0．05）。NERD组反食严重程度和发作频率也均高于RE组（P〈0．05）。（2）食管外症状：NERD组咽喉部烧灼感、异物感的发生率高于RE组[40．9％（92／225）比27．6％（61／221），42．2％（95／225）比31．7％（70／221），P值均〈0．05]，且严重程度均较RE组更重（P〈0．05）。但RE组慢性咳嗽症状比NERD组程度更重（P〈0．05）。（3）合并FD、IBS相关症状情况：两组合并IBS症状的发生率差异无统计学意义，但NERD组合并FD症状的比例更高[72．0％（162／225）比62．9％（139／221），P〈0．05]。结论NERD与RE患者在食管症状、食管外症状及合并FD、IBS症状上差异较多，支持NERD与RE为独立的疾病的观点。Objective To summarize the clinical symptoms of patients with non-erosive reflux disease（NERD） and reflux esophagitis（RE） , which is helpful to the differential diagnosis. Methods Out- patients who met the criteria of NERD or RE according to the Montreal definition in Gastroenterology Department Wuhan Union Hospital from 2010 -2014 were enrolled in our study. Clinical data were comprehensively collected. Incidence of disease, severity, frequency of esophageal and extraesophageal symptoms, and the rates of overlapping with functional dyspepsia （FD） or irritable bowel syndrome （IBS） were all studied. Results Totally 446 subjects were recruited, including 225 patients with NERD and 221 patients with RE. The occurrence rates of esophageal symptoms including heartburn [ 76. 0% （171/225） vs 52. 0% （ 115/221 ）, P 〈 0. 01 ] and acid regurgitation [ 74. 7% （ 168/225 ） vs 54. 3% （ 120/221 ）, P 〈 0. 05 ] in NERD group were significantly higher than those in RE patients, with more severe and frequent （ P 〈 0. 05 ）. Despite the rates of food regurgitation were similar, NERD patients behaved more severely and frequently （ P 〈 0. 05 ）. Extraesophageal symptoms including throat burning and foreign body sensation in NERD group [40. 9% （92/225） vs 27. 6% （61/221）, 42.2% （95/225） vs 31.7% （70/221）, all P 〈 0. 05 ~ were also higher than those in RE group, the degree of which was more severe too （P 〈 0. 05）. RE patients claimed a higher proportion of chronic cough. The incidences of overlapping with IBS in two groups were similar. But there were more patients with FD in NERD group [ 72. 0% （ 162/225 ） vs 62. 9% （ 139/ 221 ）, P 〈 0. 05 ] than in RE group. Conclusions The menifestations and degree of esophageal and extraesophageal symptoms in patients with NERD or RE are different, as well as comorbidities such as FD and IBS. These results suggest that NERD and RE are independent diseases.

关 键 词：食管炎 非糜烂性反流病 食管症状 食管外症状 

分 类 号：R571[医药卫生—消化系统]