胃食管反流病EGJ分型与反流的相关性研究  

The relationship between esophagogastric junction type and reflux in GERD patients

作　　者：张颖慧[1,2] 王一平[2] 张笛[1] 

机构地区：[1]四川省人民医院消化内科,四川成都610072 [2]四川大学华西医院消化内科,四川成都610041

出　　处：《西部医学》2016年第7期943-946,共4页Medical Journal of West China

基　　金：四川省卫生厅科研课题(110184)

摘　　要：目的研究胃食管反流病（GERD）食管胃交接区（EGJ）分型与24h食管MII-PH监测结果之间的关系。方法回顾分析2014~2015年行24h食管MII-PH检查的140例患者,根据胃食管反流病的蒙特利尔共识意见将140例患者分为98例GERD患者和42例非GERD患者。并行食管内24h食管多通道腔内阻抗-PH监测和行食管动力检测,在食管动力检测结果中测量食管下括约肌（LES）及膈肌（CD）的距离,按芝加哥标准分为EGJⅠ、Ⅱ、Ⅲ型：Ⅰ型（LES与膈肌分离G1cm）;Ⅱ型（LES与膈肌分离1~G2cm）;Ⅲ型（LES与膈肌分离≥2cm）[1,2]。结果 140例患者中81例EGJⅠ型、38例Ⅱ型及21例Ⅲ型GERD患者通过多通道腔内阻抗监测所得结果提示酸反流（包括总反流分钟及次数、长反流次数、最长反流持续时间、Demeester评分、平均酸清除时间）均为Ⅰ型〈Ⅱ型〈Ⅲ型（P〈0.05）,两两比较Ⅱ型和Ⅲ型之间无显著差异;弱酸反流及非酸反流为：弱酸反流为Ⅰ型〈Ⅱ型〈Ⅲ型（P〈0.05）,但两两比较无差异,非酸反流各型比较无显著差异;近端反流各型比较无显著差异。直立、卧位的总反流次数、酸反流次数、弱酸反流次数为：Ⅰ型〈Ⅱ型〈Ⅲ型（P〈0.05）,但两两比较Ⅱ型和Ⅲ型之间无显著差异,非酸反流次数各型之间无显著差异;非酸反流相关概率（SAP）阳性率的比较：Ⅰ型〈Ⅱ型〈Ⅲ型（P〈0.05）,Ⅱ型和Ⅲ型之间无差异（P〉0.05）。结论食管胃交接区（EGJ）分型能简单预测食管酸暴露、反流物的性质、症状相关情况。一旦出现食管下括约肌（LES）与膈肌（CD）的分离意味着有严重的反流事件发生,EGJⅡ型和Ⅲ型导致的反流结果无明显差异。Objective To study the relationship between EGJ Type and 24 hesophageal PH monitoring index.Methods 140patients（62men and 78women）with 24hMII-PH examination in 2014,according to the Montreal consensus on GERD,were divided into GERD patients（98cases）and non GERD patients（42cases）.140 patients were taken24 h multichannel intraluminal pH-impedance monitoring and esophageal motility testing including lower esophageal sphincter（LES）and crural diaphragm（CD）distance.The patients were divided into EGJⅠ,EGJⅡ and EGJⅢ according to Chicago standard.CD completely overlap on the LES was EGJⅠ.LES CD separation 0-2cm was EGJⅡ.LES CD separated more than 2cm was EGJⅢ.Results 140 patients included 81 EGJ type Ⅰ,38 EGJ type Ⅱ and 21 EGJ typeⅢ.The acid reflux indexes including total reflux minutes and the numbers,long reflux episodes times,the longest duration of reflux,demeester scores,average acid clearance time were obtained by multi channel impedance monitoring.The acid reflux indexes of EGJ typeⅠ were less than that of EGJ typeⅡ and EGJ typeⅢ（P0.05）.There were no significantly different between acid reflux indexes of EGJ typeⅡand EGJ typeⅢ.Weak acid reflux of EGJ typeⅠ were less than that of EGJ typeⅡ and EGJ typeⅢ（P0.05）.There were no significantly different between non acid reflux of EGJ typeⅠ,EGJ typeⅡ and EGJ typeⅢ（P0.05）.The positive rate of SAP of EGJ type I were less than that of EGJ typeⅡand EGJ typeⅢ（P0.05）.Conclusion EGJ typing can predict the esophageal acid exposure,the property of reflux,and the SAP of the reflux.The separation of LES and CD means that there are serious reflux events.EGJ type II and type III lead almost the same serious reflux events.

关 键 词：胃食管反流病 EGJ分型 食管测压 24hMII-PH监测 

分 类 号：R573[医药卫生—消化系统]