唾液胃蛋白酶与合并胃食管反流的慢性阻塞性肺疾病加重关系的研究  

Relationship between saliva pepsin and acute exacerbations of chronic obstructive pulmonary disease patients with gastroesophageal reflux disease

作　　者：张育先[1] 胡国超 刘殿刚[2] 张若蹊 汪忠镐[2] ZHANG Yu - xian;HU Guo - chao;LIU Dian - gang(Department of Gastroenterology, Beijing Moslem Hospital, Beijing 100054, China;Department of General Surgery, GERD Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China)

机构地区：[1]北京市回民医院消化科,北京100054 [2]首都医科大学宣武医院普外科GERD诊疗中心,北京100053

出　　处：《临床和实验医学杂志》2018年第12期1260-1264,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市"215"高层次卫生技术人才学术骨干项目(编号:008-0088);中国博士后科学基金资助项目(编号:2012M510094);中国科学院学部咨询评议项目(编号:B-SM-2017-01)

摘　　要：目的探讨唾液胃蛋白酶对评估合并胃食管反流病的慢性阻塞性肺疾病(COPD)患者加重风险的意义。方法前瞻性选取2015年1~12月年龄>50岁的COPD稳定期患者76例,根据唾液胃蛋白酶检测结果分为两组:唾液胃蛋白酶阳性组和唾液胃蛋白酶阴性组,每组各38例。两组患者每半年随访一次,共随访1年。每次随访记录两组慢性阻塞性肺疾病急性加重(AECOPD)的次数、慢性阻塞性肺病评估测试(CAT)问卷、肺功能、胃食管反流病问卷(Gerd Q)。随访1年后,两组患者均给予奥美拉唑治疗半年,继续随访至2年,观察两组患者AECOPD次数及Gerd Q评分的变化。结果在1年随访期时,两组患者均有2例病例失访,唾液胃蛋白酶阳性组患者AECOPD次数及CAT问卷评分明显高于唾液胃蛋白酶阴性组[(3.08±1.01)次/年vs.(1.79±0.70)次/年;(33.84±3.49)分vs.(27.76±4.43)分],差异具有统计学意义(P<0.01)。在随访1年时,唾液胃蛋白酶阳性组患者第1秒用力呼气容积(FEV1)较唾液胃蛋白酶阴性组明显下降[(0.83±0.11)L vs.(0.99±0.12)L],差异具有统计学意义(P<0.05);两组患者Gerd Q量表评分[(14.45±3.10)分vs.(14.34±2.68)分]比较,差异无统计学意义(P>0.05)。1年后两组均予口服奥美拉唑治疗半年,继续随访至2年,两组患者Gerd Q评分较治疗前均下降[(14.45±3.10)分vs.(3.05±2.7)分;(14.34±2.68)分vs.(7.82±2.25)分],差异具有统计学意义(P<0.05);唾液胃蛋白酶阳性组患者下降幅度较唾液胃蛋白酶阴性组大[(11.45±4.06)分vs.(6.57±3.28)分],差异具有统计学意义(P<0.01)。在2年随访期内,唾液胃蛋白酶阳性组患者AECOPD次数较1年前发作次数减少[(3.08±1.01)次/年vs.(2.50±0.50)次/年],差异具有统计学意义(P<0.05),而唾液胃蛋白酶阴性组AECOPD次数较治疗前有轻度增加[(1.79±0.70)次/年vs.(2.20±0.60)次/年],差异无统计学意义(P>0.05)。结论唾液胃蛋白酶阳性与合并胃食管反流的COPD稳定期患者的急�Objective To investigate the relationship between saliva pepsin and the aggravation of chronic obstructive pulmonary disease（ COPD） with gastroesophageal reflux disease（ GERD）. Methods A total of 76 stable COPD patients in a prospective study with symptoms suggestive of GERD were enrolled from January to December 2015. Patients were divided into two group according to results of saliva pepsin： salivary protein negative group（ 38 patients）,and salivary protein positive group（ 38 patients）. The number of AECOPD,chronic obstructive pulmonary disease assessment（ CAT） questionnaire,pulmonary function and gastroesophageal reflux disease questionnaire（ Gerd Q） score in two groups were recorded every half year in one year follow-up. After 1 year of follow-up,the two groups were treated with omeprazole for half year,and go on follow-up to 2 years. The numbers of AECOPD and Gerd Q score in the two groups were observed in the second year. Results After 1 year of follow up,two cases were lost in each group,and both the numbers of AECOPD and the CAT score in salivary protein positive group were higher than that in salivary protein negative group [（ 3. 08 ± 1. 01） vs.（ 1. 79 ± 0. 70） times/year;（ 33. 84 ± 3. 49） vs.（ 27. 76 ± 4. 43） score,P〈0. 05]. While the lung function was significantly lower in salivary protein positive group than that in salivary protein negative group [（ 0. 83 ±0. 11） vs.（ 0. 99 ± 0. 12） L,P〈0. 05]. However,no significant difference of Gerd Q scales between the two group was observed [（ 14. 45 ±3. 10） vs.（ 14. 34 ± 2. 68） score,P〉0. 05]. After half year of treatment with omeprazole,Gerd Q score significantly decreased both in the positive group and negative group [（ 14. 45 ± 3. 10） vs.（ 3. 05 ± 2. 7） score;（ 14. 34 ± 2. 68） vs.（ 7. 82 ± 2. 25） score,P〈0. 05 ] and the decrease was more significant in the positive group than in negative group[（ 11. 45 ± 4. 06） vs.（ 6. 57 ± 3. 28） score,P〈0. 01] after t

关 键 词：胃食管反流病 慢性阻塞性肺疾病急性加重 唾液胃蛋白酶 质子泵抑制剂 

分 类 号：R563.9[医药卫生—呼吸系统] R571[医药卫生—内科学]