合并或不合并食管外症状的胃食管反流病患者食管动力与反流特征及机制探讨  

Esophageal motility and reflux characteristics in gastroesophageal reflux disease patients with or without extra-esophageal symptoms

作　　者：张艳丽[1] 郑岳[2] 朱慧婷 王慧芬[1] 杜时雨[1] 王淼 卢坤玲[2] Zhang Yanli;Zheng Yue;Zhu Huiting;Wang Huifen;Du Shiyu;Wang Miao;Lu Kunling(Department of Gastroenterology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院消化内科,北京100029 [2]秦皇岛市第一医院消化内科

出　　处：《中华医学杂志》2018年第44期3579-3583,共5页National Medical Journal of China

基　　金：“十二五”国家科技支撑计划（2014BA108802）

摘　　要：目的应用食管高分辨率测压（HRM）及24h食管多通道腔内阻抗-pH（MII-pH）监测，探讨合并或不合并食管外症状胃食管反流病（GERD）患者的食管动力与反流特征及机制。方法应用前瞻性对照研究的方法，纳入2016年2月至2017年6月就诊于北京中日友好医院的30例仅有典型反流症状的GERD患者，以及30例合并食管外症状和典型反流症状的GERD患者。受试者接受HRM和MII-pH监测。分析比较两组患者的食管动力和反流特点的差异。结果GERD合并食管外症状患者的反流症状评分与不合并食管外症状GERD患者相比差异无统计学意义，但前者的食管下括约肌（LES）静息压、食管综合松弛压、食管上括约肌（UES）恢复时间均低于不合并食管外症状患者[分另0为（15±7）比（21±11）mmHg，（8±3）比（10±5）mmHg，（388±168）比（492±170）ms，1mmHg=0．133kPa]（均P〈0．05）。合并食管外症状GERD患者的食管动力障碍分型以轻度食管动力障碍为主（27％，8／30），无效食管动力占20％（6／30），与不合并食管外症状GERD患者相比，差异无统计学意义。比较两组的反流特点，GERD合并食管外症状患者的异常非酸反流发生率、弱酸反流的近端反流百分比和非酸反流的近端反流百分比均高于不合并食管外症状组[73．3％比46．7％，P=0．03；84．6％（73．2％，100．0％）比75．0％（60．0％，87．65％），P=0．048；90．0％（45．8％，100．0％）比0（0，100．0％），P=0．01]。结论GERD合并食管外症状的食管动力和反流特征与单纯GERD不同，其中近端反流比例增加以及异常非酸反流可能是前者重要的发病机制。Objective To investigate esophageal motility and reflux characteristics in gastroesophageal reflux disease （ GERD ） with and without extra-esophageal symptoms by high-resolution manometry and 24 h esophageal multiehannel intraluminal impedance combined pH （MII-pH） monitoring. Methods From February 2016 to June 2017, GERD patients with and without extra-esophageal symptoms were enrolled in this prospective controlled study. Esophageal HRM and 24 h MII-pH monitoring were performed. The differences in esophageal motility and reflux parameters were further analyzed between 30 GERD patients with extra-esophageal symptoms and 30 simple GERD patients. Results The GERD symptom scores didn＇t show statistical difference between two groups. The GERD symptom scores didn＇t show statistical difference between two groups. The relaxation pressure of lower esophageal sphincter（ LES）, the integrated relaxation pressure, and the recovery time of upper esophageal sphincter （UES） of GERD patients with extra-esophageal symptoms were all lower than those of patients without extra-esophageal symptoms [（15±7） vs （21±11）mmHg, （8±3） vs （10±5）mmHg, （388±168） vs （492±170）ms, 1 mmHg = 0. 133 kPa] , and the differences were classification of esophageal motility type of GERD statistically significant （ all P 〈 0. 05 ） . The main patients with extra-esophageal symptoms was mild esophageal motility disorders （27%, 8/30）, and the occurrence of ineffective esophageal motivation was 20% （6/30） , which were similar with simple GERD patients. The proximal reflux percentages of weak acid reflux and nonacid reflux, abnormal nonacid reflux in GERD patients with extra-esophageal symptoms were significantly higher than those in simple GERD patients [84. 6% （73.2%, 100. 0% ） vs 75.0% （60.0%, 87.65%）, P=0.048; 90.0% （45.8%, 100.0%） vs0（0, 100.0%）, P=0.017; 46.7% vs3.3%, P = 0. 03 ]. Conclusions The pathogenesis of GERD with extra-esophageal symptoms may be different from typical

关 键 词：胃食管反流 食管PH监测 食管外症状 高分辨率食管测压 

分 类 号：R571[医药卫生—消化系统]