胃食管反流病患者食管动力及酸暴露特点分析  

Characteristics of esophageal motility and acid exposure in patients with gastroesophageal reflux disease

作　　者：张亚军 黎永军[1] 李桂芹 马潇潇 李玥 Ya-Jun Zhang;Yong-Jun Li;Gui-Qin Li;Xiao-Xiao Ma;Yue Li(Department of Gastroenterology,First Affiliated Hospital of Shihezi University,Shihezi 832000,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]石河子大学第一附属医院消化内科,新疆维吾尔自治区石河子市832000

出　　处：《世界华人消化杂志》2018年第36期2096-2101,共6页World Chinese Journal of Digestology

摘　　要：目的通过对胃食管反流病(gastroesophageal reflux disease,GERD)患者食管高分辨率测压及24 h食管p H-阻抗联合监测结果分析,以探讨GERD患者食管动力及酸暴露特点.方法选取2017-07/2018-07就诊于石河子大学第一附属医院消化内科门诊及住院部具有典型症状(反酸、烧心)、根据蒙特利尔共识意见可诊断为GERD的患者59例,行胃镜、食管高分辨率测压及24 h食管p H-阻抗联合监测等检查;根据胃镜是否诊断反流性食管炎(reflux esophagitis, RE)组(27例,男/女:12/15)和非糜烂性反流病(nonerosive reflux disease, NERD)组(32例,男/女:14/18),比较两组患者食管高分辨测压及24 h食管pH-阻抗监测结果的差异.结果食管高分辨率测压结果中, RE组患者下食管括约肌静息压明显低于NERD组(P<0.05),上食管括约肌静息压及上下食管括约肌残余压比较差异无统计学意义(P>0.05), RE组患者远端波波幅低于NERD组(P <0.05),蠕动波持续时间、起始速度、远端收缩延迟时间两组间差异无统计学意义(P>0.05);分析24 h食管pH-Z监测结果, RE组DeMeester评分明显高于NERD组(P<0.05),总计酸反流时间低于NERD组(P <0.05),立卧位反流次数、总计反流次数、不同物理性质之间差异无统计学意义(P>0.05).结论不同GERD患者食管动力及酸反流存在一定的差异,RE患者食管动力障碍及酸反流较NERD更明显.AIM To investigate the characteristics of esophageal motility and acid exposure in patients with gastroesophageal reflux disease(GERD)by analyzing the results of high resolution manometry and 24-h esophageal pHimpedance monitoring.METHODS Fifty and nine outpatient or inpatient GERD patients with typical symptoms(acid reflux and heartburn)at the Department of Gastroenterology,First Affiliated Hospital of Shihezi University from July 2017 to July 2018 were selected and analyzed.Gastroscopy,highresolution esophageal manometry,and 24-h esophageal pH-impedance monitoring were performed.The patients were divided into a reflux esophagitis(RE)group(27 cases,male/female:12/15)and a nonerosive reflux disease(NERD)group(32 cases,male/female:14/18)according to the diagnosis of RE by gastroscopy.RESULTS The resting pressure of the lower esophageal sphincter in the RE group was significantly lower than that in the NERD group(P<0.05).There was no significant difference in the resting pressure of the upper esophageal sphincter or the residual pressure of the upper and lower esophageal sphincter between the RE group and NERD group(P>0.05).There was no significant difference in time,onset velocity,or distal latency between the two groups(P>0.05);24-h esophageal pH-impedance monitoring results showed that the DeMeester score in the RE group was significantly higher than that in the NERD group(P<0.05),while total acid reflux time was significantly lower than that in the NERD group(P<0.05).There was no significant difference in the number of times of reflux in the standing or supine position,total reflux times,or different physical properties(P>0.05).CONCLUSION Esophageal motility and acid reflux are different in different GERD patients.Esophageal motility disturbance and acid reflux in RE patients are more obvious than those in NERD patients.

关 键 词：胃食管反流病 食管高分辨率测压 24h食管pH-阻抗联合监测 DeMeester评分 

分 类 号：R571[医药卫生—消化系统]