胃食管反流病患者141例的24h食管阻抗-pH值监测结果  

Results of 24-hour esophageal impedance-pH monitoring in 141 patients with gastroesophageal reflux disease

作　　者：郭宝娜[1] 郭子皓[1] 姜佳丽[1] 李莉[1] 陈婧[1] 张川[1] Guo Baona;Guo Zihao;Jiang Jiali;Li Li;Chen Jing;Zhang Chuan(Department of Gastroenterology,Beijing Tongren Hospital of China Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院消化内科,100730

出　　处：《中华消化杂志》2019年第4期217-222,共6页Chinese Journal of Digestion

摘　　要：目的分析不同体型、年龄、性别、食管蠕动功能、食管下括约肌(LES)压力和临床分型等与GERD患者反流物类型的关系。方法回顾性分析2015年9月至2016年7月于首都医科大学附属北京同仁医院就诊的141例GERD患者的24h食管阻抗-pH值监测结果。比较不同体型、年龄段、性别、食管蠕动功能、LES压力和不同临床分型的GERD患者反流物类型的差异。组间比较采用Mann-Whitney检验。结果体型肥胖者(BMI>23.9kg/m2)较体型正常(BMI18.5~23.9kg/m2)者更易出现酸反流[18.5次(7.0次,45.3次)比10.0次(2.0次,32.0次)],差异有统计学意义(Z=-2.320,P=0.020)。年龄<65岁患者较≥65岁患者更易出现弱酸、非酸和气体反流[分别为58.5次(32.8次,95.0次)比40.0次(24.0次,71.0次),19.5次(6.0次,47.5次)比8.0次(3.0次,19.0次),46.0次(23.8次,79.3次)比35.0次(11.0次,56.0次)],差异均有统计学意义(Z=-2.690、-3.286、-2.091,P均<0.05)。男性较女性更易出现气体及混合反流[分别为53.5次(24.0次,122.8次)比36.0次(19.0次,67.0次),34.0次(20.8次,50.0次)比27.0次(14.0次,43.0次)],差异均有统计学意义(Z=-2.424、-1.961,P均<0.05)。食管蠕动正常者与异常者(蠕动弱或蠕动中断)比较,反流物类型差异均无统计学意义(P均>0.05);存在镜下食管黏膜损伤的反流性食管炎(RE)和Barrett食管患者较内镜阴性的非糜烂性反流病(NERD)患者更易出现弱酸、非酸和气体反流[分别为61.0次(31.3次,102.5次)比44.0次(24.5次,66.5次),18.0次(8.0次,36.5次)比8.0次(2.0次,22.0次),49.5次(27.5次,86.5次)比26.0次(11.0次,47.0次)],差异均有统计学意义(Z=-2.585、-2.942、-3.278,P均<0.05)。存在LES松弛的患者较LES功能正常者更易出现弱酸反流[57.0次(32.3次,87.0次)比40.0次(21.0次,73.0次)],差异有统计学意义(Z=-2.065,P=0.039)。结论体型、年龄、性别、LES压力和临床分型与GERD患者的反流物类型有关,而食管蠕动功能则与之无关。Objective To analyze the relationship between body type, age, gender, esophageal motility function, lower esophageal sphincter pressure (LESP) and clinical classification and type of reflux contents of patients with gastroesophageal reflux disease (GERD). Methods From September 2015 to July 2016, at Beijing Tongren Hospital of China Capital Medical University, the results of 24-hour esophageal impedance-pH monitoring of 141 patients with GERD were retrospectively analyzed. The differences of reflux contents were compared in patients with GERD among different body type, age, gender, esophageal motility function, LESP and clinical classification. Mann-Whitney test was performed for comparison between groups. Results Acid reflux was more common in obese patients (body mass index more than 23.9 kg/m2) compared with patients with normal body type (body mass index from 18.5 to 23.9 kg/m2)(18.5, 7.0 to 45.3 vs. 10.0, 2.0 to 32.0), and the difference was statistically significant (Z=-2.320, P=0.020). Patients under 65 years old had more numbers of weak acid reflux, non-acid reflux and gas reflux than patients over 65 years old (58.5, 32.8 to 95.0 vs. 40.0, 24.0 to 71.0;19.5, 6.0 to 47.5 vs. 8.0, 3.0 to 19.0;46.0, 23.8 to 79.3 vs. 35.0, 11.0 to 56.0), and the differences were statistically significant (Z=-2.690,-3.286 and -2.091, all P<0.05). Male patients had more gas and mixed reflux compared with female patients (53.5, 24.0 to 122.8 vs. 36.0, 19.0 to 67.0;34.0, 20.8 to 50.0 vs. 27.0, 14.0 to 43.0), and the differences were statistically significant (Z=-2.424 and -1.961, both P<0.05). There was no statistically significant difference in reflux contents between patients with normal esophageal motility and patients with esophageal motility disorder (weak or interrupted peristalsis)(all P>0.05). Patients with reflux esophagitis(RE)and /or Barrett′s esophagus (BE) had more weak acid reflux, non-acid reflux and gas reflux compared with patients with non-erosive reflux disease (NERD)(61.0, 31.3 to 102.5 vs. 44.0, 24.5 to 66

关 键 词：胃食管反流 24h食管pH-阻抗监测 反流物类型 

分 类 号：R571[医药卫生—消化系统]