无效食管运动的临床特点和动力学分析  

Analysis of clinical features and motility characteristics of ineffective esophageal motility

作　　者：张娜[1] 卢文婷 李虹[1] 吴黎红[2] 刘建湘[2] 焦红梅[1] Zhang Na;Lu Wenting;Li Hong;Wu Lihong;Liu Jianxiang;Jiao Hongmei(Department of Geriatrics,Peking University First Hospital,Beijing 100034,China;Department of Gastroenterology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院老年内科,100034 [2]北京大学第一医院消化内科,100034

出　　处：《中华消化杂志》2019年第10期669-673,共5页Chinese Journal of Digestion

基　　金：中央保健基金(W2013BJ29)。

摘　　要：目的明确无效食管运动(IEM)患者临床特点、食管动力学特征与食管酸暴露的关系。方法将2016年1月至2018年3月在北京大学第一医院行食管高分辨率测压(HRM)的22例IEM患者和24例HRM正常者作为研究对象。对比IEM患者和HRM正常者的临床特点、食管HRM测量参数、24 h食管pH值监测结果。根据10次吞咽的食管远段收缩积分(DCI)中位数250~450 mmHg·s·cm(1 mmHg=0.133 kPa)和<250 mmHg·s·cm,将IEM患者分为轻型IEM组(14例)和重型IEM组(8例),对比HRM正常组、轻型IEM组和重型IEM组患者的临床特点和食管动力学特征。统计学分析采用t检验、卡方检验或单因素方差分析。结果IEM组患者年龄大于HRM正常组[(64.5±11.2)岁比(50.3±18.2)岁],差异有统计学意义(t=-3.135,P=0.003);下食管括约肌静息压(LESP)低于HRM正常组[(17.0±6.8)mmHg比(22.3±7.2)mmHg],差异有统计学意义(t=2.516,P=0.016)。HRM正常组和IEM组分别有15例和14例患者行24 h食管pH值监测,分别有5例和2例患者存在食管酸暴露时间(AET)延长。重型IEM组患者近段食管体部(PEB)压力带长度短于HRM正常组和轻型IEM组[(2.8±1.5)cm比(4.2±0.7)cm、(4.6±0.9)cm],差异均有统计学意义(t=2.397、3.432,P=0.044、0.003);HRM正常组完整松弛压力和LESP均大于轻型IEM组[(9.3±2.9)mmHg比(7.2±3.3)mmHg,(22.3±7.2)mmHg比(15.4±7.1)mmHg],差异均有统计学意义(t=2.148、2.843,P=0.038、0.007)。轻型、重型IEM组分别有6例和8例患者行24 h食管pH值监测,其中2例轻型IEM患者存在AET延长。结论IEM患者LESP低,其临床表现和食管AET与IEM严重程度无关。重型IEM患者近、远段食管收缩幅度均减弱,PEB压力带缩短。Objective To clarify the correlation between the clinical characteristics,esophageal motility features and esophageal acid exposure in patients with ineffective esophageal motility(IEM).Methods From January 2016 to March 2018,at Peking University First Hospital,22 IEM patients diagnosed by esophagus high-resolution manometry(HRM)and 24 individuals with normal HRM results were enrolled.Clinical features,parameters of esophageal HRM and results of esophageal 24-hour pH monitoring of IEM patients and the individuals with normal HRM results were compared.According to the median distal contraction integral(DCI)of ten swallows,the IEM patients were divided into mild-IEM group(DCI 250-450 mmHg·s·cm(1 mmHg=0.133 kPa))(14 cases)and severe-IEM group(DCI<250 mmHg·s·cm)(eight cases).The clinical features and esophageal motility were compared between normal HRM group,mild-IEM group and severe-IEM group.T test,chi-square test and one-way analysis of various were used for statistical analysis.Results The age of IEM group was older than that of normal HRM group((64.5±11.2)years vs.(50.3±18.2)years),and the difference was statistically significant(t=-3.135,P=0.003).The lower esophageal sphincter pressure(LESP)of IEM group was lower than that of normal HRM group((17.0±6.8)mmHg vs.(22.3±7.2)mmHg),and the difference was statistically significant(t=2.516,P=0.016).There were 15 cases in normal HRM group and 14 patients in IEM group who underwent esophageal 24-hour pH monitoring and there were five and two patients with abnormal acid exposure time(AET)in normal HRM group and IEM group,respectively.The length of proximal esophageal body(PEB)pressure zone of severe-IEM group was shorter than those of normal HRM group and mild-IEM group((2.8±1.5)cm vs.(4.2±0.7)cm and(4.6±0.9)cm),and the differences were statistically significant(t=2.397 and 3.432,P=0.044 and 0.003).The integrated relaxation pressure(IRP)and LESP of normal HRM group were both higher than those of mild-IEM group((9.3±2.9)mmHg vs.(7.2±3.3)mmHg,(22.3±7.2)mmHg vs

关 键 词：食管括约肌 上段 无效食管运动 食管高分辨率测压 近段食管体部 

分 类 号：R57[医药卫生—消化系统]