基于罗马Ⅳ标准的内镜阴性胃灼热患者食管运动和抗反流屏障功能研究  

Study on esophageal motility and anti-reflux barrier function in patients with heartburn symptom and negative endoscopic findings based on RomeⅣcriteria

作　　者：贾玉婷 周世平[1] 赵希 徐晓雯 徐红[1] 王丹[1] Jia Yuting;Zhou Shiping;Zhao Xi;Xu Xiaowen;Xu Hong;Wang Dan(Department of Gastroenterology,The First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院胃肠内科,长春130021

出　　处：《中华消化杂志》2019年第12期817-823,共7页Chinese Journal of Digestion

摘　　要：目的评估基于罗马Ⅳ标准分类的不同表型内镜阴性胃灼热患者食管运动和抗反流屏障功能。方法回顾性分析2011年3月至2018年11月有胃灼热症状且内镜阴性的患者136例。联合食管高分辨率压力测定(HRM)、24 h pH值监测和PPI试验,按照罗马Ⅳ标准和新的诊断流程,分为非糜烂性反流病(NERD)组、反流高敏感组、功能性胃灼热组和未分类组;同时选择20名健康志愿者作为健康对照组。分析比较不同组间食管动力类型和食管HRM参数变化。采用单因素方差分析、Kruskal-Wallis H检验和卡方检验进行统计学分析。结果基于罗马Ⅳ标准,NERD组35例,反流高敏感组43例,功能性胃灼热组48例,未分类组10例。在下食管括约肌(LES)长度、呼气末下食管括约肌静息压(LESP)、LESP平均值、4 s完整松弛压力(4 s-IRP)、远端收缩延迟时间(DL)、上食管括约肌静息压残余压(UESRP)、上食管括约肌(UES)松弛至最低点时间、UES恢复时间和食管胃连接部收缩积分(EGJ-CI)方面,NERD组、反流高敏感组、功能性胃灼热组、未分类组间及其与健康对照组间的差异均无统计学意义(P均>0.05);NERD组和未分类组远端收缩积分(DCI)均低于健康对照组[919.7 mmHg·s·cm(411.7,1417.9)mmHg·s·cm(1 mmHg=0.133 kPa)、535.6 mmHg·s·cm(321.4,1513.4)mmHg·s·cm比1322.1 mmHg·s·cm(841.6,1918.5)mmHg·s·cm],差异均有统计学意义(Z=-2.62、-2.20,P=0.01、0.03);未分类组上食管括约肌静息压(UESP)低于健康对照组[57.0 mmHg(31.3,77.8)mmHg比70.4 mmHg(49.4,97.8)mmHg],差异有统计学意义(Z=-2.64,P=0.02);NERD组、反流高敏感组、功能性胃灼热组、未分类组间食管胃连接部(EGJ)分型的差异有统计学意(χ^2=10.85,P=0.02),未分类组EGJⅢ型患者比例最高,其次为NERD组,均高于反流高敏感组和功能性胃灼热组。在食管动力类型方面,NERD组、反流高敏感组、功能性胃灼热组、未分类组间食管动力类型构成的差异无Objective To evaluate esophageal motility and anti-reflux barrier function in patients with different phenotypes of heartburn and negative endoscopic findings based on the RomeⅣcriteria.Methods From March 2011 to November 2018,136 patients with heartburn and negative endoscopic findings were retrospectively analyzed.The patients underwent high-resolution manometry(HRM),24-hour pH monitoring and proton pump inhibitor(PPI)test and according to the RomeⅣcriteria and new diagnostic procedures,they were divided into non-erosive reflux disease(NERD)group,reflux hypersensitivity(RH)group,functional heartburn(FH)group and unclassified group.During the same period,20 healthy volunteers were selected as healthy control group.The changes of esophageal motility and HRM were analyzed among different groups.Statistical analysis was performed using one-way analysis of variance,Kruskal-Wallis H test and chi-square test.Results According to RomeⅣcriteria,35 patients were enrolled into the NERD group,43 patients were enrolled into the RH group,48 patients were included in the FH group,and 10 patients were enrolled into unclassified group.There were no significant differences between the NERD group,the RH group,the FH group,the unclassified group and healthy control group in the length of the lower esophageal sphincter(LES),end lower esophageal sphincter resting pressure(LESP),mean LESP,4-second-integrated relaxation pressure(4 s-IRP),distal latency(DL),upper esophageal sphincter residual pressure(UES-RP),upper esophageal sphincter relaxation time to nadir,upper esophageal sphincter(UES)recovery time and esophagogastric junction contractile integral(EGJ-CI,all P>0.05).The distal contractile integral(DCI)of NERD group and unclassified group were both lower than that of healthy control group(919.7 mmHg·s·cm(411.7,1417.9)mmHg·s·cm(1 mmHg=0.133 kPa),535.6 mmHg·s·cm(321.4,1513.4)mmHg·s·cm vs.1322.1 mmHg·s·cm(841.6,1918.5)mmHg·s·cm),and the differences were statistically significant(Z=-2.62 and-2.20,P=0.01 and 0.03).The

关 键 词：胃灼热 食管PH监测 非糜烂性反流病 反流高敏感 压力测定 罗马Ⅳ 

分 类 号：R573[医药卫生—消化系统]