内镜下胃食管阀瓣分型与胃食管反流病食管动力的关系  

A preliminary study on the relationship between gastroesophageal flap valve classification under endoscope and esophageal motility in gastroesophageal reflux disease

作　　者：胡莹 丁百静 HU Ying;DING Baijing(Department of Gastroenterology,The Second People’s Hospital of Wuhu,Wuhu,Anhui 241000,China)

机构地区：[1]芜湖市第二人民医院消化内科,安徽芜湖241000

出　　处：《安徽医药》2020年第8期1549-1553,I0003,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨内镜下胃食管阀瓣(GEFV)分型与胃食管反流病(GERD)食管动力的关系。方法回顾性分析2015年1月至2018年12月就诊于芜湖市第二人民医院诊断为GERD病人76例,均行内镜、食管高分辨测压、24 h食管pH监测,根据内镜下HILL分级,将GEFV分为Ⅰ~Ⅳ级,Ⅰ级、Ⅱ级为正常组,Ⅲ级、Ⅳ级为异常组,比较两组内镜下表现、食管测压、24 h食管pH监测相关指标。结果异常组反流性食管炎(RE)、Barrett食管(BE)检出率为73.0%,高于正常组(41.0%),差异有统计学意义(P<0.05),两组食管上括约肌静息压(UESP)[(57.69±32.65)mmHg比(56.32±28.50)mmHg]差异无统计学意义(P>0.05),异常组食管下括约肌静息压(LESP)[(7.93±3.85)mmHg比(19.64±5.95)mmHg]、远端收缩积分(DCI)[(223.59±195.67)mmHg·s-1·cm-1比(533.64±289.71)mmHg·s-1·cm-1]、4 s综合松弛压(IRP4s)[4.0(3.3,4.8)比5.6(4.6,6.8)]低于正常组,差异有统计学意义(P<0.05)。两组食管收缩模式、食管蠕动力度相比,差异无统计学意义(P>0.05),异常组Demeester评分[9.02(7.28,16.28)分比3.57(1.65,5.60)分]、酸反流次数[45.00(25.00,56.50)次比15.00(10.00,32.00)次]、pH<4所占的总时间百分比高于正常组,差异有统计学意义(P<0.05)。结论 GEFV异常者内镜下阳性表现发生率高,GEFV可能参与食管抗反流机制,可以有效的预测反流。Objective To explore the relationship gastroesophageal flap valve(GEFV)classification under endoscope and esophageal motility in gastroesophageal reflux disease(GERD).Methods Data of a total of 76 GERD patients treated in The Second People’s Hospital from January 2015 to December 2018 were analyzed retrospectively.All the patients received endoscopy,esophageal high resolution manometry and 24-hour pH monitoring.According to the HILL classification,GEFV was assigned into Ⅰ to Ⅳgrades,and classified into two groups:normal GEFV(HILL grades Ⅰ and Ⅱ),and abnormal GEFV(HILL grades Ⅲ and Ⅳ).Endoscopic findings,the esophageal manometry,and the 24-hour pH monitoring were analyzed and compared between the two groups.Results The detection rate of reflux esophagitis(RE),Barrett esophagus(BE)in abnormal GEFV group was 73.0%,which was higher than that in normal GEFV group(41.0%);the difference was significant(P<0.05).There was no significant difference in upper esophageal sphincter pressure(UESP)between the two groups[(57.69±32.65)mmHg vs.(56.32±28.50)mmHg,P>0.05].Lower esophageal sphincter pressure(LESP)[(7.93±3.85)mmHg vs.(19.64±5.95)mmHg],the distal contraction integral(DCI)[(223.59±195.67)mmHg·s-1·cm-1 vs.(533.64±289.71)mmHg·s-1·cm-1]and the 4 s comprehensive relaxation pressure(IRP4 S)[4.0(3.3,4.8)vs.5.6(4.6,6.8)]were significantly lower in the GEFV abnormal group than those in normal GEFV group(P<0.05).There were no significant differences in the esophageal contraction mode and the force of esophageal peristalsis between the two groups(P>0.05).The Demeester score[9.02(7.28,16.28)score vs.3.57(1.65,5.60)score],acid reflux times[45.00(25.00,56.50)times vs.15.00(10.00,32.00)times],and the total time percentage caused by pH<4 in the abnormal GEFV group were significantly higher than those in normal GEFV group(P<0.05).Conclusion The incidence of positive findings under endoscopy is high in patients with abnormal GEFV.GEFV may be involved in the mechanism of esophageal antireflux and can be used to pred

关 键 词：胃食管反流 胃镜检查 胃食管阀瓣 食管高分率测压 食管PH监测 

分 类 号：R571[医药卫生—消化系统]