内镜下阴性胃食管反流病患者食管功能及反流特点研究  

Study of esophageal function and reflux characteristics in gastroesophageal reflux disease patients with negative endoscopy

作　　者：任梓林 陶琳[2] REN Zi-lin;TAO Lin(Clinical Medicine School,Beijing University of Chinese Medicine,Beijing 100029,China;Department of Spleen and Stomach,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]北京中医药大学临床医学院,北京100029 [2]首都医科大学附属北京中医医院脾胃病科,北京100010

出　　处：《中国中西医结合消化杂志》2020年第10期740-744,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：首都卫生科研发展专项(No:首发2018-2-2231)。

摘　　要：[目的]研究反流高敏感(RH)、功能性烧心(FH)与非糜烂性反流病(NERD)患者食管功能及反流特点的差别。[方法]选取于2017年12月~2019年5月在首都医科大学附属北京中医医院消化科同时行胃镜、高分辨率食管测压以及24 h多通路腔内阻抗联合pH监测的141例患者,根据症状及检查结果分为NERD组(42例)、RH组(58例)、FH组(41例),比较3组患者食管测压、24 h食管pH及pH-阻抗情况。[结果]FH组LES静息压、同步收缩百分比显著高于RH组(P<0.05);LES长度、LESP下降例数、LES残余压、UES静息压、UES残余压、波幅平均值、无效食管动力、蠕动断裂、DCI平均值、远端收缩延迟、提前收缩百分比、快速收缩百分比3组之间差异均无统计学意义(P>0.05);3组间DeMeester评分、总反流次数、立位酸暴露时间占比、近端酸反流次数、远端酸反流次数比较,差异有统计学意义(P<0.05)。NERD组总反流时间、长反流次数、最长反流时间、总酸暴露时间占比、卧位酸暴露时间占比显著高于RH组、FH组(P<0.05)。NERD组、RH组近端反流次数显著高于FH组(P<0.05)。RH组远端弱酸反流次数、近端弱酸反流次数中显著高于FH组(P<0.05)。3组远端非弱酸反流事件差异无统计学意义(P>0.05)。[结论]3组患者均存在不同程度的食管动力异常,可通过弱酸反流增加、近端反流比率升高将RH、FH精准区分开来。[Objective]To investigate the difference of esophageal function and reflux characteristics between patients with reflux hypersensitivity(RH),functional heartburn(FH)and non-erosive reflux disease(NERD).[Methods]One hundred and fourty-one patients concurrently taking the examinations of upper gastrointestinal endoscope,High-resolution esophageal manometry and 24 h pH-impedance monitoring from Dec.2017 to May.2019 were selected from the digestive department,Beijing Chinese Medicine Hospital,Capital Medical University.According to their symptoms and examinations,the patients were divided into NERD group(42 cases),RH group(58 cases)and FH group(41 cases).High resolution esophageal manometry,24-hour esophageal pH and pH-impedance monitoring were compared in three groups.[Results]The percentage of synchronous contraction and resting pressure of LES in FH group were significantly higher than that in RH group(P<0.05).There was no significant difference in the length of LES,decline of LESP,residual pressure of LES,restingpressure of UES,residual pressure of UES,average volatility,number of IEM,number of fracture peristalsis,average DCI,DL,percentage of early contraction,percentage of rapid contraction among the three groups(P>0.05).There were significant differences in DeMeester score,total reflux times,proportion of standing position acid exposure,proximal acid reflux times,distal acid reflux times among the three groups(P<0.05).Total reflux duration,long reflux times,the longest reflux duration,proportion of total acid exposure and proportion of supine position acid exposure in the NERD group were significantly higher than that in the RH group and FH group(P<0.05).Total proximal reflux times in the NERD group and RH group was significantly higher than that in the FH group(P<0.05).Distal weak acid reflux times and proximal weak acid reflux times in RH group were significantly higher than that in FH group(P<0.05).There was no significant difference in the distal non-weak acid reflux times among the three groups(P>0.05).[C

关 键 词：非糜烂性反流病 反流高敏感 功能性烧心 高分辨率食管测压 PH监测 pH-阻抗监测 

分 类 号：R571[医药卫生—消化系统]