非糜烂性胃食管反流病、反流高敏感和功能性烧心患者临床特征比较  

Comparison of clinical characteristics of patients with non-erosive gastroesophageal reflux disease,reflux hypersensitivity or functional heartburn

作　　者：姚文柱 张阿静 狄佳[3] 崔曼莉 张明鑫 张军[3] Yao Wenzhu;Zhang Ajing;Di Jia;Cui Manli;Zhang Mingxin;Zhang Jun(Department of Internal Medicine,The First Clinical Medical School of Xi’an Medical College,Xi’an 710032,China;Department of Gastroenterology,The First Affiliated Hospital of Xi’an Medical College,Xi’an 710077,China;Department of Gastroenterology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安医学院第一临床医学院内科学教研室,710032 [2]西安医学院第一附属医院消化内科,710077 [3]西安交通大学第二附属医院消化内科,710004

出　　处：《中华消化杂志》2020年第10期669-673,共5页Chinese Journal of Digestion

摘　　要：目的比较非糜烂性胃食管反流病(NERD)、反流高敏感(RH)和功能性烧心(FH)患者的临床特征,为三者的鉴别诊断和治疗提供帮助。方法连续选择2016年10月至2019年2月西安交通大学第二附属医院消化内科内镜检查无异常的持续烧心患者64例,包括NERD患者26例(NERD组)、RH患者12例(RH组)和FH患者26例(FH组)。比较3组患者的性别、年龄、BMI、有无食管裂孔疝、PPI治疗效果、就诊前1个月内胃食管相关症状评分和发生率,以及重叠功能性消化不良(FD)、餐后不适综合征(PDS)和上腹痛综合征(EPS)的发生率。统计学方法采用单因素方差分析、最小显著性差异法、Kruskal-Wallis H检验、Mann-Whitney U检验和卡方检验。结果NERD组、RH组和FH组患者在性别、年龄和有无食管裂孔疝方面的差异均无统计学意义(P均>0.05);NERD组的BMI高于FH组[(23.74±3.10)kg/m2比(21.26±2.75)kg/m2],差异有统计学意义(t=3.066,P=0.003);NERD组的PPI治疗有效率高于RH组和FH组(分别为19、4、11例),差异均有统计学意义(χ^2=5.428、5.042,P=0.020、0.025)。NERD组上腹烧灼感症状评分和发生率均低于FH组[0分(0分,0分)比0分(0分,5分)、7.7%(2/26)比38.5%(10/26)],差异均有统计学意义(Z=-2.756,P=0.006;χ^2=6.933,P=0.008);NERD组、RH组和FH组烧心症状评分和胸痛、反流、癔球症、咽喉部烧灼感、咳嗽、上腹痛、早饱或餐后饱胀感、嗳气、恶心呕吐症状评分和发生率比较差异均无统计学意义(P均>0.05)。NERD组、RH组和FH组重叠FD、重叠PDS发生率比较差异均无统计学意义(P均>0.05),但FH组重叠EPS发生率高于NERD组[46.2%(12/26)比11.5%(3/26)],差异有统计学意义(χ^2=7.589,P=0.013)。结论NERD、RH和FH患者的临床特征有所不同,主要体现在PPI治疗反应和是否重叠EPS两个方面,FH重叠EPS发生率较高进一步强化了功能性胃肠病存在共同病理生理学机制的假说。Objective To compare the clinical characteristics of patients with non-erosive gastroesophageal reflux disease(NERD),reflux hypersensitivity(RH)and functional heartburn(FH),in order to help the differential diagnosis and treatment of the three diseases.Methods From October 2016 to February 2019,64 patients with persistent heartburn who had negative endoscopy in the Department of Gastroenterology,the Second Affiliated Hospital of Xi′an Jiaotong University and with negative results of endoscopy examination were consecutively selected,which included 26 NERD patients(NERD group),12 RH patients(RH group)and 26 FH patients(FH group).The gender,age,body mass index(BMI),presence of hiatus hernia,proton pump inhibitor(PPI)treatment effect,the score and incidence of gastroesophageal symptoms within one month before visit,and the incidence of overlapping functional dyspepsia(FD),postprandial distress syndrome(PDS)and epigastric pain syndrome(EPS)of the three groups were compared.One-way analysis of variance,least-significant difference,Kruskal-Wallis H test,Mann-Whitney U test and chi-square test were used for statistical analysis.Results There were no statistically significant differences in gender,age or incidence of esophageal hiatal hernia between NERD group,RH group and FH group(all P>0.05).BMI of NERD group was higher than that of FH group((23.74±3.10)kg/m2 vs.(21.26±2.75)kg/m2),and the difference was statistically significant(t=3.066,P=0.003).The effective rate of PPI treatment in NERD group was higher than those of RH group and FH group(19,4,and 11 cases,respectively),the differences were statistically significant(χ^2=5.428 and 5.042,P=0.020 and 0.025).The score and incidence of burning sensation in upper abdomen of NERD group were both lower than those of FH group(0,0 to 0 vs.0,0 to 5;7.7%,2/26 vs.38.5%,10/26),and the differences were statistically significant(Z=-2.756,P=0.006;χ^2=6.933,P=0.008).There were no statistically significant differences in the score of heartburn symptoms,or the scores and incidence

关 键 词：非糜烂性胃食管反流病 反流高敏感 功能性烧心 临床特征 

分 类 号：R571[医药卫生—消化系统]