伴食管外症状的胃食管反流病患者180例的临床表现和食管动力学特征分析  

Clinical manifestations and esophageal motility characteristics of 180 patients with gastroesophageal reflux disease and extra-esophageal symptoms

作　　者：杨冬[1] 王贞[2] 战秀岚 陈冬 吴继敏 Yang Dong;Wang Zhen;Zhan Xiulan;Chen Dong;Wu Jimin(Department of Gastroenterology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Clinical Laboratory,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Gastroesophageal Surgery Department,PLA Rocket Force Characteristic Medical Center,Beijing 100088,China)

机构地区：[1]大连医科大学附属第一医院消化科,116011 [2]大连医科大学附属第一医院检验科,116011 [3]中国人民解放军火箭军特色医学中心胃食管外科,北京100088

出　　处：《中华消化杂志》2021年第2期94-99,共6页Chinese Journal of Digestion

摘　　要：目的分析伴食管外症状的GERD患者的临床表现和食管动力学特征。方法回顾性纳入2018年1月1日至10月30日中国人民解放军火箭军特色医学中心180例伴食管外症状的GERD住院患者,分为咽喉症状组(65例)、气道症状组(58例)和混合症状组(57例)。比较3组的一般资料、临床症状、胃镜下表现,以及高分辨率食管测压、24 h食管pH联合多通道阻抗监测结果。采用卡方检验和单因素方差分析进行统计学分析。结果年龄<40、40~60和>60岁的患者分别占12.8%(23/180)、53.3%(96/180)和33.9%(61/180),3组比较差异有统计学意义(χ^(2)=12.030,P=0.017)。有18.9%(34/180)的患者不伴典型的反流症状。咽喉症状组、气道症状组和混合症状组胃镜下食管胃黏膜异位或巴雷特食管发生率[分别为21.5%(14/65)、5.2%(3/58)、8.8%(5/57)]比较差异有统计学意义(χ^(2)=8.578,P=0.014)。咽喉症状组、气道症状组和混合症状组食管下括约肌静息压、食管上括约肌静息压和远端收缩积分[分别为(8.57±0.76)、(8.87±0.79)、(10.51±0.97)mmHg(1 mmHg=0.133 kPa),(44.75±2.86)、(42.81±4.06)、(39.14±3.20)mmHg,(506.13±64.30)、(432.59±78.10)、(682.99±82.28)mmHg·s·cm]比较差异均无统计学意义(P均>0.05)。咽喉症状组、混合症状组和气道症状组的DeMeester评分分别为(14.33±2.09)、(21.94±5.30)、(30.47±5.85)分,3组比较差异有统计学意义(F=3.226,P=0.043)。多通道阻抗监测结果显示,患者反流物以酸反流和弱酸反流为主,分别占55.5%(76/137)和34.3%(47/137),87.6%(120/137)的患者以立位时段反流为主,12.4%(17/137)的患者以平卧位时段反流为主。结论伴食管外症状GERD的发病与年龄有关。食管胃黏膜异位或巴雷特食管更多见于以咽喉症状为主要表现的GERD患者。气道症状为主的GERD存在更多的酸暴露和病理性酸反流,立位弱酸反流在伴食管外症状GERD的反流机制中起重要作用。Objective To analyze the clinical manifestations and esophageal motility characteristics of patients with gastroesophageal reflux disease(GERD)and extra-esophageal symptoms.Methods From January 1 to October 30,2018,at PLA Rocket Force Characteristic Medical Center,180 hospitalized patients diagnosed with GERD and extra-esophageal symptoms were retrospectively analyzed.The patients were divided into laryngopharyngeal symptom group(65 cases),airway symptom group(58 cases)and mixed symptom group(57 cases).General data,clinical symptoms,gastroscopic manitestations,the results of high-resolution esophageal manometry and 24-hour multichannel intraluminal impedance and pH monitoring of each group were analyzed and compared.Chi-square test and one-way analysis of variance were used for statistical analysis.Results The patients aged<40,40 to 60 and>60 years accounted for 12.8%(23/180),53.3%(96/180)and 33.9%(61/180),respectively,and the difference was statistically significant(χ^(2)=12.030,P=0.017).There were 18.9%(34/180)of patients without typical reflux symptoms.There were statistically significant differences in the incidence of ectopic esophagogastric mucosa or Barrett esophagus under gastroscopy between laryngopharyngeal symptom group,airway symptom group and mixed symptom group(21.5%,14/65;5.2%,3/58 and 8.8%,5/57,respectively)(χ^(2)=8.578,P=0.014).There were no statistically significant differences in the lower esophageal sphincter pressure(LESP),upper esophageal sphincter pressure or distal contractile integral between laryngopharyngeal symptom group,airway symptom group and mixed symptom group((8.57±0.76),(8.87±0.79),and(10.51±0.97)mmHg(1 mmHg=0.133 kPa);(44.75±2.86),(42.81±4.06),and(39.14±3.20)mmHg;(506.13±64.30),(432.59±78.10),and(682.99±82.28)mmHg·s·cm)(all P>0.05).The DeMeester score of laryngopharyngeal symptom group,mixed symptom group and airway symptom group was(14.33±2.09),(21.94±5.30)and(30.47±5.85)points,respectively,and the difference was statistically significant(F=3.226,P=0.043).The r

关 键 词：胃食管反流病 食管外症状 反流性咳嗽 反流性哮喘 喉咽反流 食管动力学 

分 类 号：R571[医药卫生—消化系统]