不同年龄组胃食管反流病患者食管动力及临床特点  

Characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease patients of different age groups

作　　者：史海霞 王智凤[1] 孙晓红[1] Shi Haixia;Wang Zhifeng;Sun Xiaohong(Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gastroenterology,Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院消化内科,北京100730 [2]中国中医科学院望京医院脾胃病科,北京100102

出　　处：《中华医学杂志》2021年第14期1015-1019,共5页National Medical Journal of China

基　　金：国家重点研发计划(2018YFC2000300)。

摘　　要：目的探讨不同年龄人群胃食管反流病(GERD)的食管动力和临床特点,为临床诊治提供依据。方法采用病例对照研究分析2015年1月至2018年9月在北京协和医院消化内科门诊确诊的GERD患者,根据年龄分为老年组(年龄≥60岁)和中青年组(年龄<60岁)。分析两组患者性别、病程、症状、食管动力、胃镜下表现和食管裂孔功能方面的特点。结果250例患者符合纳入标准,其中老年组61例、中青年组189例。老年组和中青年组在性别、病程上差异无统计学意义[男/女:24/37比78/111;(4.9±4.2)年比(4.5±3.8)年;均P>0.05];典型症状(反酸、烧心)及非典型症状(胸痛、咳嗽、咽部异物感等)相比差异有统计学意义(典型症状/非典型症状:35/26比146/43;P<0.01),老年组以非典型症状为主,而中青年组以典型症状为主。老年组上食管括约肌(UES)静息压[(65±28)mmHg,1 mmHg=0.133 kPa]明显低于中青年组[(74±28)mmHg]、无效食管动力(IEM)比率和DeMeester评分明显高于中青年组[78.7%(48/61)比65.1%(123/189);16.3(6.0,36.3)分比6.4(2.5,18.0)分,均P<0.05]。下食管括约肌(LES)静息压及食管远端收缩积分(DCI),两组之间差异无统计学意义(P>0.05)。204例患者完成胃镜检查,老年组反流性食管炎C级和D级以及C级和D级合并食管裂孔功能障碍的比例明显高于中青年组[2.04%(8/49)比0.65%(1/155);14.29%(7/49)比0(0/155),均P<0.01)]。Pearson相关性分析显示,UES静息压与年龄呈负相关性(r=-0.145,P<0.05);LES长度与年龄呈正相关性(r=0.129,P<0.05)。结论老年GERD患者与中青年相比,非典型症状表现更为突出,随着增龄,UES的静息压降低,无效食管比率增加,食管酸暴露程度增加,老年人群抗反流能力明显降低,可能需要长期抑酸药物维持。Objective To explore the characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease(GERD)patients of different age groups.Methods This was a case-control study.Confirmed GERD patients in the Department of Gastroenterology of Peking Union Medical College Hospital from January 2015 to September 2018 were enrolled and divided into two groups:elderly group(≥60 years old)and young and middle-aged group(<60 years old).Characteristics of gender,disease course,clinical symptoms,esophageal motility,gastroscopic manifestations and esophageal hiatus function of patients in the two groups were analyzed.Results A total of 250 patients met the inclusion criteria,with 61 patients in elderly group and 189 in young and middle-aged group.There were no significant differences in gender((male/female:24/37 vs 78/111,P>0.05)and disease course((4.9±4.2)years vs(4.5±3.8)years,P>0.05)between the two groups.However,there were significant differences in typical symptoms(acid regurgitation and heartburn)and atypical symptoms(chest pain,cough,foreign body sensation in pharynx,etc.)(typical/atypical symptoms:35/26 vs 146/43,P<0.01)between the two groups.Compared with young and middle-aged group,upper esophageal sphincter(UES)resting pressure was lower((65±28)mmHg(1 mmHg=0.133 kPa)vs(74±28)mmHg,P<0.05),but the percentage of ineffective esophageal motility(IEM)(78.7%(48/61)vs 65.1%(123/189),P<0.05)and DeMeester score(16.3(6.0,36.3)vs 6.4(2.5,18.0),P<0.05)were higher in elderly group.There were no significant differences in lower esophageal sphincter(LES)resting pressure and distal contractile integral(DCI)between the two groups.Higher proportion of grade C and D reflux esophagitis,and grade C and D reflux esophagitis complicated with esophageal hiatus dysfunction was observed in elderly group compared with young and middle-aged group(2.04%(8/49)vs 0.65%(1/155);14.29%(7/49)vs 0(0/155);both P<0.01).Pearson correlation analysis showed that there was a negative correlation between UES resting pressure

关 键 词：胃食管反流 年龄 食管动力 临床表现 

分 类 号：R571[医药卫生—消化系统]