胃食管反流病患者200例立位、卧位和餐后酸反流特点分析  

Characteristics of acid reflux of 200 patients with gastroesophageal reflux disease in upright position,supine position and postprandial period

作　　者：潘红艳 汪之沫 梁雨翔 丁巍 陈冬 吴继敏 康文全 Pan Hongyan;Wang Zhimo;Liang Yuxiang;Ding Wei;Chen Dong;Wu Jimin;Kang Wenquan(Department of Gastroenterology,Huazhong University of Science and Technology Union Shenzhen Hospital(Former Nanshan District People′s Hospital),Shenzhen 518052,China;Department of Gastroesophageal Surgery,PLA Rocket Force Characteristic Medical Center,Beijing 100088,China)

机构地区：[1]华中科技大学协和深圳医院(原南山区人民医院)消化内科,深圳518052 [2]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3期159-164,共6页Chinese Journal of Digestion

摘　　要：目的分析GERD患者立位、卧位和餐后2 h的反流参数,探讨不同体位和餐后2 h各反流参数诊断GERD的临界值及其灵敏度、特异度。方法选择2016年1月至2020年7月于华中科技大学协和深圳医院(原南山区人民医院)消化内科就诊的GERD患者200例(GERD组)和非GERD患者61例(对照组),两组患者均进行胃食管反流病问卷(GERDQ)评分和上消化道内镜检查、食管高分辨率测压、24 h食管pH联合阻抗监测,采用t检验、非参数检验、卡方检验比较两组患者之间与组内立位、卧位和餐后2 h反流相关参数。绘制GERD患者立位、卧位和餐后2 h反流参数的ROC曲线,确定其诊断GERD的临界值及其灵敏度、特异度。结果对照组卧位酸反流患者比例高于GERD组[41.0%(25/61)比8.5%(17/200)],差异有统计学意义(χ^(2)=36.53,P<0.01)。对照组患者立位酸反流时间、酸反流次数、酸暴露时间(AET)、最长反流时间、弱酸反流次数均高于卧位[6.00 min(2.00 min,13.50 min)比0.00 min(0.00 min,1.50 min)、16.00次(8.00次,27.00次)比1.00次(0.00次,3.00次)、0.90%(0.33%,1.88%)比0.00%(0.00%,0.30%)、2.00 min(1.00 min,4.00 min)比0.00 min(0.00 min,1.00 min)、7.00次(3.00次,11.00次)比1.00次(0.00次,2.00次)],差异均有统计学意义(Z=5.43、6.61、5.06、3.58、6.24,P均<0.01)。GERD组患者立位酸反流时间、酸反流次数、AET、最长反流时间、长反流次数、弱酸反流次数均高于卧位[51.00 min(31.00 min,86.75 min)比8.00 min(1.00 min,42.00 min)、60.00次(48.00次,83.75次)比6.00次(2.00次,19.50次)、7.30%(3.90%,12.10%)比1.50%(0.20%,6.50%)、7.00 min(4.00 min,12.00 min)比4.00 min(1.00 min,17.00 min)、1.00次(0.00次,3.00次)比0.00次(0.00次,2.00次)、7.00次(3.00次,12.00次)比0.00次(0.00次,1.00次)],差异均有统计学意义(Z=7.92、11.22、6.90、2.56、5.11、11.76,P均<0.05)。对照组和GERD组患者餐后2 h酸反流时间、酸反流次数、AET、最长反流时间和弱酸反流次数分别为3.00 minObjective To analyze the reflux parameters of patients with gastroesophageal reflux disease(GERD)in upright position,supine position and at 2 h after meals,and to explore the cut-off value,sensitivity and specificity of the reflux parameters in different positions and at 2 h after meals in GERD diagnosis.Methods From January 2016 to July 2020,200 GERD patients(GERD group)and 61 non-GERD patients(control group)who visited Huazhong University of Science and Technology Union Shenzhen Hospital(Former Nanshan District People′s Hospital),were selected.All the patients of the two groups received gastroesophageal reflux disease questionnaire(GERDQ),upper gastrointestinal endoscopy,esophageal high resolution manometry and 24 h esophageal pH combined impedance monitoring.T test,non-parametric test and chi-square test were used to compare the related parameters in upright position,supine position and at 2 h after meals between two groups and within each group.Receiver oparative characteristic(ROC)curves of reflux parameters in upright position,supine position and 2 h after meals were drawn to determine the cut-off value,sensitivity and specificity in GERD diagnosis.Results The proportion of patients with acid reflux in supine position of the control group was higher than that of the GERD group(41.0%,25/61 vs.8.50%,17/200),and the difference was statistically significant(χ^(2)=36.53,P<0.01).In the control group,the acid reflux time in upright position,number of acid reflux,acid exposure time(AET),longest reflux time and number of weak acid reflux were more than those of in supine position in the same group(6.00 min(2.00 min,13.50 min)vs.0.00 min(0.00 min,1.50 min),16.00(8.00,27.00)vs.1.00(0.00,3.00),0.90%(0.33%,1.88%)vs.0.00%(0.00%,0.30%),2.00 min(1.00 min,4.00 min)vs.0.00 min(0.00 min,1.00 min),7.00(3.00,11.00)vs.1.00(0.00,2.00),respectively)and the differences were statistically significant(Z=5.43,6.61,5.06,3.58 and 6.24,all P<0.01).In the GERD group,the acid reflux time,number of acid reflux,AET,longest reflux time and

关 键 词：胃食管反流病 24 h食管pH联合阻抗监测 立位反流 卧位反流 餐后反流 

分 类 号：R571[医药卫生—消化系统]