胃食管连接部收缩指数对区分功能性烧心与难治性胃食管反流病的作用  

Role of Gastroesophageal Junction Contraction Index in Distinguishing Functional Heartburn from Refractory Gastroesophageal Reflux Disease

作　　者：李福 郑冬菊[2] LI Fu;ZHENG Dong-ju(Department of Gastroenterology,Dongda Hospital of Shan County,Shandong,China,274300;Department of Oncology,Ningxia People’s Hospital,Yinchuan,China,750002)

机构地区：[1]单县东大医院消化内科,山东菏泽274300 [2]宁夏回族自治区人民医院肿瘤科,宁夏银川750002

出　　处：《食管疾病》2022年第2期133-136,共4页Journal of Esophageal Diseases

摘　　要：目的探究胃食管连接部收缩指数(EGJ-CI)鉴别诊断功能性烧心(FH)与难治性胃食管反流病(RGERD)的价值。方法选取2018年3月至2020年10月山东单县东大医院收治的70例具有典型烧心症状的患者进行研究。所有患者均接受胃镜检查、质子泵抑制剂试验以及24 h食管阻抗-pH监测技术,依据食管胃连接部静息压的强弱进行分组,其中24例FH患者为实验A组、46例非糜烂性反流病(NERD)—强酸反流患者为实验B组;两组患者均开展高分辨测压,以计算其EGJ-CI相关功能参数,比较两组患者EGJ-CI各项功能参数的差异,分析其与胃食管反流参数的关系。结果两组患者EGJ-CI、胃食管收缩积分(EGJ-CIT)、胃食管静息压力以及4 s综合松弛压(IRP4 s)等功能参数比较,差异有统计学意义;实验A组患者酸暴露时间、pH<4时长占比、强酸反流次数及DeMeester积分等胃食管反流参数与实验B组相比,差异有统计学意义(P<0.05)。当EGJ-CI临界值处于10.23 mmHg·cm^(-1)时,其区分RGERD与FH的灵敏度为81.57%,特异度为53.26%,AUC为0.69(95%CI 0.56~0.83);EGJ-CI与酸暴露时间、pH<4时长占比、强酸反流次数及DeMeester积分均呈负相关(r=-0.257,-0.241,-0.289,-0.234)。结论EGJ-CI可反映人体抗反流屏障功能变化,在功能性烧心与难治性胃食管反流病鉴别中发挥一定作用,敏感度及特异性较高,从而帮助临床区分GERD与FH。Objective To explore the value of gastroesophageal junction contraction index(EGJ-CI)in differential diagnosis of functional heartburn(FH)and refractory gastroesophageal reflux disease(RGERD).Methods 70 patients with typical heartburn symptoms in our hospital from March 2018 to October 2020 were selected,and underwent gastroscopy,proton pump inhibitor test and 24-h esophageal impedance pH monitoring technology.They were grouped according to the strength of resting pressure at the esophagogastric junction;24 FH patients were divided into experimental group A and 46 non erosive reflux disease(NERD)-strong acid reflux patients were divided into experimental group B.High resolution manometry was performed in both groups to calculate the EGJ-CI related functional parameters.The differences of EGJ-CI functional parameters between 2 groups were compared,and the relationship between EGJ-CI and gastroesophageal reflux parameters was analyzed.Results There were significant differences in EGJ-CI,EGJ-CIT,resting pressure and IRP4s between 2 groups.There were significant differences in acid exposure time,pH<4 duration,times of strong acid reflux and DeMeester score between 2 group(P<0.05);When the critical value of EGJ-CI was 10.23 mmHg·cm^(-1),the sensitivity,specificity and AUC for distinguishing RGERD from FH were 81.57%,53.26%and 0.69 respectively(95%CI 0.56~0.83).EGJ-CI was negatively correlated with acid exposure time,proportion of pH<4,times of strong acid reflux and DeMeester score(r=-0.257,-0.241,-0.289,-0.234).Conclusion EGJ-CI can reflect the functional changes of human anti reflux barrier and plays a certain role in the differentiation between functional heartburn and refractory gastroesophageal reflux disease.It has high sensitivity and specificity,so as to help distinguish GERD from FH in clinic.

关 键 词：胃食管连接部收缩指数 功能性烧心 难治性胃食管反流病 高分辨测压 

分 类 号：R571[医药卫生—消化系统]