基于里昂共识诊断的内镜阴性烧心患者的食管动力及反流特征比较  

Comparison of esophageal motility and reflux characteristics of patients with endoscopic-negative heartburn based on the Lyon Consensus

作　　者：廖思宇 刘咪咪 周婧 郝嘉敏 程奕尊 吴燕娉 高雪芬 程妍[1] LIAO Siyu;LIU Mimi;ZHOU Jing;HAO Jiamin;CHENG Yizun;WU Yanpin;GAO Xuefen;CHENG Yan(Department of Gastroenterology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安交通大学第二附属医院消化内科,陕西西安710004

出　　处：《西安交通大学学报（医学版）》2022年第4期545-549,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.81700474);西安交通大学第二附属医院人才培养专项科研基金资助项目(No.RC(GG)202007);陕西省自然科学基金资助项目(No.2019JM-144)。

摘　　要：目的探讨基于里昂共识诊断标准下的内镜阴性烧心患者的食管动力及反流特征,并探讨平均夜间基线阻抗(MNBI)及反流后吞咽诱导的蠕动波(PSPW)指数对反流高敏感(RH)与功能性烧心(FH)患者的鉴别诊断价值。方法选取2017年1月至2021年6月于本院消化内科就诊的以烧心为主要症状的患者,通过胃镜检查、高分辨率食管测压及24 h-pH阻抗监测,共纳入患者132例,包括非糜烂性反流病(NERD)组24例,RH组24例,FH组84例。对食管动力学相关指标及反流相关指标进行分析比较。应用受试者工作特征(ROC)曲线分析食管近端MNBI、远端MNBI及PSPW指数对RH与FH的鉴别诊断价值。结果NERD组食管下括约肌(LES)平均静息压、LES残余压及完整松弛压力(IRP)均低于RH、FH组(P<0.05)。NERD组酸反流次数、直立位酸暴露时间(AET)、卧位AET、合计AET、DeMeester得分均高于RH、FH组(P<0.05),NERD组非酸反流、远端MNBI及PSPW指数均低于RH、FH组(P<0.05)。RH组远端MNBI及PSPW指数低于FH组(P<0.05),而近端MNBI在3组间未见统计学差异(P>0.05)。单独应用近端MNBI、远端MNBI及PSPW指数诊断RH的ROC曲线下面积依次为0.480、0.810、0.682;灵敏度分别为87.5%、100%、91.7%;特异度分别为26.2%、66.7%、51.2%。结论NERD患者存在较为明显的食管动力学异常,主要表现为LES松弛,这进一步加重了病理性酸反流,而RH、FH患者主要以生理性或非酸反流为主。在内镜阴性烧心患者中,食管远端MNBI值可提高RH的临床诊断率,有助于RH与FH的鉴别。Objective To explore the characteristics of esophageal motility and reflux of endoscopic-negative heartburn patients based on the Lyon Consensus Diagnostic Criteria and discuss the differential diagnosis value of the mean nocturnal baseline impedance(MNBI)and the postreflux swallow-induced peristaltic wave(PSPW)index for reflux hypersensitivity(RH)and functional heartburn(FH)patients.Methods We enrolled 132 patients with heartburn as the main symptom who visited the Gastroenterology Department of our hospital from January 2017 to June 2021,including 24in the non-erosive reflux disease(NERD)group,24 in the RH group,and 84 in the FH group.All the patients completed gastroscopy,esophageal high-resolution manometry and 24h-pH impedance monitoring.We analyzed and compared the related indexes of esophageal motility and reflux.The receiver operating characteristic(ROC)curve was used to analyze the esophageal proximal MNBI,distal MNBI,and PSPW indexes for the differential diagnosis of RH and FH.Results The lower esophageal sphincter(LES)average resting pressure,LES residual pressure and intact relaxation pressure(IRP)in NERD were lower than those in RH and FH(P<0.05).The number of acid reflux,the upright acid exposure time(AET),the supine position AET,the total AET,and the DeMeester score were higher in NERD than in RH and FH(P<0.05).The non-acid reflux,distal MNBI and PSPW indexes were lower in NERD than in RH and FH(P<0.05).The distal MNBI and PSPW indexes were lower in RH than in FH(P<0.05).However,there was no significant difference in proximal MNBI among the three groups(P>0.05).When the proximal MNBI,distal MNBI,and PSPW indexes were used alone respectively to diagnose RH,the area under the ROC curve was 0.480,0.810,0.682,respectively,with the sensitivities being 87.5%,100%and 91.7%,and the specificities being 26.2%,66.7%and 51.2%,respectively.Conclusion NERD patients have obvious abnormal esophageal dynamics,mainly manifested as LES relaxation,which further aggravates the pathological acid reflux,while patients wi

关 键 词：非糜烂性反流病 反流高敏感 功能性烧心 高分辨率食管测压 24 h-pH阻抗监测 

分 类 号：R571[医药卫生—消化系统]