伴有食管外症状的胃食管反流病患者食管动力学及反流特点分析  

Analysis of esophageal motility and reflux characteristics in gastroesophageal reflux disease with extra-esophageal symptoms

作　　者：郭利华[1] 王静静 温晋锋[1] 叶国良[1] GUO Lihua;WANG Jingjing;WEN Jinfeng;YE Guoliang(Department of Gastroenterology,the Affiliated Hospital of Medical School,Ningbo University,Ningbo 315020,Zhejiang,China)

机构地区：[1]宁波大学医学院附属医院消化内科,浙江宁波315020

出　　处：《中国现代医生》2023年第1期67-71,共5页China Modern Doctor

摘　　要：目的分析伴有或不伴有食管外症状的胃食管反流病(gastroesophageal reflux disease,GERD)患者的食管动力学及反流特点。方法选取2017年5月至2021年12月于宁波大学医学院附属医院就诊的72例GERD患者,根据是否伴有食管外症状将纳入患者分为伴有食管外症状组(n=30)和不伴有食管外症状组(n=42),比较两组患者的食管动力及反流的差异。结果伴有食管外症状组患者4s完整松弛压(integrated relaxation pressure,IRP)、远端收缩积分(distal contractile integral,DCI)均显著低于不伴有食管外症状组(P<0.05),蠕动中断显著长于不伴有食管外症状组(P<0.05),食管裂孔疝比率显著高于不伴有食管外症状组(P<0.05)。两组患者的食管下括约肌(lower esophageal sphincter,LES)静息压、LES长度、食管上括约肌(upper esophageal sphincter,UES)静息压及远端潜伏期比较差异均无统计学意义(P>0.05)。伴有食管外症状组患者的总反流、弱酸反流及液体反流次数均显著多于不伴有食管外症状组(P<0.05)。受试者操作特征曲线显示蠕动中断及弱酸反流对伴有食管外症状的GERD患者有一定诊断价值,蠕动中断的曲线下面积(area under the curve,AUC)为0.643,敏感度60.00%,特异性61.91%;弱酸反流AUC为0.701,敏感度66.67%,特异性69.05%。结论食管体部失蠕动及食管裂孔疝的GERD患者更易诱发或加重食管外症状,弱酸反流和液体反流在伴有食管外症状GERD的反流机制中起重要作用。蠕动中断及弱酸反流有助于分析和诊断伴有食管外症状的GERD。Objective To analyze the characteristics of esophageal motility and reflux in gastroesophageal reflux disease(GERD)patients with or without extra-esophageal symptoms.Methods A total of 72 patients with GERD admitted in the Affiliated Hospital of Medical School,Ningbo University were selected and divided into extra-esophageal symptom group(n=30)and without extra-esophageal symptom group(n=42)according to whether they were accompanied by extra-esophageal symptoms.The differences of esophageal motility and reflux between the two groups were compared.Results The integrated relaxation pressure(IRP)and distal contractile integral(DCI)in extra-esophageal symptom group were significantly lower than those in without extra-esophageal symptom group(P<0.05),the distance of peristalsis interruption was longer than that in without extra-esophageal symptom group(P<0.05),the rate of esophageal hiatal hernia was significantly higher than that in without extra-esophageal symptom group(P<0.05).There were no significant differences in lower esophageal sphincter(LES)resting pressure,LES length,upper esophageal sphincter(UES)resting pressure and distal latency between the two groups(P>0.05).The number of total reflux,weak acid reflux and liquid reflux in extra-esophageal symptom group were significantly higher than those in without extra-esophageal symptom group(P<0.05).The results of receiver operator characteristic curve showed that peristalsis interruption and weak acid reflux had certain diagnostic value in patients with GERD with extra-esophageal symptoms.The area under the curve(AUC)of peristalsis interruption was 0.643,the sensitivity and the specificity were 60.00% and 61.91%,respectively.The AUC of weak acid reflux was 0.701,the sensitivity and the specificity were 66.67% and 69.05%,respectively.Conclusion GERD patients with esophageal body dysperistalsis and esophageal hiatal hernia are more likely to induce or aggravate extra-esophageal symptoms.Weak acid reflux and liquid reflux play an important role in the reflux mechani

关 键 词：食管外症状 胃食管反流病 高分辨率食管测压 24h pH-阻抗监测 

分 类 号：R571[医药卫生—消化系统]