无效吞咽对食管动力和胃食管反流的影响  

Influence of Ineffective Swallows on Esophageal Motility and Gastroesophageal Reflux

作　　者：姚学敏[1,2] 叶必星 金颖[2] 王美峰 林琳[1] 姜柳琴[1,3] YAO Xuemin;YE Bixing;JIN Ying;WANG Meifeng;LIN Lin;JIANG Liuqin(Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,210029;Department of Gastroenterology,Suzhou Ninth People’s Hospital,Suzhou,Jiangsu Province;Department of Gastroenterology,Jinhu County People’s Hospital,Huaian,Jiangsu Province)

机构地区：[1]南京医科大学第一附属医院消化内科,210029 [2]苏州市第九人民医院消化内科 [3]淮安市金湖县人民医院消化内科

出　　处：《胃肠病学》2022年第1期9-16,共8页Chinese Journal of Gastroenterology

摘　　要：背景:研究发现食管体部动力障碍与胃食管反流病(GERD)相关,但确切关系仍不明确。目的:探讨食管高分辨率测压(HRM)中无效吞咽的比例对食管动力和胃食管反流的影响。方法:回顾性纳入2018年3月—2019年12月在南京医科大学第一附属医院完成食管HRM和24 h食管阻抗-pH监测、提示正常食管动力或轻度食管动力障碍的患者,根据HRM中10次温水吞咽中无效吞咽的次数分为4组:A组(0次)、B组(1~4次)、C组(5~7次)、D组(8~10次)。分析各组食管HRM、24 h食管阻抗-pH监测参数,评估无效吞咽辅助诊断病理性酸反流的价值。结果:共142例患者纳入研究,四组间测压参数异常者比例无明显差异(P均>0.05)。D组弱蠕动和无蠕动次数显著多于A组、B组,远端收缩积分(DCI)平均值和最高值显著低于A组、B组(P均<0.05),D组与C组间DCI平均值和最高值差异显著(P均<0.05)。酸暴露时间(AET)、DeMeester评分均随无效吞咽次数的增加逐渐增高(P均<0.05)。无效吞咽次数、弱蠕动次数与AET、DeMeester评分、酸暴露总次数之间存在适度正相关性(P均<0.05)。ROC曲线分析显示无效吞咽次数辅助诊断病理性酸反流的曲线下面积(AUC)为0.625(95%CI:0.523~0.727,P=0.027),cut-off值为4.5,相应敏感性和特异性分别为62.9%和61.7%。弱蠕动次数的诊断价值优于无蠕动次数(AUC:0.625对0.590)。结论:不同无效吞咽比例的临床意义不同,无效吞咽>70%的临床相关性可能更强,在一定程度上可预测病理性酸反流。Background:Studies showed that esophageal body dysmotility is associated with gastroesophageal reflux disease(GERD),however,their interactions are still unclear.Aims:To explore the influence of proportion of ineffective swallows on esophageal motility and gastroesophageal reflux in esophageal high-resolution manometry(HRM).Methods:Patients who completed esophageal HRM and 24 h esophageal impedance-pH monitoring and were identified as normal esophageal motility or mild dysmotility from March 2018 to December 2019 at the First Affiliated Hospital of Nanjing Medical University were recruited retrospectively.According to the times of ineffective swallows in 10 warm water swallows in HRM,these patients were allocated into four groups:Group A(0 times),Group B(1-4 times),Group C(5-7 times),Group D(8-10 times).The parameters of esophageal HRM and 24 h esophageal impedance-pH monitoring were analyzed,and the value of ineffective swallows for assistant diagnosis of pathological acid reflux was assessed.Results:A total of 142 patients were included.There were no significant differences in abnormal manometric parameters between the four groups(all P>0.05).In Group D,the number of weak and non-peristalsis were increased,while the mean and maximum value of distal contractile integral(DCI)were decreased as compared with those in Group A and Group B(all P<0.05).Between Group C and Group D,the differences in mean and maximum DCI value were significant(all P<0.05).As the times of ineffective swallows increased,the acid exposure time(AET)and DeMeester score gradually increased from Group A to Group D(all P<0.05).Times of ineffective swallows and weak peristalsis were moderately and positively correlated with AET,DeMeester score,and the total number of acid exposure(all P<0.05).ROC curve analysis revealed that the area under the curve(AUC)of ineffective swallows for assistant diagnosis of pathological acid reflux was 0.625(95%CI:0.523-0.727,P=0.027);the optimal cut-off value was 4.5,and the sensitivity and specificity were 62.9%and

关 键 词：高分辨率测压 多通道腔内阻抗-pH监测 无效食管动力 无效吞咽 酸反流 

分 类 号：R571[医药卫生—消化系统]