无效食管动力患者的临床特征及其接受质子泵抑制剂治疗的有效性分析  

The clinical characteristics and proton pump inhibitor (PPI) effectiveness of ineffective esophageal motility

作　　者：王珺文 孙会会[1] 姜元喜[1] 陈莹[1] 展婷婷 张琼梅 王振翔 许树长[1] WANG Junwen;SUN Huihui;JIANG Yuanxi;CHEN Ying;ZHAN Tingting;ZHANG Qiongmei;WANG Zhenxiang;XU Shuchang(Department of Gastroenterology,Shanghai Tongji Hospital Affiliated to Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院消化科,上海200065

出　　处：《上海医学》2023年第2期100-105,共6页Shanghai Medical Journal

基　　金：国家自然科学基金(81974067);上海市科学技术委员会科技计划项目(21Y11908500);上海市信息化发展专项资金(202001003);上海申康医院发展中心研究型医师创新转化能力培训项目(SHDC2022CRT004);上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12016109)。

摘　　要：目的 分析无效食管动力(IEM)患者的临床特征和应用质子泵抑制剂(PPI)治疗的有效性,探讨IEM在胃食管反流(GER)相关症状患者中的临床意义。方法 选择2018年8月—2020年1月间因GER相关症状至同济大学附属同济医院行高分辨率食管测压(HRM)检查的172例患者,根据检查结果分为IEM组(91例)和正常食管动力组(81例)。分析两组患者的临床特征,包括人口学特征、症状、内镜诊断、伴随疾病、测压参数及24 h pH阻抗监测参数。对单因素分析中P<0.2的因素进一步行多因素logistics回归分析,分析IEM的危险因素。将24 h pH阻抗监测资料完整且单独服用PPI至少8周的患者纳入PPI有效性分析,PPI治疗后李克特类型量表得分降低>50%定义为PPI治疗有效,否则为无效。进一步根据患者的合计酸暴露时间(acid exposure time,AET)即24 h内食管pH<4的时间百分比进行分组,<4%为AET正常,≥4%为AET异常,比较不同食管AET下IEM组患者与正常食管动力组患者的PPI疗效。结果 IEM组与正常食管动力组患者的性别、年龄、症状、内镜诊断及伴随疾病的差异均无统计学意义(P值均>0.05)。将单因素分析中P<0.2的年龄、性别,以及目前认为与IEM相关性较强的糖尿病和吸烟因素纳入多因素logistics回归分析,结果显示男性患者IEM的发生风险是女性的2.012倍(95%CI为1.024~4.196);年龄越大越容易发生IEM,增加1岁的优势比为1.028(95%CI为1.001~1.056)。IEM组患者吞咽远端收缩积分显著低于正常食管动力组,上括约肌松弛百分比显著高于正常食管动力组,远端潜伏期和最大中断长度均显著长于正常食管动力组(P值均<0.05)。共154例患者的24 hpH阻抗监测结果质量良好,其中IEM组81例,正常食管动力组73例。IEM组患者AET、DeMeester评分均显著高于正常食管动力组,最长反流时间显著长于正常食管动力组,长反流周期数显著多于正常食管动力组(P值均<0.05)。共152�Objective To analyze clinical features of ineffective esophageal motility(IEM)and validity of proton pump inhibitor(PPI),and to explore the clinical significance of IEM in patients with gastroesophageal reflux(GER).Methods A total of 172 patients with GER-related symptoms who were diagnosed as IEM or normal esophageal motility by high resolution manometry(HRM)at Shanghai Tongji Hospital from August 2018 to January 2020 were selected,including 91 IEM patients and 81 patients with normal HRM.The clinical features of the subjects were analyzed including demographic characteristics,symptoms,concomitant diseases,HRM and 24 h pH impedance results.Factors with P<0.2 in the univariate analysis were further analyzed by multivariate logistic regression analysis to analyze the risk factors for IEM.Patients with complete 24 h pH impedance data and taking PPI alone for at least 8 weeks were included in the PPI effectiveness analysis.Patients with a>50%Likert-type scale scoring reduction after PPI treatment was defined as PPI responders.According to the acid exposure time(AET),the percentage of time with esophageal pH<4 within 24 h,<4%was considered normal AET and≥4%was considered abnormal AET.The efficacy of PPI was compared between patients in the IEM group with different esophageal AET and those in the normal HRM group.Results The were no significant differences in gender,age,symptoms,endoscopic diagnosis,and concomitant diseases between the IEM group and the normal HRM group(all P>0.05).Incorporating age and gender,or diabetes and smoking,which are currently considered to be more strongly associated with IEM,into the multifactorial logistic regression analysis.Multifactorial logistic regression analysis showed that men were more likely to develop IEM than women(2.012∶1,95%CI:1.024-4.196).The older they were,the more likely they were to develop IEM,with a one-year odds ratio of 1.028(95%CI:1.001-1.056).The distal contractile integral in patients with IEM were significantly lower than those with normal HRM(P<0.05).The up

关 键 词：无效食管动力 高分辨率食管测压 pH-阻抗监测 质子泵抑制剂 

分 类 号：R571[医药卫生—消化系统]