不同类型胃食管反流病病人食管动力与反流特征探讨  

CHARACTERISTICS OF ESOPHAGEAL MOTILITY AND REFLUX IN PATIENTS WITH DIFFERENT TYPES OF GASTROESPHAGEAL REFLUX DISEASE

作　　者：董培雯 王欣欣 刘丽[1] 林琳 龙彦婵 王琼[1] DONG Peiwen;WANG Xinxin;LIU Li;LIN Lin;LONG Yanchan;WANG Qiong(Department of Gastroenterology,Chengdu Third People’s Hospital,Chengdu 610000,China)

机构地区：[1]成都市第三人民医院消化内科,四川成都610000

出　　处：《青岛大学学报（医学版）》2023年第3期420-424,共5页Journal of Qingdao University(Medical Sciences)

基　　金：四川省卫生健康委员会医学科技项目(21PJ1-43);四川省中医药管理局科学技术研究专项课题(2021MS155)。

摘　　要：目的研究胃食管反流病(GERD)不同类型病人的食管动力特征和反流特点,探究里昂共识将酸反流时间比定义为>6%是否适合中国人群。方法收集2021年1月—2021年10月在我院就诊的GERD病人,根据内镜检查结果分为反流性食管炎(RE)和非糜烂性反流病(NERD)2组,收集病人日常生活习惯等基本信息、食管测压和24 h食管pH值监测结果等指标,比较2组病人食管动力特征和反流特点。根据24 h食管pH值监测结果中酸暴露时间百分比值(AET)分为AET<4%、4%~6%和>6%共3组,比较其食管动力学及日常生活等指标的差异。结果共入组176例GERD病人,其中RE为50例,NERD为126例。RE组下食管括约肌(LES)静息压力降低的比例以及食管无效蠕动均较NERD组更多(χ^(2)=6.953、6.433,P<0.05)。RE组病理性酸反流阳性率更高,24 h的总反流次数及DeMeester评分均高于NERD组(χ^(2)=25.153,P<0.05;H=4.833、5.723,P<0.05)。3组间比较,AET>6%组的LES静息压力、平均远端收缩积分(DCI)均低于AET<4%及4%~6%组,合并食管裂孔疝病人数量明显高于其余2组(F=5.082,H=4.311,χ^(2)=11.620,P<0.01)。AET、总反流次数和DeMeester评分在3组间的差异有统计学意义(F=1539.471,H=2.872~3.207,P<0.05)。结论NERD组LES静息压力及食管体部蠕动均较RE组更好,RE病人的病理性酸反流重于NERD病人,表明食管动力异常与酸暴露共同参与了GERD病人食管黏膜损伤过程。Objective To investigate the characteristics of esophageal motility and reflux in patients with different types of gastroesophageal reflux disease(GERD),and to explore whether an acid exposure time(AET)of>6%in the Lyon Consensus is suitable for the Chinese population.Methods The patients with GERD who attended our hospital from January to October,2021,were enrolled,and according to the results of endoscopic examination,they were divided into reflux esophagitis(RE)group and non-erosive reflux disease(NERD)group.Related data were collected,including daily living habits,esophageal manometry,and 24 h esophageal pH monitoring results,and the characteristics of esophageal motility and reflux were compared between the two groups.According to AET in 24 h esophageal pH monitoring,the patients were divided into AET<4%group,4%-6%AET group,and AET>6%group,and the indicators such as esophageal motility and daily life were compared between groups.Results A total of 176 patients with GERD were enrolled,among whom 50 had RE and 126 had NERD.Compared with the NERD group,the RE group had significantly higher proportion of patients with reduction in lower esophageal sphincter(LES)resting pressure and number of ineffective esophageal peristalsis(χ^(2)=6.953,6.433;P<0.05).Compared with the NERD group,the RE group also had significantly higher positive rate of pathological acid reflux,total number of reflux episodes,and DeMeester score at 24 h(χ^(2)=25.153;H=4.833,5.723;P<0.05).Compared with the AET<4%group and the 4%-6%AET group,the AET>6%group had significantly lower LES resting pressure and mean DCI and a significantly higher number of patients with esophageal hiatal hernia(F=5.082,H=4.311,χ^(2)=11.620,P<0.01).There were significant differences in AET,the total number of reflux episodes,and DeMeester score between the three groups(F=1539.471,H=2.872-3.207,P<0.05).Conclusion The NERD group tends to have better LES resting pressure and esophageal peristalsis than the RE group,and patients with RE have more severe pathological acid

关 键 词：胃食管反流 食管炎 消化性 食管PH值监测 测压法 

分 类 号：R573.9[医药卫生—消化系统] R571[医药卫生—内科学]