应用24 h多通道腔内阻抗⁃pH监测分析平均夜间基线阻抗值对胃食管反流病患者的诊断价值  

Diagnostic Value of Mean Nocturnal Baseline Impedance for Gastroesophageal Reflux Disease by 24⁃Hour Multichannel Intraluminal Impedance⁃pH Monitoring

作　　者：高鑫 年媛媛 孟宪梅[1] GAO Xin;NIAN Yuanyuan;MENG Xianmei(Department of Gastroenterology,the Second Affiliated Hospital of Baotou Medical College,Baotou,Inner Mongolia Autonomous Region,014030)

机构地区：[1]包头医学院第二附属医院消化内科,014030

出　　处：《胃肠病学》2022年第11期652-656,共5页Chinese Journal of Gastroenterology

基　　金：内蒙古自治区自然科学基金(2019LH08042);内蒙古自治区科技计划项目(2021GG0232);包头医学院科学研究基金(BYJJ⁃YF⁃2018024)。

摘　　要：背景:24 h多通道腔内阻抗⁃pH(24 h MII⁃pH)监测对大部分胃食管反流病(GERD)患者的诊断不明,平均夜间基线阻抗值(MNBI)对GERD的诊断价值尚有争议。目的:分析GERD患者食管各通道MNBI的特点,探讨MNBI对GERD的诊断价值。方法:回顾性分析2019年5月—2021年12月于包头医学院第二附属医院疑诊为GERD并行24 h MII⁃pH监测的111例患者的临床资料,根据DeMeester标准将患者分为非GERD组和GERD组,比较两组反流参数和各通道MNBI,并分析食管远端、近端MNBI与各反流参数的相关性,以ROC曲线评估MNBI诊断GERD的敏感性和特异性。结果:GERD患者酸暴露时间百分比(AET)、DeMeester评分、总反流次数、酸反流次数、非酸反流次数均显著高于非GERD组,差异均有统计学意义(P<0.01);GERD组患者距齿状线上方3 cm、5 cm、7 cm处的MNBI、远端MNBI均显著低于非GERD组,差异均有统计学意义(P<0.01)。Spearman相关性分析发现食管远端MNBI与AET、DeMeester评分、酸反流次数、弱酸反流次数之间具有明显负相关性(P<0.05),食管近端MNBI与AET、DeMeester评分、弱酸反流次数之间具有明显负相关性(P<0.05)。ROC曲线分析结果表明,食管远端MNBI诊断GERD的AUC为0.72(95%CI:0.66~0.81,P<0.01),当临界值为1191.42Ω时,诊断GERD的敏感性为82.9%,特异性为53.9%。结论:食管远端MNBI对于GERD患者具有较好的诊断意义,可作为GERD辅助诊断的一项新阻抗指标。Background:The value of 24⁃hour multichannel intraluminal impedance⁃pH(24 h MII⁃pH)monitoring is still unknown in most patients with gastroesophageal reflux disease(GERD),and the value of mean nocturnal baseline impedance(MNBI)in the diagnosis of GERD remains controversial.Aims:To analyze the characteristics of esophageal MNBI in GERD patients,and to investigate the diagnostic value of MNBI for GERD.Methods:The clinical data of 111 patients suspected of GERD and monitored for 24 h MII⁃pH from May 2019 to December 2021 at the Second Affiliated Hospital of Baotou Medical College were retrospectively analyzed.According to DeMeester standard,patients were divided into non⁃GERD group and GERD group.Reflux parameters and MNBI of each channel between the two groups were compared.The correlation between distal and proximal esophageal MNBI and reflux parameters were analyzed.ROC curve was used to evaluate the sensitivity and specificity of MNBI for GERD.Results:Compared with non⁃GERD patients,the acid exposure time(AET),DeMeester score,total reflux times,acid reflux times and non⁃acid reflux times in GERD group were increased,the differences were statistically significant(P<0.01).MNBI at 3 cm,5 cm and 7 cm above the dentate line and distal MNBI in the GERD group were decreased,the differences were statistically significant(P<0.01).Spearman correlation analysis showed that distal MNBI was negatively correlated with AET,DeMeester score,acid reflux times and weak acid reflux times(P<0.05).There were significant negative correlations between proximal MNBI and AET,DeMeester score and weak acid reflux times(P<0.05).ROC curve analysis showed that AUC of distal MNBI for the diagnosis of GERD was 0.72(95%CI:0.66⁃0.81,P<0.01),when the cut⁃off value was 1191.42Ω,the sensitivity and specificity of distal MNBI for diagnosis of GERD were 82.9%and 53.9%,respectively.Conclusions:Distal esophageal MNBI has good diagnostic significance for GERD patients,and can be used as a new impedance index for the auxiliary diagnosis

关 键 词：胃食管反流病 24 h多通道腔内阻抗⁃pH监测 平均夜间基线阻抗值 诊断 

分 类 号：R571[医药卫生—消化系统]