胃食管反流性咳嗽患者食管动力障碍检测和对抗反流疗效影响  

Esophageal dysmotility detection in patients with gastroesophageal reflux-related cough and its influence on the efficacy of anti-reflux therapy

作　　者：张梦茹 张利 阿丽米热·艾尔肯 陈强[1] 余莉[1] 徐镶怀[1] 邱忠民[1] Zhang Mengru;Zhang Li;Alimire Aierken;Chen Qiang;Yu Li;Xu Xianghuai;Qiu Zhongmin(Department of Pulmonary and Critical Care Medicine,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院呼吸与危重症医学科,上海200065

出　　处：《中华结核和呼吸杂志》2023年第10期985-992,共8页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：上海市科委课题(20Y11902500,21140903400)。

摘　　要：目的分析拟诊为酸或非酸反流性胃食管反流性咳嗽(GERC)患者的食管动力障碍特点,并与抗反流药物治疗反应相关联,寻找筛选适合抗反流治疗慢性咳嗽患者人群的有效指标。方法回顾性纳入2020年6月至2022年12月在同济大学附属同济医院呼吸与危重症医学科慢性咳嗽专科门诊就诊的拟诊GERC患者173例,其中男87例,女86例,年龄(45.1±14.6)岁。收集患者的一般临床资料、高分辨率食管测压(HRM)及食管多通道腔内阻抗-pH监测(MII-pH)的检查结果,以及患者病因诊治过程和最终诊断等信息。根据治疗反应将纳入病例分为常规抗反流有效组、强化抗反流有效组和抗反流无效组,分析抗反流治疗的疗效预测因素。使用χ^(2)检验、Student-Newman-Keuls检验或Kruskal-Wallis H(K)检验比较组间差异。采用基于最大似然估计的向前逐步回归法进行logistic回归分析筛选出影响因素。结果173例拟诊GERC患者包括常规抗反流有效者45例(26.0%)、强化抗反流有效组54例(31.2%)和抗反流无效组74例(42.8%)。52.0%患者存在食管动力障碍(90/173),但常规抗反流有效组该比例较低(χ^(2)=8.09,P=0.018)。反流类型以非酸反流为主(136/173,78.6%),常规抗反流有效组酸反流比例(χ^(2)=19.49,P<0.001)和酸暴露时间(H=11.04,P=0.004)明显高于另外两组。酸和非酸GERC患者食管动力障碍比例相似(64.9%比48.5%,χ^(2)=3.11,P=0.078);非酸GERC患者食管蠕动中断长度较短[2.4(0.7,5.6)cm比6.1(1.4,10.0)cm,Z=-2.39,P=0.017],食管上括约肌长度较长[(4.1±0.9)cm比(3.7±1.3)cm,t=-2.09,P=0.038],食管正常收缩百分比较高[60.0%(17.8%,90.0%)比30.0%(0,80.0%),Z=-2.14,P=0.032],蠕动大中断百分比较低[10.0%(0,40.0%)比50.0%(0,100.0%),Z=-2.92,P=0.004]。强化抗反流有效组和抗反流无效组的食管下括约肌平均静息压明显低于常规抗反流有效组(H=7.49,P=0.024),而食管无效收缩百分比则明显较高(H=8.60,P=0.014)。多因素logistObjectiveTo investigate the characteristics of esophageal dysmotility in patients with an initial diagnosis of acid/non-acid gastroesophageal reflux-related cough(GERC),and its correlation with the therapeutic response to anti-reflux treatments to search for the useful indicators to screen patients with chronic cough suitable for anti-reflux therapy.MethodsA total of 173 patients with suspicious GERC who attended the Chronic Cough Specialist Clinic of Department of Pulmonary and Critical Care Medicine,Tongji Hospital,School of Medicine,Tongji University between June 2020 and December 2022 were retrospectively selected for the study.The age of the patients was(45.1±14.6)years old,including 87 males and 86 females.Their demographic characteristics,clinical manifestations,and the results of high-resolution manometry(HRM)and multichannel intraluminal impedance-pH monitoring(MII-pH)were collected.Information on the etiological identification process and final diagnosis was also recorded.The recruited cases were grouped according to therapeutic outcomes and divided into cases with a favourable response to conventional anti-reflux treatment,cases with a favourable response to intensified anti-reflux treatment,and cases with no response to anti-reflux treatment.Factors influencing the efficacy of anti-reflux treatment were investigated.Differences between groups were compared using theχ^(2) test,Student-Newman-Keuls test,and Kruskal-Wallis H(K)test,where applicable.Logistic regression analysis using forward stepwise regression based on maximum likelihood estimation was used to screen for influence factors.ResultsThe 175 patients with suspicious GERC included 45(26.0%)patients who responded to conventional anti-reflux treatment,54(31.2%)who responded to intensified anti-reflux treatment and 74(42.8%)who did not respond to anti-reflux therapies.Esophageal dysmotility was present in 52.0%of patients(90/173),but was less common in patients who responded to conventional anti-reflux treatment(χ^(2)=8.09,P=0.018).Although th

关 键 词：咳嗽 胃食管反流 高分辨率食管测压 食管动力障碍 

分 类 号：R571[医药卫生—消化系统]