平均夜间基线阻抗和反流后吞咽诱导的蠕动波指数在内镜阴性烧心患者诊疗中的应用研究  

Application research of mean nocturnal baseline impedance and post-reflux swallow-indueed perislaltic wave index in the diagnosis and efficacy evaluation of paticnts with endoscopie negative heartburn

作　　者：何静静 李玥[1] 胡祥鹏[1] 宋莎莎[1] 路燕 章礼久[1] HE Jing-jing;LI Yue;HU Xiang-peng;SONG Sha-sha;LU Yan;ZIIANG Li-jiu(Departement of Gastroenterology,the Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院消化内科,安徽合肥230601

出　　处：《中国实用内科杂志》2024年第10期836-841,847,共7页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81800524);安徽省高等学校省级教学研究项目(2020jxtd130);安徽医科大学校级青年科学基金(2021xkj044)。

摘　　要：目的探讨平均夜间基线阻抗(MNBI)和反流后吞咽诱导的蠕动波(PSPW)指数对内镜阴性烧心患者的诊断价值及与质子泵抑制剂(PPI)疗效的关系。方法前瞻性选取2022年3月至2023年7月于安徽医科大学第二附属医院消化内科就诊的胃镜提示食管黏膜无破损且具有典型烧心症状患者,进行高分辨率食管测压、问卷调查以及多通道24 h食管pH-阻抗监测,根据检查结果共纳入患者61例,其中非糜烂性反流病(NERD)20例、反流高敏感(RH)9例、功能性烧心(FH)32例,比较三组反流指标,通过受试者工作特征曲线(ROC)分析以探讨远端MNBI和PSPW指数对FH的诊断价值。将61例患者分为PPI有效组(32例)和无效组(29例),比较两组反流指标,应用二分类logistic回归分析影响PPI疗效的因素。结果FH组远端MNBI和PSPW指数均高于RH组和NERD组(P<0.05),RH组远端MNBI高于NERD组(P<0.05)。使用远端MNBI及PSPW指数诊断FH,ROC曲线下面积分别为0.743和0.908;远端MNBI和PSPW指数的界值分别为1981.88Ω、15.25%;灵敏度分别为43.8%、78.1%,特异度均为100%;logistic回归分析显示PPI无效组远端MNBI的OR为1.003(P=0.011)。结论远端MNBI和PSPW指数可用于FH和RH的鉴别诊断,在内镜阴性烧心患者中远端MNBI是PPI无效的独立危险因素。Objective To investigate the diagnostic value of the MNBI and PSPW index in patients with endoscopynegative heartburn and its relationship with the efficacy of PPIs.Methods High-resolution esophageal manometry,questionnaires,and multichannel 24-hour impedance-pH monitoring were selected from patients with gastroscopy suggesting that the esophageal mucosa was not broken and with typical heartburn symptoms who presented to the department of gastroenterology of the Second Affiliated Hospital of Anhui Medical University from March 2022 to July 2023.61 patients were enrolled according to the examination results,of which 20 were NERD,9 were RH and 32 were FH.The reflux indexes of the three groups were compared,and the diagnostic value of distal MNBI and PSPW indexes for FH was investigated by ROC analysis.All patients were divided into the PPI effective group(32 patients)and the ineffective group(29 patients)according to the questionnaire,and the reflux indexes of the two groups were compared,and the factors affecting the efficacy of PPI were analysed by applying bicategorical logistic regression.Results Distal MNBI and PSPW index were higher in FH group than in RH and NERD groups(P<0.05),the distal MNBI was higher in the RH group than in the NERD group(P<0.05);Using distal MNBI and PSPW index to diagnose FH,the area under the ROC curve was 0.743 and 0.908;the cut-off value of distal MNBI was 1981.88,the sensitivity was 43.8%,and the specificity was 100%;the cut-off value of PSPW index was 15.25%,the sensitivity was 78.1%,and the specificity was 100%.Logistic regression shows that the OR for distal MNBI in the PPI ineffective group is 1.003(P=0.011).ConclusionJDistal MNBI and PSPW index can be used for a differential diagnosis of FH and RH,and distal MNBI can be an independent risk factor for ineffective PPI in patients with endoscopy-negative heartburn.

关 键 词：平均夜间基线阻抗 反流后吞咽诱导的蠕动波 质子泵抑制剂 24 h-pH阻抗监测 烧心 

分 类 号：R571[医药卫生—消化系统]