反流后吞咽诱发的蠕动波指数对肠脑互动障碍性食管疾病与胃食管反流病的鉴别价值  

The value of differential diagnosis of post-reflux swallow-induced peristaltic wave index between esophageal diseases of gut-brain interaction and gastroesophageal reflux disease

作　　者：于旭彤 王瑞峰 郭晓娟[1] 霍雪茹 应小芳 任渝棠 Yu Xutong;Wang Ruifeng;Guo Xiaojuan;Huo Xueru;Ying Xiaofang;Ren Yutang(Department of Gastroenterology,Beijing Tsinghua Changguang Hospital,School of Clinical Medicine,Tsinghua University,Beijing102218,China)

机构地区：[1]清华大学临床医学院北京清华长庚医院消化内科,北京102218

出　　处：《中华医学杂志》2024年第43期3967-3971,共5页National Medical Journal of China

摘　　要：目的分析反流后吞咽诱发的蠕动波指数(PSPWI)鉴别肠脑互动障碍性食管疾病(E-DGBI)和胃食管反流病(GERD)的价值。方法回顾性纳入2016年6月至2018年6月北京清华长庚医院消化内科确诊为E-DGBI和GERD的患者,收集患者的病历、胃镜检查报告和24 h食管pH-腔内阻抗监测报告等。根据临床诊断将患者分为E-DGBI组和GERD组,比较2组间PSPWI、酸暴露时间(AET)、DeMeester评分、总反流次数以及平均夜间基线阻抗(MNBI)的差异。绘制PSPWI、AET、总反流次数和MNBI的受试者工作特征(ROC)曲线,以鉴别E-DGBI和GERD的灵敏度和特异度;使用约登指数计算其临界值,比较其曲线下面积(AUC)。结果共纳入73例患者,男36例,女37例,年龄[M(Q1,Q3)]为54.0(42.6,63.0)岁;其中E-DGBI组39例,GERD组34例。E-DGBI组食管24 h AET[0.5(0.1,1.6)比6.0(3.6,11.9)]、DeMeester评分[2.8(1.1,5.7)分比20.4(14.7,47.4)分]和总反流次数[32.0(19.0,53.0)次比66.0(34.3,96.0)次]均低于GERD组(均P<0.001);MNBI高于GERD组[2375.0(1726.0,2978.0)Ω比1361.0(814.0,2273.5)Ω,P<0.001)]。E-DGBI组PSPWI高于GERD组(0.56±0.19比0.25±0.15,P<0.001)。根据ROC,以PSPWI>0.46为临界值,其鉴别E-DGBI和GERD的AUC为0.895(95%CI:0.827~0.963),灵敏度为94.1%,特异度为69.2%。PSPWI与AET、总反流次数的AUC差异均无统计学意义(均P>0.05);但PSPWI的AUC高于MNBI(AUC=0.749,95%CI:0.632~0.866,P=0.031)。结论PSPWI可较好地鉴别E-DGBI和GERD。Objective To analyze the value of differential diagnosis of post-reflux swallow-induced peristaltic wave index(PSPWI)between esophageal diseases of gut-brain interaction(E-DGBI)and gastroesophageal reflux disease(GERD).Methods The patients diagnosed as E-DGBI and GERD in the Department of Gastroenterology,Beijing Tsinghua Changguang Hospital from June 2016 to June 2018 were retrospectively included.The medical records,gastroscopy and 24-hour pH-intraluminal impedance monitoring reports were collected.According to clinical diagnosis,the patients were divided into E-DGBI group and GERD group.PSPWI,acid exposure time(AET),DeMeester score,total reflux times and mean nocturnal baseline impedance(MNBI)were compared between the both group.The receiver operating characteristic curve(ROC)of PSPWI,AET,total reflux times and MNBI was drawn to identify the sensitivity and specificity of E-DGBI and GERD.The cut-off values were calculated with Youden index and the area under the curve(AUC)was compared.Results A total of 73 patients were included,including 36 males and 37 females,whose age[M(Q 1,Q 3)]was 54.0(42.6,63.0)years.There were 39 cases in E-DGBI group and 34 cases in GERD group.The 24-h AET[0.5(0.1,1.6)vs 6.0(3.6,11.9)],DeMeester score[2.8(1.1,5.7)vs 20.4(14.7,47.4)score]and total reflux times[32.0(19.0,53.0)vs 66.0(34.3,96.0)times]were significantly higher in E-DGBI group than those in GERD group(all P<0.001);MNBI in E-DGBI group was higher than that in GERD group[2375.0(1726.0,2978.0)Ωvs 1361.0(814.0,2273.5)Ω,P<0.001].The PSPWI in E-DGBI group is higher than that in GERD(0.56±0.19 vs 0.25±0.15,P<0.001).According to ROC,with PSPWI>0.46 as the cut-off value,the AUC was 0.895(95%CI:0.827-0.963)in differentiating E-DGBI and GERD.The sensitivity was 94.1%and the specificity was 69.2%.There were no significant differences of AUC between PSPWI and AET or total reflux events(all P>0.05).But the AUC of PSPWI was higher than that of MNBI(AUC=0.749,95%CI:0.632-0.866,P=0.031).Conclusion PSPWI can better distinguish E-DGBI fr

关 键 词：胃食管反流 肠脑互动障碍性食管疾病 反流后吞咽诱发的蠕动波指数 鉴别诊断 

分 类 号：R571[医药卫生—消化系统]