不同類型胃食管反流病食管內(nèi)pH和食管動力學(xué)的差異比較研究

肖饒軍+謝代剛+汪蓓蓓

摘 要 目的：探討不同類型胃食管反流病食管內(nèi)pH和食管動力學(xué)的差異。方法：根據(jù)內(nèi)鏡下表現(xiàn)及病理特征將115例胃食管反流病患者分為糜爛性食管炎（EE）組，非糜爛性反流病（NERD）組，巴雷特食管（BE）組，根據(jù)3組患者食管內(nèi)24 h pH監(jiān)測指標(biāo)和食管壓力，比較3組患者食管內(nèi)pH和食管動力學(xué)差異。結(jié)果：EE組DeMeester評分明顯高于NERD和 BE兩組，而最長反流時間、立位反流時間明顯低于NERD和 BE兩組（P＜0.05），組間臥位反流時間比較差異無統(tǒng)計學(xué)意義（P＞0.05）；EE組以重度食管酸暴露為主，占54.17% ，NERD組以輕度食管酸暴露為主，占51.35%，BE組以中度食管酸暴露為主，占53.34%。EE組食管括約肌的靜息壓低于NERD、BE兩組，但比較差異無顯著性（P＞0.05），EE組食管體部壓力L3 和L8明顯高于NERD、BE兩組，但食管體部壓力L13明顯低于NERD、BE兩組（P＜0.05），組間食管體部壓力L18比較差異無統(tǒng)計學(xué)意義（P＞0.05），EE組無效食管運動數(shù)明顯多于NERD、BE組。結(jié)論：食管內(nèi)酸反流情況、食管體部蠕動和括約肌功能受限是形成胃食管反流病不同類型損傷的主要原因。

關(guān)鍵詞胃食管反流病食管內(nèi)pH食管動力學(xué)

中圖分類號：R571文獻(xiàn)標(biāo)識碼：B文章編號：1006-1533(2014)13-0053-04

Comparative study of esophageal pH and esophageal

dynamics in different types of gastroesophageal reflux disease*

XIAO Raojun XIE Daigang WANG Beibei

(The Ping Mine General Hospital of Pingxiang Jiangxi Province, Pingxiang 337000, China)

ABSTRACT Objective: To discuss the differences of esophageal pH and esophageal dynamics in different types of gastro esophageal reflux disease (GERD). Methods: One hundred and fifteen cases of patients with GERD were divided into an erosive esophagi (EE) group, a non-erosive reflux disease (NERD) group, and a Barrett (BE) group according to endoscopic manifestations and pathological features, and their differences in esophageal pH and esophageal dynamics were compared based on esophageal pH values monitored within 24 h and esophageal pressure in three groups. Results: DeMeester score was obviously higher in EE group than in NERD and BE groups while the longest reflux time and stand reflux time were significantly lower in EE group than in NERD and BE groups (P< 0.05), and the comparison of fowlers reflux time among three groups had no statistical significance (P>0.05). Severe, mild and moderate esophageal acid exposures were dominated in EE, NERD and BE groups, respectively, which accounted for 54.17%, 51.35%, 53.34%, respectively. Resting lower esophageal sphincter was lower in EE group than in NERD and BE groups, however, their comparison had no significant difference (P>0.05). The pressures of esophageal body L3 and L8 were significantly higher in EE group than in NERD and BE groups while the pressure of esophageal body L13 was significantly lower in EE group than in NERD and BE groups (P<0.05). The comparison in pressure of esophageal body L18 among three groups had no statistical significance (P>0.05), and the number of ineffective esophageal movement was obviously increased in EE group than in NERD and BE groups. Conclusion: Esophageal acid reflux condition, esophageal peristalsis and sphincter function limitation are the main reasons for different types of GERD injury.

KEY WORDSGERD; esophageal pH; esophageal dynamics

胃食管反流病（gastroesophageal reflux disease，GERD）是常見的消化內(nèi)科疾病，是由胃內(nèi)容物反流引起患者不適及其他并發(fā)癥的一種疾病，根據(jù)內(nèi)鏡檢查特征可將GERD分為糜爛性食管炎（erosive esophagitis，EE），非糜爛性反流病（non-erosive reflux disease，NERD）和巴雷特(Barrett)食管癥[1]。本研究通過比較不同類型GERD食管內(nèi)pH和食管動力學(xué)的差異，探討食管內(nèi)pH和食管動力學(xué)指標(biāo)在EE、NERD、和Barrett食管中的鑒別價值，現(xiàn)報道如下。

資料與方法