不同类型胃食管反流病食管内pH和食管动力学的差异比较研究

肖饶军+谢代刚+汪蓓蓓

摘 要 目的：探讨不同类型胃食管反流病食管内pH和食管动力学的差异。方法：根据内镜下表现及病理特征将115例胃食管反流病患者分为糜烂性食管炎（EE）组，非糜烂性反流病（NERD）组，巴雷特食管（BE）组，根据3组患者食管内24 h pH监测指标和食管压力，比较3组患者食管内pH和食管动力学差异。结果：EE组DeMeester评分明显高于NERD和 BE两组，而最长反流时间、立位反流时间明显低于NERD和 BE两组（P＜0.05），组间卧位反流时间比较差异无统计学意义（P＞0.05）；EE组以重度食管酸暴露为主，占54.17% ，NERD组以轻度食管酸暴露为主，占51.35%，BE组以中度食管酸暴露为主，占53.34%。EE组食管括约肌的静息压低于NERD、BE两组，但比较差异无显著性（P＞0.05），EE组食管体部压力L3 和L8明显高于NERD、BE两组，但食管体部压力L13明显低于NERD、BE两组（P＜0.05），组间食管体部压力L18比较差异无统计学意义（P＞0.05），EE组无效食管运动数明显多于NERD、BE组。结论：食管内酸反流情况、食管体部蠕动和括约肌功能受限是形成胃食管反流病不同类型损伤的主要原因。

关键词胃食管反流病食管内pH食管动力学

中图分类号：R571文献标识码：B文章编号：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）是常见的消化内科疾病，是由胃内容物反流引起患者不适及其他并发症的一种疾病，根据内镜检查特征可将GERD分为糜烂性食管炎（erosive esophagitis，EE），非糜烂性反流病（non-erosive reflux disease，NERD）和巴雷特(Barrett)食管症[1]。本研究通过比较不同类型GERD食管内pH和食管动力学的差异，探讨食管内pH和食管动力学指标在EE、NERD、和Barrett食管中的鉴别价值，现报道如下。

资料与方法