夜间酸突破与食管下段酸暴露的相互关系

摘要

目的 了解夜间酸突破(NAB)的发生与食管下段酸暴露的相互关系.方法 选取61例十二指肠球部溃疡(DU)患者,均接受质子泵抑制剂(PPI)治疗,即奥美拉唑20 mg/次,2次/d.治疗第5天进行24 h食管、胃pH监测,对夜间胃内pH与食管下端pH相互关系采用一元线性回归方程分析.并把患者分为NAB组与非NAB组,比较两组患者夜间食管下段平均pH值及夜间pH＜4时段所占时间百分比.结果 夜间食管下段平均pH值(x)与胃内平均pH值(y)所作回归方程为:y=4.054+0.288x,回归系数检验P＜0.001.夜间食管下段pH＜4时段所占时间百分比(x)与胃内pH＜4时段所占时间百分比(y)所作回归方程为:y=5.780+0.204x,回归系数检验P＜0.001.NAB组患者夜间食管下段平均pH值(5.31±0.89)显著低于非NAB组(5.92±0.99),差异有统计学意义(P＜0.05);而夜间食管下段pH＜4时段所占时间百分比(39.30%)则显著高于非NAB组(26.32%),差异有统计学意义(P＜0.05).结论 食管夜间平均pH值、pH＜4时段所占时间百分比随胃内相应指标同向变化.DU患者在接受PPI治疗时,发生NAB的患者,其食管下段酸暴露增加.%Objective To investigate the correlation between nocturnal acid break - through ( NAB ) and acid exposure in lower esophagus. Methods Totally 61 patients with duodenal ulcer confirmed by gastroscopy received omeprazole ( 20 mg twicea day ) for 5 days. Ambulatory 24 - hour intragastric and esophageal pH monitoring was performed on day 5. The relationship hetween nocturnal intragastric pH and lower esophagus pH was analyzed using equation of monovariate linear regression. Patients were divided into NAB group and non - NAB group , and the mean lower esophageal nocturnal pH and the mean nocturnal percentage of time of pH ＜ 4 in lower esophagus were compared. Results The regression equation between the mean lower esophageal nocturnal pH and that of intragastric pH was as follows : y = 4. 054 + 0. 288x. The regression equation between lower esophageal nocturnal percentage of time of pH ＜4 and that of intragastric pH was as follows : y = 5. 780 +0. 204x. The mean lower esophageal nocturnal pH in the NAB group and non - NAB group was ( 5. 31 ±0. 89 ) and ( 5. 92 ±0. 99 ), respectively ( P ＜0. 05 ) . The mean nocturnal percentage of time of pH ＜4 in lower esophageal in the NAB group and non - NAB group was 39. 30％ and 26. 32％ , respectively ( P ＜ 0. 05 ) . Conclusion The mean lower esophageal nocturnal pH and the lower esophageal nocturnal percentage of time of pH ＜4 change along with those of intragastric pH. The acid exposure of lower esophagus increases in patients experience NAB when receiving proton pump inhibitor treatment.