食管基线阻抗值在鉴别胃食管反流病和功能性烧心中的应用

摘要

目的 分析中国胃食管反流病(GERD)患者和功能性烧心(FH)患者食管基线阻抗(BI)的特点,并寻找最佳截断值鉴别非糜烂性反流病 (NERD)和FH.方法 筛选2014年10月-2016年6月在中国人民解放军总医院消化科就诊的反酸或烧心患者共150例,最终纳入122例,分为三组:NERD组69例、反流性食管炎(RE)组39例和FH组14例.所有受试者均接受胃镜检查和24 h食管pH-阻抗监测及质子泵抑制剂试验.分别对各组患者食管下括约肌上方3、5、9、15和17 cm(通道z6、z5、z3、z2和z1)的BI值进行分析.结果 NERD组各个通道食管BI值均显著低于FH组 (P<0.001),但均显著高于RE组 (P<0.001).根据受试者工作特征曲线可得出区分NERD和FH的食管远端BI最佳截断值为2 415 Ω(灵敏度为79.7%,特异度为92.9%).NERD及RE组的酸暴露时间(AET)均显著高于FH组;NERD组和RE组的AET差异无统计学意义(P>0.05).NERD和RE中食管BI值均与AET呈负相关(r值分别为-0.649、-0.536,P<0.001).结论 食管远端的BI值2 415 Ω可用于鉴别NERD和FH.GERD患者食管BI值降低与食管酸暴露程度相关.%Objective To analyze the differences of esophageal baseline impedance (BI) levels between gastroesophageal reflux disease (GERD) and functional heartburn (FH), and find out the cut-off value for differentiating nonerosive reflux disease (NERD) from patients with FH.Methods A controlled study at the Department of Gastroenterology, Chinese PLA General Hospital from Oct.2014 to Jun.2016 was performed.One hundred and fifty patients were screened and 122 included in which 108 patients with GERD [69 had NERD, 39 had reflux esophagitis (RE)]and 14 patients with FH.All patients underwent esophagogastroduodenoscopy and 24-h multichannel intraluminal impedance and pH monitoring, as well as PPI test.Esophageal BI levels at 3, 5, 9, 15, and 17 cm above the lower esophageal sphincter (z6, z5, z3, z2, z1) were analyzed.Results The esophageal BI levels of both NERD group and RE group were lower than those of FH group, and the difference was statistically significant (P<0.001).A cut-off value of less than 2 415 Ω was suitable for the discrimination between NERD and FH with the sensitivity (79.7%) and specificity (92.9%).Patients with NERD had longer AET than FH (9.4 vs 1.05,P<0.001).Patients with RE had longer AET than FH (10.5 vs 1.05,P<0.001).But there was no significantly statistical difference of AET between NERD and RE.Esophageal BI level was negatively correlated with AET in NERD group (r=-0.649, P<0.001).Esophageal BI level was negatively correlated with AET in RE group (r=-0.536, P<0.001).Conclusion Esophageal BI of 2 415Ω at the distal esophagus can distinguish NERD from FH.The decrease of esophageal BI level in GERD is negatively correlated with esophagus acid exposure.