24h食管pH阻抗监测在胃食管反流性咳嗽中的临床应用

摘要

目的：应用24 h pH阻抗监测技术分析胃食管反流性咳嗽（ gastroesophageal reflux cough，GERC）患者的反流特点，探讨GERC的发病机制。方法选取慢性咳嗽患者116例，根据24 h pH阻抗监测结果和抗反流治疗结果将符合GERC诊断标准患者定为GERC组，选取健康志愿者30例设为对照组。比较两组pH阻抗联合监测结果。结果根据24 h pH阻抗监测结果和抗反流治疗结果符合GERC诊断标准的患者共有96例，其中28例患者合并弱酸反流异常，12例患者合并弱碱反流异常。 GERC组24 h食管pH监测的6项参数及DeMeester评分均高于对照组，差异均有统计学意义（P＜0．01）。与对照组相比，GERC组24 h食管阻抗监测近端反流次数，气体反流、液体反流及混合反流次数，酸反流、弱酸反流、弱碱反流次数差异均有统计学意义（P＜0．01）；GERC患者总反流次数、总弱酸反流次数与总弱碱反流次数与SAP呈正相关（ P＜0．05）。结论 GERC患者存在反流物理性质和酸碱性方面的反流异常，直立位反流较卧位明显。 GERC患者存在两种不同类型的发病机制，以低位反流为主，但57．93％的反流物可至食管近端。24 h食管pH阻抗监测是诊断GERC的可靠方法，在临床上具有较好的应用前景。%Objective To analyze the reflux characteristics of gastroesophageal reflux cough ( GERC ) patients by 24 h pH/impedance monitoring technology, and to study the pathogenesis of GERC.Methods One hundred and six-teen patients with chronic cough were collected.Patients with demeester integral ≥12.7 points and ( or) SAP≥75%and being effective to treatment were diagnosed as GERC group, 30 healthy persons were as the control group.The re-sults of 24 h pH/impedance monitoring between two groups were compared.Results According to the results of 24 h pH/impedance monitoring and anti-reflux treatment, 96 patients were diagnosed as GERC, which included 28 patients with weakly acidic reflux and 12 patients with weakly ackaline reflux.Compared with the control group, six monitoring parameters and DeMeester score in GERC group were higher (P<0.01).There were significant differences in the num-ber of proximal reflux, gas reflux, liquid reflux, mixed gas-liquid reflux, acid reflux, weakly acidic reflux, weakly ack-aline reflux between control group and GERC group (P<0.01).SAP was positively correlated with total number of re-flux, weakly acidic reflux, gas reflux and weakly alkaline reflux (P<0.05).Conclusion GERC patients have abnor-mal reflux in terms of physical properties and acid reflux material nature.Reflux symptoms appear more obviously in up-right position than supine position.There are two different types of pathogenesis in GERC.Distal esophageal reflux is main reflux style of GERC patients, and 57.93%of the reflux material can be available to the proximal esophagus.24 h pH/impedance monitoring technology is a reliable method to diagnose GERC, and it has good application prospect in clinic.