高分辨率食管测压联合双通道24 h食管pH监测在胃食管反流病发病机制研究中的应用

摘要

Objective To study the esophageal kinetic characteristics and acid reflux status of different kinds of patients with gastro-esophageal reflux disease ( GERD) by using high resolution esophageal manometry combined with du-al channel 24h esophageal pH monitoring technology, and to explore the effect of esophageal dyskinesis and acid reflux on GERD pathogenesy. Methods A total of 67 GERD patients with typical gastroesophageal reflux symptom and 25 healthy people taking medical examinations ( control group) during October 2011 and December 2013 underwent electronic gas-troscopy, high resolution esophageal manometry and dual-channel 24 h esophageal PH monitoring respectively. The 67 GERD patients were divided into erosive esophagitis group ( EE group, n =36 ) and non-erosive reflux disease group (NERD group, n=31) according to the esophageal mucosa erosion condition under endoscope, and the esophageal mo-tility and acid reflux status in the three groups were compared. Results Compared with those in the control group, all patients in the EE and NERD groups had esophageal dyskinesis with the distal contractile integral ( DCI) and contractile front velocity (CFV) significantly reducing (P<0. 01), and values of DCI and CFV in EE group were significantly lower than those in NERD group (P<0. 05);values of all acid reflux indexes in EE and NERD groups were significantly in-creased ( P <0. 01 ) , and the values in EE group were significantly higher than those in NERD group ( P <0. 05 ) . Conclusion High resolution esophageal manometry combined with dual-channel 24 h esophageal PH monitoring clearly shows that esophageal dyskinesis and acid reflux are important mechanism of GERD pathogenesy. There are differences of esophageal motility and acid reflux among different GERD patients, and the conditions of esophageal dyskinesis and acid reflux in EF patients are more significant.%目的：应用高分辨率食管测压联合双通道24 h食管pH监测技术了解不同类型胃食管反流病( GERD)患者的食管动力学特征及酸反流情况,探讨食管动力障碍和酸反流在GERD发病中的作用。方法选取2011年10月-2013年12月在海军总医院消化科就诊的具有典型胃食管反流症状的GERD患者67例和健康体检者25例(对照组),分别行电子胃镜检查、高分辨率食管测压和双通道24 h食管 pH监测。依据内镜下有无食管黏膜糜烂将GERD患者分为糜烂性食管炎(EE)组(n=36)及非糜烂性反流病(NERD)组(n=31),比较3组食管动力及酸反流的差异。结果与对照组比较,EE组、NERD组均存在食管动力障碍,表现为食管远端收缩积分( DCI)、收缩前沿速度(CFV)显著降低(P<0.01),EE组DCI、CFV较NERD组降低更为显著(P<0.05)。与对照组比较,EE组、NERD组各项酸反流指标均显著增高(P<0.01),EE组各项酸反流指标较NERD组增高更为显著(P<0.05)。结论高分辨率食管测压联合双通道24 h食管pH监测结果更清晰地揭示了食管动力障碍及酸反流是GERD发病的重要机制,不同类型的GERD患者之间存在食管动力及酸反流差异,EE患者的食管动力障碍及酸反流更明显。