食管動力異常與胃食管反流病的相關性研究

[摘要] 目的 探討食管動力異常與食管黏膜損害及酸反流發生的臨床相關性。 方法 選擇筆者所在醫院2011年6月～2012年6月收治的符合胃食管反流病診斷標準的148例患者以及15名其他受試者納入研究，均接受食管壓力和食管24 h pH值測定，GERD患者根據壓力分組，其他受試者納入對照組，對所有受試者食管壓力以及24 h食管pH值進行比較分析。 結果 52例（35.1%）患者符合下食管括約肌低壓標準，49例（33.1%）患者符合食管無效動力標準，33例（22.3%）患者兩項均符合，14例（9.5%）患者兩項均不符合。對照組的LESP要顯著高于其他四組，差異有統計學意義（P<0.05）；C組在遠端反流指數、總反流時間、最長反流時間和EAC方面均顯著高于A、B和D組，差異有統計學意義（P<0.05）；B和C組在pH<4總時間百分比、立位pH<4時間百分比和臥位pH<4時間百分比方面顯著高于其他3組，差異有統計學意義（P<0.05），而B和C組間差異無統計學意義（P>0.05）。 結論 胃食管反流病的發生與多因素有關，下食管括約肌低壓和食管無效動力都是誘發因素之一，其中反流性食管炎的程度與酸反流密切相關，而與食管無效動力無相關性。

[關鍵詞] 胃食管反流；食管括約肌低壓；食管無效動力

[中圖分類號] R571 [文獻標識碼] A [文章編號] 2095-0616（2012）22-12-03

Relative study between esophageal dysmotility and gastroesophaeal reflux disease

NIU Yichun ZHAO Gongfang HUANG Hua CHANG Jiang LI Weihua HE Haiyu

FU Wen WANG Meilian

Department of Gastroenterology， the Second Affiliated Hospital of Kunming Medical University， Kunming 650101， China

[Abstract] Objective To instigate the relationship between esophageal dysmotility and gastroesophaeal reflux disease. Methods 148 patients with GERD and 15 other people of our hospital from June 2011 to June 2012 were selected and tested by esophageaI manometry and 24 h pH monitoring.148 patients were grouped by esophageaI manometry， and healthy people as control group， all the esophageaI manometry and 24 h pH monitoring results were compared. Results 52 patients （35.1%） were complied with standard of LES low pressure. 42 patients （33.1%） were complied with standard of IEM. 33 patients （22.3%） were complied with both， and 14 patients （9.5%） complied neither. The LESP of control group were significantly higher than other four groups （P<0.05）， and distal reflux index， total reflux time， longest reflux time and EAC of group C were the higher than group A， B and D （P<0.05）.The total， orthostatic and supine percentage time of pH below 4 of group B and C were the highest （P<0.05）， and there was no difference between group B and C （P>0.05）. Conclusion The incidence of GERD has multi-factors. LESP and IEM are one of the predisposing factors. The degree of reflux esophagitis are closely related to acid reflux and have no correlation with IEM.

[Key words] Gastroesophaeal reflux disease； Esophageal sphincter low pressure； Esophageal invalid power

胃食管反流病（gastroesophageal reflux disease，GERD）是指胃、十二指腸內容物反流入食管引起反酸、燒心等不適癥狀或并發癥[1]。該病的發病機制尚不明確，目前認為可能與防御因素（抗反流屏障、食管酸清除和黏膜抵抗力）和侵襲因素（胃酸pH值、酸分泌量和十二指腸內容物反流）的不平衡有關[2-3]。其中食管動力……