非心源性胸痛患者与酸反流的关系

The relationship between acid reflux and noncardiac chest pain

目的探讨非心源性胸痛患者(NCCP)的临床特点,调查NCCP患者的生活质量状况,了解NCCP与酸反流的关系及质子泵抑制剂(PPI)试验对NCCP病因诊断的价值。方法详细记载87例NCCP患者症状并评分后,给予7 d兰索拉唑治疗试验(兰索拉唑30 mg口服,2次/d),并在PPI试验前后均进行问卷调查,内容包括一般社会资料,症状评分表,简明健康状况调查表SF-36,焦虑量表(SAS),抑郁量表(SDS),所得分数与健康对照组进行比较。结果①NCCP最常见的病因是胃食管反流病,典型反流症状发生率为34.5%。②87例NCCP患者中酸相关性NCCP为56.3%(49/87),非酸相关性NCCP为43.7%(38/87)。PPI试验敏感性为91%,特异性为81%。③NCCP患者的生活质量在8个健康概念上除情绪角色功能外均明显比健康人差(P<0.01)。除躯体疼痛外,非酸相关性NCCP组在生理功能、生理职能、精神健康、总体健康、社会功能情感职能、活力6个维度,积分下降更为显著(P<0.05)。④NCCP患者焦虑、抑郁的发生率明显高于健康对照组(P<0.01),平均焦虑、抑郁程度高于对照组(P<0.01),非酸相关性NCCP组焦虑症和抑郁症的发生率明显高于酸相关性NCCP组(P<0.05)。结论NCCP最常见的病因是酸相关性食管疾病,NCCP患者伴有不同程度的精神障碍,PPI试验是临床诊断酸相关性NCCP的简便而实用的方法。

Objective To characterize the clinical presentation of noncardiac chest pain（NCCP）, to investigate the quality of life among NCCP patients, and to understand the relation between NCCP and acid reflux and the value of proton pump inhibitor（PPI） in diagnosis of NCCP. Methods Eighty seven NCCP patients were enrolled to the study. All patients received lansoprzole 30 mg twice daily for 7 days. Patients filled out a questionnaire survey before and after the PPI treatment. The questionnaire included the general personal data, the symptom scale, the medical outcome study 36-item short form healthy survey（SF 36）, Zung Self-Rating Anxiety Scale（SAS） and Zung Self-rating Depression Scale（SDS）. The results were analyzed in comparisons of healthy control group. ResuIts （1） The most common cause for NCCP was gastroesophageal reflux disease（GERD）. The typical reflux syndrome presented among 34.5% of the patients. （2） Among 87 patients, acid-related NCCP was accounted for 56.3 - （49/87）, whereas non-acid related NCCP was accounted for 43.7- （38/87）. The sensitivity and specificity of PPI test were 91% and 81%, respectively. （3） Except the role of role emotional（RE）, 7 healthy conceptions in the health-related quality of life in NCCP patients were significantly lower than those in healthy volun teers（P 〈 0.01）. Non-acid related NCCP patients had significantly lower scores in SF-36 including physical function, role physical, mental health, general health, social functioning, RE and vitality. The quality life of patients with acid related NCCP was significantly lower than that of healthy control（P 0.01）. （4） The incidences of anxiety and depression among NCCP patients were significantly higher than those among the healthy control（P 〈 0. 01）. The incidences of anxiety and depression among the patients with non-acid related NCCP were higher than those with acid related NCCP and healthy control. Conclusions GERD is the most common cause of NCCP. Patients with NCCP suffered from various psy chological disorders. PPI is a simple and convenient test for diagnosing acid-related NCCP.