胡桃夹食管病理生理机制及其临床特点

Pathophysiologic mechanisms and clinical characteristics in patients with nutcracker esophagus

目的探讨胡桃夹食管(NE)的病理生理机制及其临床特征和变迁。方法回顾性分析22例NE患者(NE组)的临床资料,共随访7例(随访组),并以10名健康志愿者为对照组。对受试者采用食管测压、多导胃电图(MEGG)、自主神经功能(ANS)及心理测试。结果①NE组以反流、胸痛和吞咽不适为主要症状者分别为12例(54.5%)、7例(31.8%)和3例(13.6%);以反流和胸痛为主要症状者间食管体部平均压力(MCA)差异无统计学意义(P值均>0.05)。②NE组中有13例接受24h pH监测,其中8例(61.5%)为阳性;17例接受内镜检查,其中4例(23.5%)表现为反流性食管炎(RE);存在酸相关异常的NE患者14例,其中12例经抑酸治疗后7例(58.3%)症状明显改善。③随访组在MEGG主频和主功方面与对照组比较差异均无统计学意义(P值均>0.05);而餐前、餐后无节律百分比和慢波耦联率分别低于对照组(P<0.05和0.01)。④随访组ANS各参数与对照组比较差异均无统计学意义(P值均>0.05)。⑤随访组含服硝酸甘油前、后,7例MCA均无明显变化(P>0.05);4例(57.1%) NE患者存在抑郁状态。结论NE临床表现多样,其症状与MCA无关,与胃食管反流相关,可能为胃食管反流病的一种亚型,胃动力异常和心理因素可能参与NE的发病。

Objectives To investigate the pathophysiologic mechanisms and the clinical characteristics and variations of nutcracker esophagus（NE）. Methods Clinical data obtained from 22 patients with NE were retrospectively analyzed. Seven followed-up patients had esophageal motility, multi-channel electrogastrography（MEGG）, the autonomic nervous system（ANS） and psychology tests and were com- pared to 10 healthy subjects（HS）. Results ①In NE group, 12 patients had reflux symptom（55%）, 7 patients had chest pain（32% ） and 3 patients had dysphagia（13% ）. There was no statistical difference in mean contraction amplitude（MCA） between patients with reflux symptom and chest pain. ②Eight out of the 13 patients with NE who received 24 h pH monitoring were positive reflux, and 4 out of 17 patients had reflux esophagitis in endoscopic examinations. The symptoms were improved in 58% patients（7/12） by regular acid-suppression therapies. ③There was no statistical difference beween NE and HS groups in dominant frequency and power of MEGG. However, the percentages of normal rhythm in preprandial and slow wave coupling in pre and postprandial of NE patients were significantly decreased than those in HS. ④The ANS function in NE group had no statistical difference compared to those in HS. QIn follow- up group, no difference was found before and after nitroglycerin sublingually. Four patients had depression. Conclusions The clinical presentations of NE are vary. The symptoms of NE were poorly correlated with M（＇A, but partially correlated with GER, which may represent a special subtype of GERD. Gastric dysmotility and psychological factors might contribute to the pathogenesis of NE.