24小时食管pH监测对诊断胃食管反流的临床研究

AMBULATORY 24 HOUR ESOPHAGEAL pH MONITORING IN GASTROESOPHAGEAL REFLUX

目的:探索24h食管pH检测对胃食管反流和胃食管反流性疾病的诊断价值。 方法:采用携带式24h食管pH分析仪对37例具有胃食管反流症状患者作为疾病组在常态下进行24h食管pH监测,并以20名健康成人作为对照组进行比较。 结果:20名正常成人中平均97.7％的时间食管pH>4,观察6项食管pH测定指标,得出95％的正常值范围:pH<4的总时间百分率为4.97％;pH<4的立位时间百分率为3.82％;pH<4的卧位总时间百分率2.34％,反流持续≥5min的次数<2.57;最长反流持续时间<18.62min,pH<4的反流次数为25.69次。疾病组与对照组相比有显著差异(P<0.01),24h食管pH监测的阳性检出率为94.59％,明显高于食管钡餐X线检查(27.02％)、内镜检查(40.54％)及食管粘膜活检(51.35％)等方法。 结论:24h食管pH监测的指标对鉴别生理性与病理性GER,深入了解GER与食管炎的关系,特别对GERD的诊断和疗效判定,提供了可靠的依据。其诊断价值明显优于食管钡餐X线检查和内镜检查。

Ambulatory 24 - hour esophageal pH monitoring was performed on 37 patients with gastroesophageal reflux disease (GERD) and 20 normal subjects. The results show that the esophageal pH in the control group remained above 4 for 97.7% of the circadian. The following values were obtained through observation of six parameters of esophageal pH in the control group, and were found to be consistent for 95% of all normal subjects: The rate in esophageal pH <4 of total fraction time was 4. 97 % , upright fraction time was 3.82 % , supine fraction time was 2. 34 % . Number of reflux episodes longer than five minutes was less than 2. 57; longest reflux episode was less than 18. 62 minutes; number of relux episodes in pH< 4 was 25.5. The results for the GERD group were 15. 84 % ; 10. 45 % ; 14.32 % ; 7. 16;21.21min;35. 37, respectively. The differences between the reflux indexes in the GERD group and the control group were significant ( P < 0.01). The detectable rate of 24 hour esophageal pH monitoring in GERD was 94. 59 %, which is markedly higher than that of esophagography, endoscopy, and esophageal mucosal biopsy.