非糜烂性反流病与反流性食管炎患者体表胃电活动及自主神经功能观察

Multi-channel electrogastrography and autonomic nervous system function in patients with non-erosive reflux disease and reflux esophagitis

目的分析非糜烂性反流病（NERD）及反流性食管炎（RE）患者体表胃电及心率变异性（HRV）的变化，探讨胃电活动及自主神经系统（ANS）功能在发病中的作用。方法NERD21例、RE21例和健康对照20名，描记试餐前后的多导体表胃电和心电活动。胃电参数包括主频、主功率、正常胃电慢波节律百分比（N％）和慢波耦联百分比（％SWC）。对心电信号进行HRV功率谱分析评价ANS功能，参数包括交感活性、迷走活性和交感迷走平衡。试验过程包括空腹30min和试餐后60min。结果NERD、RE和健康对照组餐后主频均高于空腹，而N％和％SWC均低于空腹（均P〈0．05）。NERD组空腹％SWC值低于健康对照组[70．5％（40．6％～81．9％）、76．3％（66．4％-91．4％），P〈0．05]，餐后％SWC值低于健康对照和RE组，但差异均无统计学意义（均P〉0．05）。NERD、RE和健康对照组餐后交感活性和交感迷走平衡均高于空腹，迷走活性低于空腹（均P〈0．01），NERD组餐后交感迷走平衡显著低于RE组[1．d（0．8～2．5）、2．2（1．3—4．4），P〈0．05]。结论NERD胃电空间协调性及自主神经功能较RE显著异常，是其区别于RE的重要特征。

Objective To investigate the gastric myoelectrical activity and autonomic nervous system （ANS） function in patients with non-erosive reflux disease （NERD） and reflux esophagitis （RE）. Methods 42 patients with gastroesophageal reflux disease （GERD） , 21 with NERD and 21 with RE, and 20 healthy volunteers （ controls ） underwent multi-channel electrogastrography （ MEGG ） and electrocardiography simultaneously for 30 min in the fasting state and 60 min after a standard test meal. The MEGG parameters included dominant frequency （ DF）, dominant power （ DP）, normal percentage of 2 - 4 times/min gastric slow waves （N%）, and percentage of slow wave coupling （% SWC ）. ANS was determined according to power spectra analysis of heart rate variability （HRV） which was conducted by using electrocardiogram recording, including the parameters of sympathetic activity, vagal activity, and sympathovagal balance ratio so as to evaluate the ANS function. Results The DF levels of the NERD and RE patients and healthy volunteers after test meal were all significantly higher than those in fasting state （all P 〈 0. 05）. The % SWC levels of the 3 groups after test meal were all significantly lower than those when fasting （ all P 〈 0. 05 ） , and the % SWC level of the NERD patients was significantly lower than that of the healthy volunteers in fasting state [ 70. 5 % （40. 6% - 81.9 % ,76. 3 % （ 66. 4% - 91.4% ）, P 〈 0. 05 ]. Test meal significantly increased the sympathetic activity and sympathovagal balance ratio of the NERD and RE patients and healthy volunteers （ all P 〈 0. 05 ） , and the vagal activity levels of the 3 groups after test meal were all significantly lower than those when fasting （all P 〈 0. 01 ）. The sympathovagal balance ratio of the NERD group was significantly lower than that of RE group after meal [ 1.4 （ 0. 8 - 2.5 ）, 2. 2 （ 1.3 - 4. 4 ）, P 〈 0. 051. Conclusion The spatial regularity of gastric slow waves and ANS function in NERD patients are significantly different from those in RE patients.