自发性夜间胃碱化对十二指肠溃疡病的诊断价值

Value of spontaneous nocturnal alkalinization of stamoch in diagnosis of duodenal ulcer

探讨自发性夜间胃碱化对十二指肠溃疡病的诊断价值。方法对３２例内镜诊断的活动性十二指肠球溃疡（ＤＵ），２１例胃食管反流性疾病〔有反酸、烧心和（或）胸痛等症状，内镜下为０～２级食管炎，食管下段动态２４ｈｐＨ检查积分＞１５．６〕，２３例功能性消化不良患者（有上腹部不适、胀满、上腹痛等症状，内镜下仅为红白相间等慢性炎症表现，食管下段动态２４ｈｐＨ检查积分＜１５．６）和１１例无上消化道症状的健康对照者的２４ｈ胃底（ＬＥＳ下５ｃｍ）和食管下段（ＬＥＳ上５ｃｍ）动态ｐＨ进行了研究。分析了夜间８ｈ（２３ｐｍ～７ａｍ）时间窗内自发性夜间胃碱化（ｓｐｏｎｔａｎｅｏｕｓｎｏｃｔｕｒ－ｎａｌｇａｓｔｒｉｃａｌｋａｌｉｎｉｚａｔｉｏｎ，ＳＮＡ）现象（ｐＨ＞４，时间大于５ｍｉｎ的ｐＨ升高）。结果①ＤＵ组夜间ＳＮＡ阳性率较对照组、ＦＤ和ＧＥＲＤ组明显低（Ｐ＜０．０５，Ｐ＜０．０１，Ｐ＜０．００１）。②对照组的ＳＮＡ阳性率与ＦＤ和ＧＥＲＤ组比较无显著性差别。③ＳＮＡ诊断ＤＵ的特异性和敏感性分别为８１．８％和８４．３％。结论本文结果说明自发性夜间胃碱化缺乏既是球溃疡发病的重要机制之一，亦可作为诊断球溃疡病的一个重要参考指标。

Objective To study the value of spontaneous nocturnal alkalinization of stamoch in diagnosis of duodenal ulcer.Methods Intragastric and esophageal simultaneous 24h pH recordings of 87 subjects were analyzed to evaluate the spontaneous noctumal alkalinization of stomach(SNA,a spontaneously nightly gastric alkaline phase of pH>4,lasting for more than 5 min).Among them there were 32 patients with active duodenal ulcer (DU),23 patients with functional dyspepsia(FD,with the symptoms of early satiety,postprandial abdominal bloation and pain,without acid reflux and heartburn;24h esophageal pH score<156),21 patients with gastroesophageal reflux disease(GERD,with the symptoms of acid reflux,regurgitation and heartburn;endoscopicly esophagitis grade 0～11;24h esophageal pH score>156)and 11 asymptomatic controls(CO,24h esophageal pH score<156).Two probes were placed in the sites of the distal esophagus and the fundus of 5cm above and below lower esophageal sphincter(LES)respectvely.Results ①There was no significant difference in SNA positive rates between the patients with FD(7826%),GERD(8095%)and the subjects of CO(7272%)(P>005);②The SNA positive rate of the patients with DU(1562%)was significantly lower than those of the subjects of FD,GERD and CO(P<0.001);③Sensitivity and specificity were 84.3% and 81.8% respectively by using SNA absence as a test to diagnosing DU;④The prevalence rate of noctumal upper abdominal pain in DU patients without SNA was higher than that with SNA.Conclusion Our study shows ①The absence of SNA could be a more sensitive sign for diagnosing duodenal ulcer disease.②The nocturnal upper abdominal pain in patients with DU may be related to the lack of SNA.