酸袋在反流性食管炎中作用的研究

The effect and their mechanism of acid pocket in reflux esophagitis

目的 探讨酸袋在反流性食管炎中的作用.方法 应用胃食管反流病问卷（RDQ量表）和胃镜检查确诊15名健康者和24例反流性食管炎患者.使用4通道食管测压系统确定受试者下食管括约肌（LES）位置,将单通道pH电极置于LES远端下方1 cm处监测空腹pH值o.5 h,给予标准餐后继续监测pH值2 h,然后将探针移至LES近端上方5 cm处行24 h动态pH临测.结果 16例反流性食管炎患者（66.67%）与10名健康者（10/15）存在酸袋.反流性食管炎组较健康组酸袋出现时间早[11.00（4.25～17.00）min比30.00（15.50～54.25）min,P＜0.05]、平均pH值低[1.84（1.59～2.19）比2.32（1.96～2.71）,P＜0.05].而餐前胃食管连接部平均pH值及酸袋持续时间差异无统计学意义.结论 反流性食管炎患者有异常食管酸反流,且酸袋出现时间早、平均pH值低,其食管黏膜损伤可能与此有关.

Objective To investigate the function of acid pocket in reflux esophagitis. Methods The 15 healthy controls and 24 reflux esophagitis patients were identified by reflux disease questionnaire （RDQ） and gastric endoscopy. The location of subjects＇ lower esophageal sphincter （LES） was determined by 4 channel esophageal manometry system. Then a single-channel pH electrode was positioned 1 cm below the distal border of the LES to monitor fasting pH for half an hour. After a standard meal, the pH was continuously measured for two hours. Then the electrode was moved to 5 cm above the proximal border of the LES to monitor the dynamic pH for 24 h.Results Acid pocket was found in 16 cases of reflux esophagitis patients（66.67%） and 10 cases of healthy individuals （10/15）. Acid pocket occurred earlier in reflux esophagitis group than healthy controls [11.00（4.25-17.00） min vs 30.00（15.50-54.25） min, P〈0.05], and the average pH value was lower [1.84（1.59-2. 19） vs 2.32 （1.96-2.71）, P〈0.05]. There was no statistic difference in mean pH value of gastroesophageal junction and the duration of acid pocket before the meal.Conclusion There is abnormal acid reflux in reflux esophagitis patients, and acid pocket with earlier occurrence and lower pH value may relevant to esophageal mucosal impairment.