内镜下胃食管阀瓣分级的临床应用价值研究

Clinical value of gastroesophageal flap valve classification by endoscopy

目的探讨内镜下胃食管阀瓣（GEFV）分级在胃食管反流病（GERD）临床诊治中的应用价值。方法选择分析2009年7月~2011年1月在该院行胃镜检查的550例病人,分为RE组（反流性食管炎组）与非食管炎组,RE组按洛杉矶标准进行内镜下分级,按Hill分类法对两组均进行GEFV的分级,并对RE组进行病史采集。通过统计分析,探讨GEFV在抗反流防御机制中的作用及临床应用价值。结果检查的550例中,异常（Ⅲ＋Ⅳ级）GEFV发生率29.45%。≥30岁,年龄增长与异常GEFV的发生率呈正相关（r=0.111,P=0.011）。异常GEFV中RE发生率（22.84%）高于正常GEFV中RE发生率（9.02%）;RE组的异常GEFV发生率（51.39%）高于非食管炎组（22.2%）,P=0.000。重症RE（C＋D级）发生率异常GEFV组（21.62%）明显高于正常GEFV组（2.86%）,P=0.040。RE分级与GEFV级别呈正相关（r=0.286,P=0.015）。RE组GEFV级别与患者病程呈正相关（r=0.246,P=0.037）。结论 GEFV是抗反流机制重要因素之一,GEFV分级可作为预测发生反流风险和治疗反应的方法,在临床诊治中有一定的预测价值。

Aim To explore the clinical value of gastroesophageal flap valve（GEFV）classification by endoscopy on gastroesophageal reflux disease（GERD）.Methods We selectively analyzed 550 definite cases of gastroesophageal reflux disease diagnosed by endoscopy in our hospital from July 2009 to January 2011.All cases were divided into reflux esophagitis（RE）group and non-RE group.RE was classified by Los Angeles classification system and GEFV of both groups by Hill system.The history of RE group was also taken.The role and clinical value of GEFV in resistance to reflux was analyzed through the statistical analysis.Results The overall incidence of abnormal GEFV（grade Ⅲ and Ⅳ）in 550 cases was 29.45%.The incidence of abnormal GEFV was positively correlated with age over 30 years old（r=0.111,P=0.011）.The incidence of RE in abnormal GEFV group was significantly higher than that in normal GEFV group（22.84% vs 9.02%）.The incidence of abnormal GEFV in RE patients was higher than that in non-RE（51.39% vs 22.2%,P=0.000）.The incidence of severe RE（grade C and D）in abnormal GEFV group was significantly higher than that in normal GEFV group（21.62% vs 2.86%,P=0.040）.RE grades were positively correlated with GEFV grades（r=0.286,P=0.015）.GEFV grades of RE group were positively correlated with course of the disease（r=0.246,P=0.037）.Conclusion GEFV is an important factor in resistance to reflux mechanism.GEFV classification can predict reflux risk and response to treatment and has certain predictive value in clinical diagnosis and treatment.