反流性食管炎患者胃肠道自主神经功能研究

The study on the function of gastrointestinal autonomic nerve in reflux esophagitis patients

目的探讨反流性食管炎（RE）患者自主神经功能的特点及自主神经功能异常在RE发病中的作用。方法RE患者（n=20）和健康对照者（n=18）均接受心率变异（HRV）频域分析联合进餐刺激法检测自主神经功能。RE患者同时进行内镜下RE洛杉矶分级、反流症状积分、胃食管反流病相关生活质量量表（GERD-HRQL）、焦虑自评量表（SAS）和抑郁自评量表（SDS）评测。其中12例RE患者予以质子泵抑制剂（PPI）治疗2～4个月[平均（3．7±0．8）个月]后复查自主神经功能。结果餐前RE组交感活性高于健康对照组，副交感活性低于健康对照组（P值分别=0．022和0．034）。餐后RE组及健康对照组自主神经功能变化趋势相同。RE患者餐后交感活性与反流症状积分呈负相关，副交感活性与反流症状积分正相关，进餐对交感-副交感平衡的影响与反流症状积分负相关（r=-0．48，P=0．022），进餐对副交感神经的影响与反流症状积分及GERD-HRQL评分均呈正相关。PPI治疗后RE患者反流症状积分、GERD-HRQL评分、SAS评分、SDS评分均明显降低。PPI治疗前、后自主神经功能元改善。结论RE患者存在胃肠道自主神经功能异常，表现为空腹交感活性增高，副交感活性降低。RE患者胃肠道自主神经功能与反流症状积分相关。胃肠道自主神经功能异常可能是RE的发病原因之一。

Objective To explore the features of autonomic nerve function in reflux esophagitis （RE） patients, and the role of abnormal function in the pathogenesis of RE. Methods Twenty RE patients （RE group） and 18 healthy controls （HS group） all underwent heart rate variability （HRV） with meal stimulation to test the function of autonomic nerve. At same time, the endoscopic Los Angeles （LA） Classification, RE symptom score, Gastroesophageal reflux disease-health related quality of life （GERD-HRQL）, Self-rating Anxiety Scale （SAS） and Self-rating Depression Scale （SDS） were evaluated in the RE patients. Of those, 12 RE patients were re-examined the function of autonomic never after 2 to 4 months [mean （3. 7 ±0. 8） months] of proton pump inhibitors （PPI） treatment. Results In fasting state, the sympathetic activity was higher in RE group than in HS group, while the parasympathetic activity was lower in HS group （P = 0. 022 and 0. 034）. Postprandial, the trend of autonomic functional change was the same in RE group and HS group. Postprandial, the sympathetic activity was negatively correlated with symptom score in RE patients; however, the parasympathetic activity was positively correlated with RE symptom score. The influence of meal on the balance of sympathetic and parasympathetic was negatively correlated with RE symptom score （r=0. 48, P=0. 022）. The influence of meal on the parasympathetic nerve was positively correlated with RE; symptom score and GERD-HRQL score. After PPI treatments, RE symptom score, GERD-HRQL score, SAS score and SDS score were all significantly decreased in RE patients. There was no significant difference in autonomic nerve function before and after PPI treatment. Conclusions There is abnormal autonomic nerve function in RE patients, characterized by higher sympathetic activity and lower parasympathetic activity in fasting state. The autonomic nerve function is correlated with RE symptom score. The abnormal autonomic nerve function may be one of the causes of RE.