24h食管pH-阻抗联合监测评估以慢性咳嗽为表现的GERD患者的反流特征

Reflux Characteristics Detected by 24-Hour Esophageal pH-Impedance Monitoring in GERD Patients Presenting with Chronic Cough

背景:腔内阻抗技术与24 h食管pH监测联用,可检出各种类型的胃食管反流事件,明确反流物的性质及其酸碱性。目的:应用24 h食管pH-阻抗联合监测初步探讨以慢性咳嗽为表现的胃食管反流病(GERD)患者的反流特征。方法:连续纳入胸部X线检查无明显异常、无典型胃食管反流症状的不明原因慢性咳嗽患者73例,其中内镜检查无异常发现且pH-阻抗联合监测结果符合GERD诊断者定义为慢性咳嗽GERD组,21例健康志愿者作为正常对照组,比较两组pH-阻抗联合监测结果。结果:单纯根据pH监测结果,17例患者诊断为GERD,根据pH-阻抗联合监测结果,则有26例患者诊断为GERD。慢性咳嗽GERD组以气-液混合反流为主(46.3%),正常对照组以气体反流为主(68.9%),两组均以弱酸反流为主(59.9%和59.1%)。两组间DeMeester计分以及气体反流、酸反流、近端反流次数等差异有统计学意义(P<0.05)。结论:以慢性咳嗽为表现的GERD患者以气-液混合反流和弱酸反流为主,无论是立位还是卧位时均存在明显的异常反流且近端反流较正常人多见。24 h食管pH-阻抗联合监测对疑似GERD的慢性咳嗽患者有重要诊断价值。

Background： When combined with 24-hour esophageal pH monitoring, intraluminal impedance technique can detect various types of gastroesophageal reflux events and determine the physical and pH properties of the refluxate. Aims： To study the reflux characteristics of gastroesophageal reflux disease （GERD） patients presenting with chronic cough by 24-hour esophageal pH-impedance monitoring. Methods： Seventy-three consecutive chronic cough patients with normal chest radiography and without typical gastroesophageal reflux symptoms were enrolled. Among them, those with normal endoscopic findings and fulfilling the GERD criteria by pH-impedance monitoring were defined as GERD-chronic cough group. Twenty- one healthy volunteers were recruited as normal controls. The parameters of pH-impedance monitoring were compared between the two groups. Results： Using pH monitoring only, 17 patients were diagnosed as GERD; however, 26 patients were diagnosed as GERD when pH-impedance monitoring was use＆ The GERD-chronic cough group was characterized by gas/liquid mixed reflux （46.3%） and weakly acidic reflux （59.9%）, while normal control group was characterized by gas reflux （68.9%） and weakly acidic reflux （59.1%）. Parameters including DeMeester score and episodes of gas reflux, acid reflux and proximal reflux etc. were significantly different between the two groups （P〈0.05）. Conclusions： Gaslliquid mixed reflux and weakly acidic reflux are predominant in GERD patients presenting with chronic cough. Pathological refluxes are commonly seen in both upright and supine positions, and proximal reflux is more frequent than that in healthy adult. 24-hour esophageal pH-impedance monitoring is of important diagnostic value in chronic cough patients with suspected GERD.