NERD患者症状与食管鳞状上皮细胞间隙关系的研究

Relationship between Symptoms and Esophageal Squamous Epithelial Intercellular Spaces in Patients with NERD

背景:通过光学显微镜可发现非糜烂性反流病(NERD)患者存在食管鳞状上皮细胞间隙增宽(DIS),但关于不同症状与DIS的研究少见。目的:研究NERD患者症状与食管鳞状上皮细胞间隙之间的关系。方法:选取40例通过内镜检查和质子泵抑制剂试验诊断为NERD的患者,按照症状分为反流组、烧心组和胸痛组,同时选取10名健康志愿者作为对照。行胃镜检查和HE染色,测量光镜下平均细胞间隙(LMIS)。NERD患者同时行症状评分,并分析与LMIS的关系。结果:NERD组LMIS明显高于健康对照组[(1.38±0.43)μm对(0.45±0.07)μm;t=4.47,P=0.00]。反流组、烧心组和胸痛组之间LMIS差异有统计学意义(F=177.89,P<0.01),烧心组、胸痛组又明显高于反流组[(1.46±0.73)μm、(1.45±0.49)μm对(1.34±0.41)μm;P=0.00,P=0.00]。反流组、烧心组和胸痛组LMIS与症状评分之间均呈正相关(r=0.925,P<0.01;r=0.919,P<0.01;r=0.922,P<0.01)。结论:DIS是NERD对食管上皮组织损伤的一种微观变化,与NERD症状发生相关,烧心和胸痛患者DIS变化更为明显。

Background： It is reported that dilated intercellular spaces （DIS） of esophageal squamous epithelium can be found by light microscopy in patients with non-erosive reflux disease （NERD）. However, few investigations have been performed in studying the relationship between DIS and symptoms in NERD patients. Aims： To study the correlation between DIS of esophageal squamous epithelium and symptoms in NERD patients. Methods： Forty NERD patients diagnosed by endoscopy and proton pump inhibitor test were divided into 3 groups according to symptoms occurred： regurgitation group, heartburn group and chest pain group. Ten healthy volunteers were served as controls. Gastroscopy and HE staining were performed, light microscopic intercellular spaces （LMIS） of squamous epithelium was measured. Symptom score were evaluated in NERD patients, and correlation with LMIS was analyzed. Results： LMIS in NERD group was significantly higher than that in control group [ （ 1.38 ±0.43） μm vs. （0.45 ±0.07） μm; t =4.47, P =0.00]. Significant differences in LMIS were seen among regurgitation group, heartburn group and chest pain group （F=177.89, P 〈 0.01 ）. LMIS in heartburn group and chest pain group was significantly higher than that in regurgitation group [ （ 1.46 ± 0.73 ） μm, （ 1.45 ± 0.49） μm vs. （1.34 ± 0.41 ） μm; P = 0. 00, P = 0.00]. Positive correlation was found between LMIS and symptom score in regurgitation group, heartburn group and chest pain group （ r = 0. 925, P 〈 0.01 ; r = 0. 919, P 〈 0.01 ; r = 0. 922, P 〈 0.01 ）. Conclusions： DIS is a microscopic change denoting esophageal epithelial tissue injury in NERD, and is correlated with the occurrence of NERD symptoms, especially in patients with heartburn and chest pain.