食管高分辨率测压联合pH监测对内镜阴性食管源性胸痛的诊断价值

Evaluation of esophageal high-resolution manometry combined with 24-hour pH monitor in detecting endoscopy-negative chest pain of esophageal origin

目的探讨食管高分辨率测压联合24h食管pH监测在内镜阴性食管源性胸痛诊断中的价值。方法收集40例反复发作的食管源性胸痛患者的临床资料，总结分析食管高分辨率测压联合24h食管pH监测结果。结果27例（67．5％）存在胃食管反流，DeMeester积分平均为（18．3±3．4）分，其中19例存在食管体部运动功能障碍，11例存在食管下括约肌压力降低（平均降低5．7mmHg）；6例（15．0％）贲门失弛缓症，Ⅰ型1例（2．5％）、Ⅱ型5例（12．5％），平均食管下括约肌松弛率为（30．1±2．3）％；4例（10．0％）弥漫性食管痉挛，平均食管收缩前沿速度为（12．3±2．4）cm·s^-1，食管下括约肌压力增高1例、正常3例，食管下括约肌松弛率下降2例、正常2例，4例食管体部均存在异常收缩波，其中3例存在自发性同步收缩波；2例（5．0％）胡桃夹食管，平均食管远端收缩积分为（6745．5±175．2）mmHg·cm^-1·s^-1，平均食管收缩前沿速度为（4．3±0．4）cm·s^-1；1例（2．5％）食管失蠕动，食管下括约肌压力为2mmHg，DeMeester积分为38．3分，结合食管活检及辅助检查结果诊断为系统性硬化症食管累及。结论食管高分辨率测压联合24h食管pH监测，对于内镜阴性的食管源性胸痛有较好的诊断价值。

Objective To investigate esophageal high-resolution manometry （HRM） combined with 24-hour pH monitor in detecting endoscopy-negative chest pain of esophageal origin. Methods Test results of esophageal HRM combined with 24-hour pH monitor from 40 patients with recurring chest pain of esophageal origin were retrospectively analyzed. Results In 40 patients, 27 （67. 5% ） were diagnosed as gastroesophageal reflux disease with an average DeMeester scores at 18.3 ± 3.4, including 19 patients with esophageal body dismotility and 11 with reduced lower esophageal sphincter pressure （LESP） at a mean reduction of 5.7 mm Hg. There were 6 cases （ 15.0% ） of achalasia, in which 1 （2. 5% ） was type Ⅰ and 5 （ 12. 5% ） was type Ⅱ , with an average relaxation ratio of lower esophageal sphincter （RRLES） at （ 30. 1 ± 2. 3 ） %. There were 4 cases of diffuse esophageal spasm （DES）, with an average contraction frontal velocity （CFV） of 12. 3 ± 2. 4 cm.s^- 1 and abnormal contraction waves in esophageal body, spontaneous synchronous contraction waves were observed in 3 of 4 patients LESP increased in 1 patient with DES and remained normal in other 3. RRLES decreased in 2 cases with DES and remained normal in other 2. There were 2 cases （5. 0% ） of nutcracker esophagus, with an average distal contractile integral at 6745.5 ± 175.2 mm Hg.cm^-1 .s^-1 and an average CFV at4. 3 ±0. 4 cm.s^-1. There was 1 case （2. 5% ） with absence of esophageal peristalsis, with a low LESP at 2 mmHg and DeMeester scores at 38. 3. The patient was finally diagnosed as systemic sclerosis according to esophageal biopsy and other auxiliary examination. Conclusion HRM combined with 24-hour pH monitor is valuable in detecting endoscopy-negative chest pain of esophageal origin.