肝硬化患者食管动力与肝功能障碍的关系研究

Investigation on Relationship of Esophageal Motility and Liver Dysfunction in Cirrhotic Patients

目的 研究肝功能减退对食管动力的影响。方法 对无腹水或经治疗腹水消退后的肝硬化患者 6 3例 ,进行Child -pugh分级 ,和健康对照组 2 2例分别进行食管测压及 2 4小时pH监测。结果 肝硬化组下食管括约肌压力 (LESP)、远端食管蠕动波幅 (PA)、蠕动时间 (PD)和蠕动传导速度 (PV)与对照组比较显著异常 (P <0 0 5 )。LESP在ChildC级较ChildB级显著下降 (P <0 0 5 ) ,与Child -Pugh分数呈负相关 (r =-0 5 2 3 ,P <0 0 1) ,伴各胃食管酸反流指标显著异常和胃食管反流病 (GERD)发生率升高 ,P均小于 0 0 1。食管静脉曲张程度也显著影响PA、PD和PV(P <0 0 5 ) ,而LESP无明显下降。结论 肝硬化患者食管动力异常和胃食管酸反流的原因除食管静脉曲张外 ,肝功能减退使其加重和LESP下降。

Aim To study the effects of liver dysfunction on the esophageal motility in cirrhotic patients.Methods LESP,PA,PD,PV and 24h pH monitoring were determined by PC Polygraf HR system respectively in cirrhotics of no ascites or after paracentesis (n=63) and controls (n=22).Results LESP, PA PD and PV were significantly abnormal in comparison with those in the control group( P <0 05) LESP was markedly lower in Child C than in Child B( P <0 05),and was negatively correlated with Child-Pugh score( P <0 01,r=-0 523), With the significant abnormalities of acid-reflux parameter and higher morbidity of GERD in child B and C than in Child A( P <0 01).Esophageal varices also affected PA, PD, and PV(P<0 05),but LESP was not significantly decreased.Conclusions The progress of liver dysfunction reduced the LESP, worsen the esophageal motility abnormalities and the acid-reflux of the cirrhotic patients with esophageal varices.