24小时食管动态pH-阻抗联合监测评估小儿胃食管反流性咳嗽的临床特征

Clinical characteristics of chronic cough detected by 24-hour ambulatory esophageal impedance-pH monitoring in children

目的探讨24h食管动态pH-阻抗联合监测对以慢性咳嗽为主要表现的胃食管反流病(GERD)患儿的临床表现及反流特征的评估价值。方法对2012年2月至2013年7月40例南京医科大学附属南京儿童医院门诊及住院的可疑胃食管反流性咳嗽(RERC)患儿,利用24h食管pH-阻抗联合监测GERD患者的各项指标。结果 40例慢性咳嗽患儿中,单纯用24h食管pH监测符合GERD的患儿有23例(57.5%),利用24h食管动态pH-阻抗联合监测符合GERD的患儿有34例(85.0%),明显高于单纯用24h食管pH监测的结果。且在小儿慢性咳嗽中主要是在直立时弱酸反流和酸反流为主(P<0.05),同时发生频率最高的在直立状态下的混合反流(P<0.05),而食团清除时间在直立与仰卧时差异无统计学意义(P>0.05),近端反流是以仰卧位为主(P<0.05)。总反流次数与症状指数(SI)呈正相关(r=0.818,P<0.05)。结论利用24h食管动态pH-阻抗联合监测技术可以检出酸反流、弱酸反流和非酸反流,使GERD的诊断更精确,对以慢性咳嗽为主要表现的GERD有着重要的诊断价值,具有较好的临床应用前景。

Objective To investigate the characteristics of gastroesophageal reflux disease （GERD） with chronic cough by 24-hour ambulatory esophageal impedance-pH monitoring in children.MethodsFrom February 2012 to July2013,40 cases of inpatients and outpatients in Nanjing Children′s Hospital Affiliated to Nanjing Medical University,who were suspected with gastroesophageal reflux cough（RERC）,were recruited;all these cases underwent 24-hour am-bulatory esophageal impedance-pH monitoring.ResultsAmong the 40 children with chronic cough,23 patients werediagnosed with GERD refering to pH monitoring;34 children were diagnosed with GERD by 24-hour ambulatory esopha-geal impedance-pH monitoring. Esophageal acid reflux were significantly higher in the upright than supine position（P〈0.05）,and the characteristics of GERD with chronic cough was mainly weak acidic reflux and acid reflux in the upright（P〈0.05）;the mixed reflux was the highest frequency in the upright（P〈0.05）. There was no difference between in theupright and supine position about the bolus clearance time;proximal reflux in the supine position was the main way inthe total reflux（P〈0.05）. The total reflux and SI demonstrated positive correlation（r = 0.818,P〈0.05）.ConclusionAcid reflux,weak acid reflux and non-acid reflux can be detected by 24-hour ambulatory esophageal impedance-pHmonitoring. The 24-hour ambulatory esophageal impedance-pH monitoring can make more accurate diagnosis of GERDin chronic cough children,and it may have a good prospect for clinical application.