酸反流与异常非酸反流性胃食管反流性咳嗽症状与诊断的临床比较

Symptoms and diagnosis of acid vs non-acid gastroesophageal reflux induced cough

目的:比较酸和非酸性胃食管反流性咳嗽(gastroesophageal reflux induced cough,GERC)的症状与诊断方法.方法:收集2011-01/2013-12于我院诊断为GERC的患者共40例,其中酸性GERC组21例,DeMeester积分≥12.70,而非酸性GERC组19例,DeMeester积分<12.70.对其临床症状及反流诊断问卷(gastroesophageal reflux diagnostic questionnaire,GerdQ)积分、DeMeester积分等进行统计评价.结果:非酸性GERC组的年龄及反流现象发生率明显低于酸性GERC组(χ2=6.686,P=0.010);而在咳嗽性质、咳嗽时间、胸闷情况以及胃病史、合并阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hyponea syndrome,O S A S)等方面均无统计学差异(P>0.05).与酸性GERC组相比,非酸性GERC组患者的GerdQ和DeMeester积分较低,差异具有统计学意义(χ2=3.337,P=0.003);而日间和夜间的咳嗽积分间的差异无统计学意义(P>0.05).结论:酸反流与异常非酸反流性胃食管反流性咳嗽在临床症状方面差别甚微,应根据包括GerdQ及DeMeester积分在内的多通道食管腔内阻抗-pH监测等方面对其进行全面检测,对临床治疗起到了重要作用.

AIM： To compare the symptoms and diagnosis of acid and non-acidic gastroesophageal reflux induced cough（GERC）.METHODS： Forty patients diagnosed with GERC were collected between January 2011 and December 2013 at our hospital, including 21 cases of acid GERC（DeMeester score ≥ 12.70） and 19 cases of non-acid GERC（DeMeester score 〈12.70）. The clinical symptoms, gastroesophageal reflux diagnostic questionnaire（GerdQ） score, and DeMeester score were compared between the two groups. RESULTS： The age and incidence of reflux were significantly lower in the non-acid GERC group than in the acid GERC group（χ^2 = 6.686, P = 0.010）. There were no significant differences in the nature of cough, cough duration, frowsty bosom, history of stomach problems or complicated obstructive sleep apnea syndrome（OSAS） between the two groups（P〉0.05）. Compared with the acid GERC group, the non-acid GERC group had significantly lower GerdQ score and DeMeester score（χ^2 = 2.337, P = 0.003）, although there was no significant difference between daytime and nighttime cough（P〉0.05）. CONCLUSION： Acid and non-acid GERC differs little in terms of clinical symptoms and should be diagnosed based on comprehensive evaluation including GerdQ and DeMeester scores.