远端收缩积分和无效食管动力与胃食管反流的关系

Relation between distal contractile integral, ineffective esophageal motility and gastroesophageal reflux

目的探讨食管高分辨率测压（HRM）下远端收缩积分（DCI）和无效食管动力（IEM）与GERD患者反流情况的关系。方法共纳入69例GERD患者，均完成食管HRM、24hpH联合阻抗监测检查。应用Pearson相关分析研究DCI、无效吞咽次数和DeMeester评分的相关性。根据10次5mL液体吞咽试验发生无效吞咽的次数分成3组，5～10次无效吞咽为IEM组（21例），1～4次无效吞咽为动力异常组（19例），0次无效吞咽为动力正常组（29例），采用t检验比较3组平均DCI、残余的有效吞咽DCI平均值、DeMeester评分、酸反流时间、食团暴露时间、近端反流次数的差异。结果69例GERD患者中，其10次5mL液体吞咽平均DCI和DeMeester评分呈负相关（r=-0．363，P=0．003），无效吞咽次数和DeMeester评分呈正相关（r=0．374，P=0．002）。动力正常组、动力异常组和IEM组10次5mL液体吞咽平均DCI分别为（1458．96±545．10）、（986．48±577．50）和（288．50±167．25）mmHg·s·cm，IEM组低于动力正常组和动力异常组（t=-11．42、-2．12，P均〈0．05）。动力正常组、动力异常组和IEM组残余的有效吞咽DCI平均值分别为（1458．96±545．10）、（1187．90±669．40）和（450．78±350．73）mmHg·s·cm，IEM组低于动力正常组和动力异常组（t=-8．05、-5．27，P均〈0．01）。IEM组的DeMeester评分为（15．42±8．79）分，高于动力正常组的（6．34±3．45）分，差异有统计学意义（t=2．43，P〈0．05）。IEM组的酸反流时间、食团暴露时间分别为（54．93±37．07）min、（O．64±0．49）％，分别长于动力异常组的（37．37±22．66）min、（0．52±0．24）％，动力正常组的（21．22±13．98）min、（0．39±0．14）％，差异均有统计学意义（t=2．36、2．17，2．60、2．54，P均〈0．05）。IEM组和动力异常组的总反流次数分别为（67．10±32．94）、（57．26±38．90）次，均多于动力正常组的（44．61±23．84）次，差异均有统计学意义（t=2．48、2．17，P均〈0．05）。结论DCI和无效吞咽次数在一定程度上可预测GERD患者发生反流的情况，IEM组食管体部收缩力度最弱，食管对反流物的廓清能力最差。

Objective To investigate the relationships among distal contractile integral （DCI）, ineffective esophageal motility （IEM） and gastroesophageal reflux through high resolution manometry （HRM） in patients with gastroesophageal reflux disease （GERD）. Methods A total of 69 patients with GERD were enrolled. All patients received HRM and 24 hour pH and impedance monitoring examination. Pearson correlation analysis was performed to analyze the correlation between DCI, number of invalid swallowing and DeMeester score. All the patients were divided into three groups according to the number of invalid swallowing in 10 times of 5 mL liquid swallowing test. Patients with 5 to 10 invalid swallowing was in IEM group （n=21）, one to four was in abnormal motility group （n=19）, and zero was in normal motility group （n= 29）. The t test was performed for comparison of average DCI, average DCI of residual effective swallowing, DeMeester score, acid reflux time, bolus exposure time and proximal reflux timesamong the three groups. Results Among the 69 patients with GERD, there was negative correlation between DCI and DeMeester score （r=-0. 363,P=0. 003） in 10 times of 5 mL liquid swallowing test; the number of invalid swallowing was positively correlated with DeMeester score （r=0. 374, P= 0. 002）. The mean DCI in 10 times of 5 mL liquid swallowing of normal motility group, abnormal motility group and IEM group was （1 458.96±545.10）, （986.48±577.50） and （288. 50±167. 25） mmHg· s·cm, respectively, and that of IEM group was lower than normal motility group and abnormal motility group （t=-11.42 and -2.12, both P〈0.05）. The average DCI of residual effective swallowing of normal motility group, abnormal motility group and IEM group was （1 458. 96 ±545. 10）, （1 187. 90 ± 669.40） and （450.78± 350. 73） mmHg , s·cm, respectively, and that of IEM group was also lower than normal motility group and abnormal motility group （t = 8.05 and -5.27, both P〈0.01）. The DeMeester score of IEM group （15.42±8.79） was higher than that of normal motility group （6.34±3.45）, and the difference was statistically significant （t= 2.43, P〈0.05）. The acid reflux time and bolus exposure time of IEM group were （54. 93 ± 37. 07） rain and （0. 64± 0. 49） %, respectively, which were longer than abnormal motility group （（37.37±22.66） min, （0.52±0.24）%） and normal motility group （（21.22± 13.98） min, （0.39±0.14）%）, and the differences were statistically significant （t= 2.36, 2. 17, 2. 60 and 2.54, all P〈0.05）. The total number of reflux of IEM group and abnormal motility group were 67.10± 32.94 and 57.26±38.90, which were both more than that of normal motility group （44.61±23.84）, and the differences were statistically significant （t=2. 48 and 2. 17, both P 〈 0. 05 ）. Conclusions DCI and the number of invalid swallowing can predict reflux condition of GERD patients in a certain degree. The contraction strength of esophageal body was the weakest and esophageal clearance was the worst in IEM group.