不同亚型贲门失弛缓症患者食管动力学的高分辨率测压特点及临床意义

High resolution manometry analysis of esophageal motility characteristics in patients with different subtypes of achalasia

目的:应用2014新版芝加哥分类标准评价不同亚型贲门失弛缓症(achalasia,AC)患者食管动力学的高分辨率测压(high resolution manometry,HRM)特征.方法:收集2014-03/12在华中科技大学同济医学院同济医院就诊的30例未经治疗的初诊AC患者,行HRM检测并按芝加哥分类标准进行分型,比较不同亚型患者的食管动力学特点.结果:30例AC患者中,其中Ⅰ型7例(23.3%),Ⅱ型19例(63.3%),Ⅲ型4例(13.3%).下食管括约肌(lower esophageal sphincter,LES)长度、腹内段长度、LES静息压、4 s完整松弛压(integrated relaxation pressure,IRP)在各亚型间差异均无统计学意义(P>0.05).Ⅱ型患者全段食管增压比例为91.76%±3.12%,显著高于Ⅲ型患者(53.33%±11.81%,P<0.05).上食管括约肌(upper esophageal sphincter,UES)静息压Ⅱ型患者显著高于Ⅰ型患者(65.74±5.21 mmHg vs 38.73±3.37 mmHg,P<0.05),但Ⅱ型与Ⅲ型以及Ⅰ型与Ⅲ型之间差异无显著意义;UES残余压在各亚型组之间差异无显著意义,但在Ⅱ型患者中,UES残余压为13.41 mmHg±1.55 mmHg,高于正常值12mmHg,表现为松弛不良.结论:贲门失弛缓患者中,以Ⅱ型最为多见,Ⅱ型患者表现为全段食管增压和LES松弛障碍,UES静息压增高和UES松弛不良.HRM有助于对各亚型贲门失弛缓患者精确分型,从而可以早期诊断和选择下一步治疗方案.

AIM： To investigate the esophageal motilitycharacteristics by high resolution manometry （HRM） in patients with different subtypes of achalasia categorized by 2014 Chicago classification criteria. METHODS： Thirty untreated achalasia patients referred to our clinic between March 2014 and December 2014 were enrolled for HRM examination and typing by the Chicago classification criteria. The esophageal motility characteristics of different subtypes of achalasia were analyzed. RESULTS： Of the 30 achalasia patients, 7 （23.3%） were classified as having subtype Ⅰ, 19 （63.3%） as having subtype Ⅱ and 4 （13.3%） as having subtype Ⅲ. No significant difference was found among the three subtypes in lower esophageal sphincter （LES） resting pressure, average LES length, average intraabdominal LES length and integrated relaxation pressure （IRP） （P 〉 0.05）. The percentage of patients with panesophageal pressurization in subtype Ⅱ patients was 91.76% ±3.12%, significantly higher than that of subtype Ⅲ patients （53.33% ± 11.81%, P 〈 0.05）. Compared to subtype Ⅰ patients, upper esophageal sphincter （UES） resting pressure was significantly higher in subtype II patients （65.74 mmHg ± 5.21 mmHg vs 38.73 mmHg ± 3.37 mmHg, P 〈 0.05）, but no significant difference was noted between subtypes I and III or between subtypes Ⅱ and .Ⅲ. Although no significant difference was found among the three subtypes in UES residual pressure, in subtype Ⅱ, UES residual pressure was 13.41 mmHg - 1.55 mmHg, higher than normal value（12 mmHg）, of UES. which means abnormal relaxation CONCLUSION In patients with achalasia, subtype Ⅱ is more common. Subtype II patients often exhibit LES relaxation disorder, panesophageal pressurization, UES resting pressure increase and UES abnormal relaxation. HRM contributes to early diagnosis and accurate classification and thus helps to make proper treatment choices.