食管胃交界部收缩指数在胃食管反流病与功能性烧心患者中的特点

The characteristics of esophagogastric junction contractile index in patients with gastroesophageal reflux disease or functional heartburn

目的研究食管胃交界部收缩指数（EGJ-cI）对胃食管反流病（GERD）患者抗反流屏障功能的判断价值，探讨其在GERD及功能性烧心（FH）患者中的差异及鉴别价值。方法纳入北京大学第三医院2012年1月至2015年6月具有典型烧心症状的门诊患者，根据胃镜、24h阻抗-pH监测、质子泵抑制剂试验的结果将受试者分成FH组、反流性食管炎组、非糜烂性反流病（NERD）-酸反流组及NERD-弱酸反流组。所有受试者接受食管高分辨率压力测定，依据第3版芝加哥分型建议，计算EGJ-cI等食管胃交界部功能参数，分析各组间相关参数的差异及其与反流参数的关系。结果共115例患者纳入分析，其中反流性食管炎组18例[（49．0±18．9）岁，男：女=10：8]，NERD-酸反流组25例[（48．7±14．4）岁，男：女=13：12]，NERD-弱酸反流组37例[（52．0±14．8）岁，男：女=15：22]，FH组35例[（53．6±14．8）岁，男：女=8：27]。四组间胃食管反流病问卷（Gerd-Q）积分的差异无统计学意义。（1）EGJ-CI与食管酸暴露（r=-0．283，P=0．002）、酸反流事件（r=-0．233，P：0．012）、弱酸反流事件（r=-0．213，P=0．022）及非酸反流事件（r=-0．200，P=0．032）均呈负相关。（2）FH组EGJ-CI水平显著高于GERD的3个亚组（P值均〈0．01）；FH组食管胃交界部静息压力高于NERD-酸反流组（P〈0．01）；NERD-酸反流组的4s综合松弛压（IRP4s）显著低于FH组及NERD-弱酸反流组（P〈0．05）。（3）ROC曲线分析显示，EGJ—CI较EGJ收缩积分（EGJ-CIT）、食管胃交界部静息压力及IRP4s各参数诊断GERD的AUC更大（分别为0．686、0．678、0．641和0．578）。分析EGJ-CI对FH与GERD患者食管胃交界部抗反流屏障功能的区别能力，当EGJ—CI的cut-off值为9．74mmHg·cm时，其提示具有典型烧心症状患者为GERD的敏感度为82．86％，特异度为51．25％。结论EGJ-CI能有效反映抗反流屏障功能的变化。EGJ—cI在FH及GERD患者间存在明显差异，以9．74mmHg·cm为cut-off值时，ECJ-CI可较灵敏提示具有烧心症状的患者是否存在胃食管反流，在FH与GERD的鉴别中具有一定的意义。

Objective To study the role of esophagogastric junction contractile index （EGJ-CI） in evaluating the function of anti-reflux barrier, and in differentiating patients with gastroesophageal reflux disease （GERD） from those with functional heartburn （FH）. Methods A total of 115 patients presenting heartburn were enrolled in the study from January 2012 to June 2015. All subjects had completed Gerd-Q questionnaire and undergone gastroscopy, 24-hour pH-impedance monitoring and esophageal high-resolution manometry. GERD patients were divided into as reflux esophagitis, acid-nonerosive reflux disease （NERD） and weakly acid-NERD groups. Patients with normal esophageal mucosa, normal acid exposure and negative proton pump inhibitor test were enrolled in FH group. EGJ-CI （mmHg · cm） as well as EGJ rest pressure and 4s integrated relaxation pressure （IRP 4s） were measured. Results Among the 115 patients, 18 were reflux esophagitis [ （49. 0 ± 18.9） years, M： F = 10：8 ], 25 were acid-NERD [ （48.7 ± 14. 4） years, M： F= 13： 12], 37 were weakly acid-NERD [ （52.0 ± 14. 8） years, M： F = 15： 22] and 35 were FH [ （53.6 ±14. 8）, M： F = 8： 27 ]. No differences of Gerd-Q scores were noticed between the four groups.（1） Negative correlations were demonstrated between EGJ-CI and esophageal acid exposure time （r = - 0. 283,P = 0. 002）, EGJ-CI and acid reflux events （ r= - 0. 233, P = 0. 012）, EGJ-CI and weakly acid reflux events （r = - 0. 213, P = 0. 022 ） , EGJ-CI and non-acid reflux events （ r = - 0. 200, P = 0. 032 ）. （2） The value of EGJ-CI was significantly higher in FH patients than in the three subgroups of GERD （ all P 〈 0. 01 ）. EGJ rest pressure of FH group was higher than that of acid-NERD （ P 〈 0. 01 ）. IRP 4s in acid- NERD group was lower than that of FH and weakly acid-NERD （P 〈 0.05 ）. （3）The area under curve （AUC） of EGJ-CI was higher than that of EGJ-CIT, EGJ rest pressure or IRP 4s（0. 686 vs 0. 678, 0. 641 and 0. 578 ）. The cut-off value of EGJ-CI to differentiate GERD from FH was 9. 74 mmHg · cm with sensitivity 82. 86% and specificity 51.52%. Conclusions The EGJ-CI values are negatively correlated with esophageal acid exposure time, weakly acid reflux events and non-acid reflux events. Thus it might be used as a metric to reflect the anti-reflux function of EGJ. According to the cut-off value of EGJ-CI 9.74 mmHg · cm, patients with GERD can be sensitively differentiated from patients with FH.