上食管括约肌异常与食管动力障碍疾病的相关性

Relationship between upper esophageal sphincter abnormalities and esophageal motility disorders

目的探究上食管括约肌(upper esophageal sphincter,UES)异常与食管动力障碍疾病的相关性。方法回顾性分析2014年11月-2015年10月在我院消化动力中心行高分辨率食管测压(high resolution esophageal manometry,HRM)的患者资料,共447例连续入组。所有患者被分为UES静息压(upper esophageal sphincter resting pressure,UESP)正常组(349例)和UESP异常组,其中异常组包括UESP高压组29例、UESP低压69例;又分为UES松弛残余压(upper esophageal sphincter relaxation pressure,UESRP)正常组(355例)和UESRP异常(即松弛障碍)组(92例),对不同分组间临床资料和HRM数据进行比较分析。结果 UESP低压患者平均年龄显著大于UES正常者[(55.62±11.71)岁vs(45.79±13.66)岁,P<0.000 1],而UESP高压患者平均年龄显著小于UES正常者[(40.62±9.72)岁vs(45.79±13.66)岁,P=0.012]。20例(69.0%)UESP高压患者以及65例(70.7%)UES松弛障碍患者出现吞咽困难症状,显著高于UES正常组(P<0.001)。UES松弛障碍患者发生反酸烧心、胸痛等症状的比例显著小于UESRP正常组(P=0.001,P=0.026)。UESP高压患者和UES松弛障碍患者患有Ⅱ型贲门失弛缓症的比例均显著高于正常组(P<0.001)。70例(76.1%)UES松弛障碍患者同时并发下食管括约肌综合松弛压异常。结论 UESP与年龄呈负相关;UES异常与吞咽困难的发生相关;在贲门失弛缓症Ⅱ型患者中UES异常的发生率高于其他食管动力障碍疾病;UES松弛障碍与LES松弛障碍常同时出现。UES异常在食管动力障碍患者中十分常见。

Objective To evaluate the relationship between upper esophageal sphincter（UES） abnormalities and esophageal motility disorders. Methods We performed a retrospective study of 447 patients undergoing high resolution esophageal manometry（HRM） at our Digestive Endoscopic Center from November 2014 to October 2015. Patients were divided into normal upper esophageal sphincter resting pressure（UESP） group（n=349） and abnormal UESP group, including hypertensive group（n=29）, hypotensive group（n=69）, or normal upper esophageal sphincter relaxation pressure（UESRP） group（n=355） and impaired relaxation group（n=92）. Clinical data and HRM data were compared. Results Patients with hypotensive UESP were older than those with normal UES function [（55.62±11.71） years vs（45.79±13.66） years, P 0.000 1], while patients with hypertensive UESP were younger compared with those with normal UESP [（40.62±9.72） years vs（45.79±13.66） years, P=0.012]. In respect of clinical symptoms, dysphagia occurred in 20（69.0%） patients with UESP hypertensive and 65（70.0%） patients with impaired UES relaxation, which were significantly higher than UES normal patients（P〈0.001）. In patients with UES impaired relaxation, incidences of symptoms including acid reflux and heartburn, retrosternal pain were significant lower than those of UES normal group（P=0.001, P=0.026）. Patients with hypertensive UES resting pressure or impaired UES relaxation were significantly more likely to have achalasiaⅡ as compared with those with normal UES function（P〈0.001）. In additional, 70（76.1%） patients with impaired UES had integrated relaxation pressure（IRP） abnormality simultaneously. Conclusion Our study shows a negative correlation between age and UESP. Hypertensive UESP and impaired UES relaxation have relationship with some clinical symptoms such as dysphagia. Also, there is a high frequency of UES abnormalities observed in patients with manometric diagnosis of achalasiaⅡ. Majority of impaired UES relaxation patients have IRP abnormalities.