食管平均夜间基线阻抗值与胃食管反流的关系

Correlation between esophageal mean nocturnal baseline impedance and gastroesophageal reflux

目的探讨食管平均夜间基线阻抗(mean nocturnal baseline impedance,MNBI)值与胃食管反流的关系。方法回顾性分析2015年1月至2017年12月间以烧心为主要症状就诊,在本院消化内科同时行胃镜和24小时多通路腔内阻抗pH联合监测检查的240例患者的临床资料。根据诊断结果将患者分为反流性食管炎组31例,非糜烂性反流病组66例,反流高敏感组63例,功能性烧心组80例。按DeMeester评分分为病理性酸反流组(≥14.72分)68例和生理性酸反流组(<14.72分)172例。结果反流性食管炎组、非糜烂性反流病组、反流高敏感组、功能性烧心组远端食管MNBI中位数分别为1236.6, 1534.7, 2536.1和2572.6?(P<0.001);近端食管MNBI分别为1985.3,2136.0,2481.5和2295.5?(P=0.005)。病理性酸反流组和生理性酸反流组间远端食管MNBI中位数值分别为1339.5和2410.4?(P<0.001),近端食管MNBI中位数值分别为2048.5和2345.9?(P=0.019)。Spearman相关性分析显示远端食管MNBI值与酸暴露时间和酸反流次数呈明显负相关(P<0.001)。结论酸反流可明显降低远端食管MNBI值,食管MNBI值可能用于烧心症状的鉴别诊断。

Objective To investigate the correlation between gastroesophageal reflux and esophageal mean nocturnal baseline impedance（MNBI）. Method In this study, heartburn patients＇ clinical data were retrospectively analyzed from the digestive department, Beijing Anzhen Hospital, Capital Medical University, after taking the examinations of upper gastrointestinal endoscope and 24-hour MultiChannel Intraluminal Impedance and p H Recording（MII/p H） between 2015 and 2017. Result 31 reflux esophagitis（RE）, 66 non-erosive reflux disease（NERD）, 63 reflux hypersensitivity（RH） and 80 functional heartburn（FH） were entered. Median values for RE, NERD, RH and FH were as follows： distal esophageal MNBI 1236.6, 1534.7, 2536.1 and 2572.6Ω（P〈0.001）, proximal esophageal MNBI 1985.3, 2136.0, 2481.5 and 2295.5？（P=0.005）. Median values for pathologic and physiologic acid reflux were as follows： distal esophageal MNBI 1339.5 and 2410.4Ω（P〈0.001）, proximal esophageal MNBI 2048.5 and 2345.9Ω（P=0.019）. Spearman correlation analysis showed distal esophageal MNBI was significantly negatively correlated with acid exposure time and acid reflux events（P〈0.001）. Conclusion Acid reflux can significantly impair the esophageal mean nocturnal baseline impedance, and esophageal mean nocturnal baseline impedance may be used to differentiate the different diagnosis of heartburn.