胃镜阀瓣分级在胃食管反流病中的意义

Significance of Hill classification in patients with gastroesophageal reflux disease

目的探讨胃镜阀瓣(Hill)分级在胃食管反流病(gastroesophageal reflux disease,GERD)患者检查中的意义。方法收集2015年10月至2019年5月就诊于首都医科大学附属北京同仁医院消化内科,诊断为GERD且完成食管高分辨测压(HRM)、24 h pH-阻抗监测及胃镜检查的患者527例。分析胃镜阀瓣Hill分级与患者年龄、性别、BMI、HRM、24 h pH-阻抗监测及反流性食管炎洛杉矶(Los Angeles,LA)分级的关系。结果胃镜阀瓣Hill分级与GERD患者年龄、性别(男)、BMI呈正相关(P<0.05);Hill分级与远端收缩构成(distal contractile integral,DCI)、食管下括约肌平均静息压(lower esophageal sphincter pressure,LESP)呈负相关(P<0.05);Hill分级与DeMeester评分、AET4、直立酸反流评分、仰卧位酸反流评分、仰卧位混合反流评分呈正相关(P<0.05)。Hill分级与反流性食管炎LA分级呈正相关(P<0.05)。结论胃镜阀瓣Hill分级在预测GERD患者反流性食管炎严重程度、食管动力受损程度及有无病理性酸反流均有一定意义。

Objective To investigate the significance of Hill classification in patients with gastroesophageal reflux disease(GERD).Methods 527 patients with GERD who underwent HRM, 24 h pH-impedance monitoring and gastroscopy in the Department of Gastroenterology, Beijing Tongren Hospital from Oct. 2015 to May 2019 were analyzed retrospectively.Results The Hill classification was positively related with GERD patients’ age, gender(male), BMI(P<0.05);the Hill classification was negatively related with distal contractile integral(DCI) and lower esophageal sphincter pressure(LESP)(P<0.05);the Hill classification was positively related with DeMeester score, AET4, vertical acid reflux score, supine acid reflux score and supine mixed reflux score(P<0.05). The Hill classification was positively related with LA classification of reflux esophagitis(P<0.05).Conclusion The evaluation of severity of reflux esophagitis, esophageal motility and pathological acid reflux by Hill classification have certain application value.