高分辨率食管测压联合食管24h pH-阻抗监测对胃食管反流病的诊断意义

Diagnostic significance of high resolution esophageal manometry combined with 24-hour pH impedance monitoring for gastroesophageal reflux disease

目的探讨高分辨率食管测压联合食管24 h多通道pH-阻抗监测对胃食管反流病(gastroesophageal reflux disease,GERD)食管基线阻抗(baseline impedance,BI)值的影响。方法选取2017年6月至2019年3月到本院就诊具有典型GERD症状的患者150例,其中反流性食管炎(reflux esophagitis,RE)38例(RE组)、非糜烂性反流病(non-erosive reflux disease,NERD)68例(NERD组),功能性烧心(functional heartburn,FH)44例(FH组)。研究对象均行常规胃镜检查、24 h食管pH-阻抗监测和PPI试验,分别分析3组患者食管下括约肌上方3、5、7、9、15、17 cm处(a5通道、a4通道、a3通道、a2通道、a1通道)BI值,使用SPSS22.0统计软件对数据进行分析。结果 RE组、NERD组远端收缩积分(distal contractile integral,DCI)和收缩前沿速度(contractile front velocity,CFV)均显著低于FH组(P<0.05);FH组5个通道食管BI值均显著高于NERD组和RE组(P<0.05)。ROC曲线结果显示,NERD组和FH组a5通道食管BI最佳截断值为2 416Ω,曲线下面积为0.92,灵敏度为79.8%(95%CI:0.40~0.87),特异度为93.1%(95%CI:0.48~0.94),阳性预测值为98.3%(95%CI:0.52~0.99),阴性预测值为48.2%(95%CI:0.53~0.90)。NERD组[9.40%(4.46%~25.70%)]和RE组[10.60%(4.71%~24.29%)]食管酸暴露时间(acid exposure time,AET)均显著高于FH组[1.06%(0.20%~2.16%),P<0.05],NERD组AET显著低于RE组(P<0.05);NERD组和RE组BI值均与AET呈负相关(r=-0.651、-0.542,P<0.05)。FH组BI值与AET无相关性(r=-0.402,P=0.240)。结论高分辨率食管测压联合食管24 h多通道pH-阻抗监测结果提示食管远端的BI值2 416Ω可作为鉴别NERD和FH的最佳截断值,食管酸暴露程度与GERD患者食管BI值降低有关。

Objective To investigate the effect of high resolution esophageal manometry combined with 24-hour esophageal multi-channel pH-impedance monitoring on baseline esophageal impedance in patients with gastroesophageal reflux disease(GERD). Methods A total of 150 patients with typical GERD symptoms admitted in our hospital from June 2017 to March 2019 were enrolled in this study. They were divided into reflux esophagitis group(RE, n=38), non-erosive reflux disease group(NERD, n=68) and functional heartburn group(FH, n=44). All subjects underwent routine gastroscopy, 24-hour esophageal pH-impedance monitoring and proton inhibitor(PPI) test. The BI values at 7, 9, 15 and 17 cm(a5 channel, a4 channel, a3 channel, a2 channel, a1 channel) above the lower esophageal sphincter were obtained respectively in the 3 groups, and the results were analyzed by SPSS22.0 statistical software. Results The distal contractile integral(DCI) and contractile front velocity(CFV) in the RE group and NERD group were significantly lower than those in FH group(P<0.05). The BI values at the 5 channels of esophagus were obviously higher in the FH group than the NERD group and the RE group(P<0.05). Receiver operating characteristic(ROC) curve analysis showed that the best cut-off value of esophageal BI of A5 channel in NERD group and FH group was 2 416 Ω, and the area under curve(AUC) was 0.92. And the sensitivity was 79.8%(95%CI: 0.40~0.87), specificity was 93.1%(95%CI: 0.48~0.94), positive predictive value was 98.3%(95%CI: 0.52~0.99), and negative predictive value was 48.2%(95%CI: 0.53~0.90). The acid exposure time(AET) was significantly longer in the NERD group [9.40%(4.46%~25.70%)] group and the RE group [10.60%(4.71%~24.29%)] when compared with the FH group [1.06%(0.20%~2.16%), P<0.05], and obvious difference was seen in the former 2 groups(P<0.05). The BI values in the NERD group and the RE group were negatively correlated with AET respectively(r=-0.651,-0.542, P<0.05), but no such correlation was seen in the FH group(r=-0.402, P=0.240). Conclusion The results of high-resolution esophageal manometry combined with 24-hour multichannel pH impedance monitoring indicate that the BI value at 2 416 Ω of the distal esophagus is the best cut-off value for distinguishing NERD and FH. The degree of esophageal acid exposure is associated with the decrease of BI value of the esophagus in GERD patients.