非心源性胸痛27例食管体部收缩模式的研究

Study on the contraction pattern of esophageal body in 27 patients with non-cardiac chest pain

目的分析不同类型非心源性胸痛(NCCP)患者食管体部收缩模式的差异。方法选择2019年1月1日至2020年12月31日在浙江中医药大学附属第一医院就诊的46例NCCP患者,参考里昂共识意见和罗马Ⅳ诊断标准,结合胃镜检查和24 h食管多通道腔内阻抗联合pH监测结果,最终纳入27例患者。将27例患者分为功能性胸痛组(12例)和胃食管反流病(GERD)组(15例),根据高分辨率食管测压数据[第1、2、3收缩节段(S1、S2、S3)的收缩波压力峰值、收缩波幅平均值、传送时间、对应传送的食管段长度、远端收缩积分(DCI)、S2与S3 DCI的比值]分析2组食管体部收缩模式的差异。统计学方法采用独立样本t检验和卡方检验。结果GERD组S3对应传送的食管段长度和传送时间均短于功能性胸痛组,DCI小于功能性胸痛组,S2与S3 DCI的比值大于功能性胸痛组[(5.69±0.55)cm比(6.61±0.99)cm、(3.45±0.49)s比(4.15±0.90)s、(798.88±354.70)mmHg·s·cm(1 mmHg=0.133 kPa)比(1421.45±802.47)mmHg·s·cm、0.99±0.44比0.67±0.17],差异均有统计学意义(t=2.682、2.249、2.308、-2.616,P均<0.05)。GERD组内S2对应传送的食管段长度长于S3[(7.02±1.40)cm比(5.69±0.55)cm],功能性胸痛组内S2传递时间短于S3[(3.29±0.80)s比(4.15±0.90)s],差异均有统计学意义(t=3.413、-2.269,P均<0.05)。结论S3高幅收缩主要发生在功能性胸痛患者而不是GERD患者中,提示其对于鉴别功能性胸痛与GERD可能具有一定价值。

Objective To analyze the differences in the contraction pattern of esophageal body in patients with different types of non-cardiac chest pain(NCCP).Methods From January 1,2019 to December 31,2020,46 NCCP patients visited the First Affiliated Hospital of Zhejiang Chinese Medical University were selected.According to the Lyon consensus and RomeⅣdignostic criteria,combined with the results of gastr oscopy and 24 h muitichannel intraluminal impedance combined with pH detection monitoring,27 patients were finally included.The 27 patients were divided into functional chest pain group(12 cases)and gastroesophageal reflux disease(GERD)group(15 cases).The differences in contraction pattern of esophageal body between the two groups were analyzed according to the results of high-resolution esophageal manometry(the maximal wave amplitude of each contraction segment(S1,S2,S3),average contraction amplitude,contraction transmission time,segment lengths,distal contractile integral(DCI)and the DCI ratio of S2 to S3).Independent sample t test and chi-square test were used for statistical analysis.Results The segment length and contraction transmission time of S3 in GERD group were shorter than those in functional chest pain group,the DCI of S3 in GERD group was lower than that in functional chest pain group,and the DCI ratio of S2 to S3 was higher than that of functional chest pain group((5.69±0.55)cm vs.(6.61±0.99)cm,(3.45±0.49)s vs.(4.15±0.90)s,(798.88±354.70)mmHg·s·cm(1 mmHg=0.133 kPa)vs.(1421.45±802.47)mmHg·s·cm,0.99±0.44 vs.0.67±0.17),and the differences were statistically significant(t=2.682,2.249,2.308 and-2.616,all P<0.05).In GERD group,the transmitted segment length of S2 was longer than that of S3((7.02±1.40)cm vs.(5.69±0.55)cm),the contraction time of S2 of functional chest pain group was shorter than that of S3((3.29±0.80)s vs.(4.15±0.90)s),and the differences were statistically significant(t=3.413 and-2.269,both P<0.05).Conclusion High-amplitude contraction of S3 mainly occurs in patients with functional chest pain rather than GERD patients,suggesting that it may have a certain value in differential diagnosis of functional chest pain and GERD.