反流性哮喘与典型胃食管反流病的检查参数对比研究

Comparative study on the parameters between reflux asthma and typical gastroesophageal reflux disease

目的分析反流性哮喘(RA)与典型胃食管反流病(TGERD)患者反流相关参数的差异和临床意义。方法回顾性分析2017年6月至2020年6月于解放军火箭军特色医学中心同期行胃镜、高分辨率食管测压(HREM)和24 h pH-阻抗监测检查的120例胃食管反流病(GERD)患者的临床资料。根据症状相关性指数将GERD患者分为RA组和TGERD组,每组各60例,比较2组反流性食管炎(RE)评分、胃镜下食管裂孔疝表现、胃食管阀瓣Hill分级评分、食管上括约肌(UES)压力、DeMeester积分和反流次数等反流相关参数。统计学方法采用Mann-WhitneyU检验和卡方检验。结果TGERD组和RA组RE评分、胃食管阀瓣Hill分级评分[0.0分(0.0分,1.0分)比0.0分(0.0分,1.8分)、3.0分(2.0分,3.0分)比3.0分(2.0分,3.0分)]比较差异均无统计学意义(P均>0.05)。RA组UES压力<34 mmHg(1 mmHg=0.133 kPa)检出率高于TGERD组[41.7%(25/60)比23.3%(14/60)],差异有统计学意义(χ^(2)=4.596,P=0.032)。RA组UES压力低于TGERD组[51.7 mmHg(23.6 mmHg,70.1 mmHg)比62.0 mmHg(37.4 mmHg,77.4 mmHg)],差异有统计学意义(Z=-2.105,P=0.035)。TGERD组和RA组HREM其他参数比较差异均无统计学意义(P均>0.05)。RA组DeMeester积分≥14.7分、酸暴露时间百分比≥4.5%和反流总次数≥73次的检出率均高于TGERD组[分别为41.7%(25/60)比23.3%(14/60)、40.0%(24/60)比21.7%(13/60)、38.3%(23/60)比20.0%(12/60)],差异均有统计学意义(χ^(2)=5.546、4.728、4.881,P均<0.05)。RA组反流总次数和弱酸性气体反流次数均多于TGERD组[60次(43次,98次)比52次(34次,69次)和12次(6次,21次)比9次(3次,14次)],差异均有统计学意义(Z=-2.323、-2.053,P均<0.05)。TGERD组和RA组24 h pH-阻抗监测其他参数比较差异均无统计学意义(P均>0.05)。结论UES压力过低、食管酸暴露异常和反流次数特别是弱酸性气体反流次数增多可能更易诱发RA。

Objective To analyze the difference and clinical significance of reflux related parameters between patients with reflux asthma(RA)and typical gastroesophageal reflux disease(TGERD).Methods From June 2017 to June 2020,at PLA Rocket Force Characteristic Medical Center,the clinical data of 120 patients with gastroesophageal reflux disease(GERD)who underwent gastroscopy,high-resolution esophageal manometry(HREM)and 24 h pH-impedance monitoring contemporaneously were retrospectively analyzed.The GERD patients were divided into RA group and TGERD group according to the symptom correlated indexes,60 cases in each group.The reflux related indexes of two groups were compared,which included reflux esophagitis(RE)score,esophageal hiatal hernia,Hill grade score of gastroesophageal flap valve,upper esophageal sphincter(UES)pressure,DeMeester score,and reflux episodes.Mann-Whitney U test and chi-square test were used for statistical analysis.Results There were no significant differences in RE score and Hill grade score between TGERD group and RA group(0.0,0.0 to 1.0 vs.0.0,0.0 to 1.8;3.0,2.0 to 3.0 vs.3.0,2.0 to 3.0)(both P>0.05).The detection rate of UES pressure less than 34 mmHg(1 mmHg=0.133 kPa)of RA group was higher than that of TGERD group(41.7%,25/60 vs.23.3%,14/60),and the difference was statistically significant(χ^(2)=4.596,P=0.032).The UES pressure of RA group was lower than that of TGERD group(51.7 mmHg,23.6 mmHg to 70.1 mmHg vs.62.0 mmHg,37.4 mmHg to 77.4 mmHg),and the difference was statistically significant(Z=-2.105,P=0.035).There were no significant differences in other parameters of HREM between TGERD group and RA group(all P>0.05).The detection rates of DeMeester score more than 14.7,acid exposure time more than 4.5%and total reflux episodes more than 73 episodes of RA group were all higher than those of TGERD group(41.7%,25/60 vs.23.3%,14/60;40.0%,24/60 vs.21.7%,13/60;38.3%,23/60 vs.20.0%,12/60,respectively),and the differences were all statistically significant(χ^(2)=5.546,4.728 and 4.881,all P<0.05).The total reflux episodes and weak acid gas reflux episodes of RA group were both higher than those of TGERD group(60 episodes,43 episodes to 98 episodes vs.52 episodes,34 episodes to 69 episodes;12 episodes,6 episodes to 21 episodes vs.9 episodes,3 episodes to 14 episodes),and the differences were statistically significant(Z=-2.323 and-2.053,both P<0.05).There were no significant differences in other parameters of 24 h pH-impedance monitoring between TGERD group and RA group(all P>0.05).Conclusion Low UES pressure,abnormal esophageal acid exposure and increased reflux episodes,especially weak acid gas reflux episodes,may be more likely to induce RA.