24 h pH/阻抗监测在胃食管反流性咳嗽中的应用价值

Application value of 24 hour pH/impedance monitoring in gastroesophageal reflux cough

目的明确24 h pH联合阻抗监测在胃食管反流性咳嗽(GERC)中的应用价值。方法回顾性选取2013年8月至2014年12月解放军总医院第六医学中心消化科专病门诊就诊的伴有慢性咳嗽的胃食管反流病(GERD)患者116例,并根据24 h pH/阻抗监测结果将符合GERC诊断标准的患者定为GERC组,选取同期体检的健康志愿者30例设为对照组,所有受试者均进行胃镜检查,再进行24 h pH联合阻抗监测,记录24 h pH/阻抗监测参数。确诊的GERC患者均给予抑酸、促胃肠动力治疗,合并碱反流者给予利胆治疗,疗程12周。记录GERC患者治疗前、治疗后4周、8周、12周胃食管反流病调查(GERD-Q)量表、咳嗽症状积分、反流症状积分、莱斯特咳嗽问卷(LCQ)量表评分变化。结果24 h pH/阻抗GERC诊断率(82.8%)明显高于单纯24 h pH GERC诊断率(54.3%)(P<0.01)。GERC组反流时间>5min的次数,pH值<4的反流次数,总、立、卧位状态pH值<4的时间占监测时间的比例,最长反流时间及DeMeester评分均高于对照组(P<0.05);立、卧位状态下GERC组与对照组的液体、气体及混合反流次数存在统计学差异(P<0.05);立、卧位状态下两组间的酸、弱酸、弱碱反流次数有统计学差异(P<0.05);GERC组的近端反流次数占总反流次数明显高于对照组的(57.93%vs 20.39%)(P<0.01);抗反流治疗后GERC患者的GERD-Q积分、咳嗽症状积分、反流症状积分逐渐下降,而LCQ积分逐渐上升,差异有统计学意义(P<0.05)。结论24 h pH联合阻抗监测的GERC诊断率明显高于单纯pH监测法,可明确反流物的酸碱性、物理性质、反流高度及运动方向,同时指导GERC患者的治疗,达到提高疗效的目的,为GERC患者的规范化诊治提供了重要参考依据。

Objective To clarify the application value of 24-hour pH/impedance monitoring in gastroesophageal reflux cough.Methods 116 GERD patients with chronic cough were selected from the Gastroenterology Specialty Clinic of the Sixth Hospital of the PLA General Hospital from August 2013 to December 2014.According to the 24-h pH/impedance monitoring results,the patients who met the GERC diagnostic criteria were designated as the GERC group,and 30 healthy volunteers who received physical examination at the same time were selected as the control group.All subjects underwent gastroscopy,followed by 24-hour pH/impedance monitoring,and 24-hour pH/impedance monitoring parameters were recorded.The confirmed GERC patients were given acid suppression and gastrointestinal motility therapy,and those with alkaline reflux were given additional cholestatic therapy,for 12 weeks.We record the changes of reflux symptom score,GERD-Q scale score,cough symptom score and LCQ scale score before treatment,4 weeks,8 weeks,and 12 weeks after treatment of GERC patients.Results The diagnostic rate of 24 h pH/impedance GERC(82.8%)was significantly higher than that of pure 24 h pH GERC(54.3%),(P<0.01).The reflux time>5min times,pH<4 reflux times,the time of pH<4(total,upright position and supine positions)as a percentage of the total monitoring time,the longest reflux time and the DeMeester scores in GERC group were higher than those in the healthy control group(P<0.05);the differences in the number of liquid reflux,gas reflux and mixed reflux in upright position and supine positions between the GERC group and the control group were statistically significant(P<0.05);There was a statistically significant difference in the number of acid reflux,weak acid reflux,and weak base reflux in upright position and supine positions between the two groups(P<0.05);The number of proximal reflux in the GERC group accounted for the total number of refluxes was significantly higher than that in the control group(57.93%vs 20.39%),and the difference was statistically significant(P<0.01).After anti-reflux treatment,the GERD-Q score,cough symptom score,and reflux symptom score of GERC patients gradually decreased,while the LCQ score gradually increased,and the difference was statistically significant(P<0.05).Conclusion The diagnostic rate of GERC by the 24-hour pH combined impedance monitoring method is significantly higher than that of the pure pH monitoring method.It can clarify the physical properties,acidity and alkalinity of the reflux,determine the direction and height of the reflux,and guide the treatment of GERC patients,And ultimately achieve the purpose of improving the efficacy,providing an important reference for the standardized diagnosis and treatment of GERC patients.