24 h多通道腔内阻抗-pH监测在儿童胃食管反流病的应用和诊断价值研究

Diagnostic value and application of 24 h multichannel intraluminal impedance-pH monitoring in children with gastroesophageal reflux disease

目的评价24 h多通道腔内阻抗-pH监测(24 h MII-pH)在儿童胃食管反流病(GERD)中的诊断和应用价值。方法横断面研究。选取2013年1月至2020年12月在首都儿科研究所附属儿童医院消化内科行24 h MII-pH监测的417例患儿为研究对象。根据监测结果将417例患儿分为GERD组(监测阳性组)和非GERD组(监测阴性组),比较两组反流事件的差异。将132例行电子胃镜检查的GERD组患儿分为反流性食管炎组(RE)组和非糜烂性反流病(NE)组,比较两组反流事件的差异。组间比较采用独立样本t检验或非参数Mann-Whitney U检验。结果417例患儿男232例、女185例,年龄(7.3±3.9)岁,病程0.5(0.1,2.0)年,主要的临床症状有反酸(128例)、呕吐(173例)、腹痛(101例)、咳嗽(76例)等。24 h MII-pH监测显示反流阳性率为58.3%(243/417),高于24 h食管pH监测的反流阳性率[43.6%(182/417)]。24 h MII-pH监测结果显示,GERD和非GERD组酸反流次数、弱酸反流次数、非酸反流次数、液体反流次数、混合反流次数差异均有统计学意义[10(4,19)比4(1,9)次/24 h、14(6,32)比7(3,13)次/24 h、0(0,0)比0(0,0)次/24 h、19(10,34)比8(3,14)次/24 h、6(2,12)比3(1,5)次/24 h,Z=-6.96、-7.25、-5.62、-8.75、-6.48,均P<0.05]。RE组和NE组Boix-Ochoa评分、长反流次数、长反流时间、弱酸反流次数差异均有统计学意义[51.2(21.4,153.2)比20.7(12.1,34.7)分,5(2,10)比1(0,4)次/24 h,19(7,87)比8(3,22)min,5(2,15)比15(6,33)次/24 h,Z=-3.44、-3.41、-2.65、-2.27,均P<0.05]。结论24 h MII-pH监测可识别反流物的类型,不仅提高了儿童GERD的检出率,而且为初步探索疾病的病因提供了可能。

Objective To evaluate the diagnostic value and application of 24 h multichannel intraluminal impedance-pH(24 h MII-pH)monitoring in children with gastroesophageal reflux disease(GERD).Methods This is a cross-sectional study.From January 2013 to December,2020,417 patients who received 24 h MII-pH monitoring in Department of Gastroenterology of Children′s Hospital Capital Institute of Pediatrics were included.According to results,these children were divided into the GERD and non-GERD groups.Furthermore,the 132 children with GERD who had gastroscopy were divided into the reflux esophagitis(RE)and non-erosive reflux disease(NE)groups to investigate the differences in their refluxes.Non-parametric Mann-Whitney U test or indepentent sample t test was used for comparisons between the groups.Results Among the 417 children,232 were males and 185 females,aged(7.3±3.9)years.The course of disease was 0.5(0.1,2.0)years.The main clinical symptoms included acid reflux(128 cases),vomiting(173 cases),abdominal pain(101 cases),and cough(76 cases).The 24 h MII-pH monitoring were positive in 243 children(58.3%,243/417),which was higher than that by 24 h esophageal pH monitoring(43.6%,182/417).The 24 h MII-pH monitoring results demonstrated significant differences in the episodes of acid reflux,weakly acidic reflux,non-acidic reflux,liquid reflux and mixed reflux between GERD and non-GERD groups(10(4,19)vs.4(1,9)times/24 h,14(6,32)vs.7(3,13)times/24 h,0(0,0)vs.0(0,0)times/24 h,19(10,34)vs.8(3,14)times/24 h,and 6(2,12)vs.3(1,5)times/24 h,Z=-6.96,-7.25,-5.62,-8.75,and-6.48,all P<0.05,respectively).Besides,the results also showed significant differences in Boix-Ochoa score,episodes of long reflux,course of long reflux,and episodes of weakly acidic reflux between the RE and NE groups(51.2(21.4,153.2)vs.20.7(12.1,34.7),5(2,10)vs.1(0,4)times/24 h,19(7,87)vs.8(3,22)min,and 5(2,15)vs.15(6,33)times/24 h,Z=-3.44,-3.41,-2.65,and-2.27,all P<0.05,respectively).Conclusion 24 h MII-pH monitoring not only improves the detection rate of GERD in children,but also provides a possibility to early etiological diagnosis.