北京地区老年反流性食管炎患者临床特点和食管黏膜菌群结构分析

Clinical characteristics and analysis of esophageal mucosal flora in elderly patients with reflux esophagitis in Beijing

目的探讨北京地区老年反流性食管炎(RE)患者的临床特点和食管黏膜菌群结构。方法选择2018年1月至2021年11月北京地区219例老年RE患者,根据Savary-Miller分级和内镜诊断将患者分为轻度组(n=63)、中度组(n=109)、重度组(n=47)。纳入同期50名健康志愿者为对照组。比较不同程度老年RE患者年龄、性别、临床典型症状和非典型症状,其中典型症状包括反酸、胃灼热、胸痛等;非典型症状包括吞咽困难、呕吐、呕血黑便、贫血、嗳气、食欲减退等。比较不同程度老年RE患者24 h最长胃食管反流时间、>5 min反流次数及食管pH监测中pH<4总时间、pH<4反流次数。采集各组对象食管下段黏膜样本并提取细菌基因组DNA进行基因扩增,采用Illumina测序技术进行菌群分析。结果不同程度老年RE患者年龄、胃灼热、反酸例数差异均有统计学意义(均P<0.05);其中重度RE患者胃灼热例数(40例,85.1%)高于轻度RE患者(39例,61.9%),重度RE患者反酸例数(42例,89.4%)高于轻度RE患者(43例,68.3%)(均P<0.05)。不同程度老年RE患者24 h最长胃食管反流时间、>5 min反流次数、pH<4总时间、pH<4反流次数差异均有统计学意义(均P<0.05)。不同程度老年RE患者食管黏膜菌群中拟杆菌属、普氏菌属、螺杆菌属、乳杆菌属丰度均低于对照组(均P<0.05)。重度老年RE患者螺杆菌属丰度低于轻度和中度RE患者(均P<0.05)。结论北京地区老年RE患者出现不同程度的胃食管反流、胃灼热、反酸等症状,且不同程度RE患者食管下段黏膜菌群构成与健康人群相比变化显著。

Objective To observe the clinical characteristics and structure of esophageal mucosal flora in elderly patients with reflux esophagitis(RE)in Beijing.Methods A total of 209 elderly patients with RE in Beijing from January 2018 to November 2021 were selected and classified as mild group(n=63),moderate group(n=109)and severe group(n=47)according to the Savary-Miller classification and endoscopic diagnosis.Fifty healthy volunteers were included as the control group.The age,gender,typical clinical symptoms and atypical symptoms were compared among the patients with different degrees of RE.The typical symptoms included acid reflux,heartburn,and chest pain;the atypical symptoms included dysphagia,vomiting,hematemesis and melena,anemia,belching,and loss of appetite.The longest duration of gastroesophageal reflux during 24 hours,number of times of reflux episode>5 minutes,total duration and number of times of pH<4 in esophageal pH monitoring were compared among the patients with different degrees of RE.Lower esophageal mucosa samples were collected,and bacterial genomic DNA was extracted for gene amplification.Illumina sequencing technology was used for bacterial classification.Results There were significant differences in age,heartburn and acid reflux among the patients with different degrees of RE(all P<0.05).40 patients(85.1%)with severe RE vs 39 ones(61.9%)with mild RE had heartburn;42 patients(89.4%)with severe RE vs 43 ones(68.3%)with mild RE had acid reflux(all P<0.05).There were significant differences in the longest reflux duration during 24 hours,number of times of reflux episode>5 minutes,total duration of pH<4,and number of times of pH<4 among the elderly patients with different degrees of RE(all P<0.05).The abundances of Bacteroidetes,Prevotella,Helicobacter and Lactobacillus in esophageal mucosa of the patients with different degrees of RE were lower than those in the control group(all P<0.05).The abundance of Helicobacter in severe RE patients were lower than that in mild and moderate RE patients respectively(all P<0.05).Conclusion Elderly patients with RE in Beijing have different degrees of gastroesophageal symptoms,heartburn,acid reflux and other symptoms,and the compositions of lower esophageal mucosal bacteria in patients with different degrees of RE are significantly changed compared with healthy people.