平均夜间基线阻抗对食管外症状胃食管反流病的临床诊断价值

The clinical value of mean nocturnal baseline impedance for gastroesophageal reflux disease patients with extra-esophageal symptoms

目的探讨食管平均夜间基线阻抗(MNBI)对表现为食管外症状的胃食管反流病(GERD)的临床诊断价值。方法回顾性分析2018年1月至2019年12月期间以烧心、反流、咳嗽或声音嘶哑等为主要症状就诊于首都医科大学附属北京朝阳医院,并行24 h多通路腔内pH-阻抗监测的210例患者。按照诊断及分组标准将纳入患者分为四组,GERD食管外症状组39例、GERD典型症状组64例、GERD混合症状组52例及对照组55例。分析并比较各组间食管远端及近端平均夜间基线阻抗及其它反流参数。结果GERD食管外症状组的近端食管MNBI值、食管下段平均pH值低于典型症状组(P<0.05)。相关性分析显示近端及远端食管MNBI值与DeMeester积分、酸暴露时间和酸反流事件次数呈显著负相关(P<0.05)。食管外症状的GERD患者,近端食管MNBI值的诊断曲线下面积显著大于远端食管MNBI值的诊断曲线下面积(P<0.05),最佳诊断临界值为2484.38Ω,诊断敏感性及准确性分别达92.3%和84%,高于远端食管MNBI值的诊断敏感性及准确性。结论近端及远端食管MNBI值均与食管酸暴露相关。近端食管MNBI值可提高多通路pH-阻抗监测对食管外症状的GERD患者的检出率,具有重要的临床诊断价值。

Objective To investigate the clinical significance of esophageal mean nocturnal baseline impedance(MNBI)in patients with extra-esophageal symptoms of gastroesophageal reflux disease(GERD).Methods We performed a retrospective study of 210 patients with heartburn,reflux,cough,and hoarseness as their main symptoms who underwent 24-hour multichannel intraluminal impedance and pH monitoring in Beijing ChaoYang hospital from January 2018 to December 2019.According to diagnostic criteria and their main clinical manifestations,patients were divided into four groups,the extra-esophageal symptoms group,the typical symptoms group,the mixed symptom group with both typical and extra-esophageal symptoms,and the control group.We analyzed and compared distal and proximal esophageal MNBI value and other reflux parameters among the four groups.Results The proximal esophageal MNBI value and mean pH at distal esophagus in GERD extra-esophageal symptoms group were lower than those in the typical symptom group(P<0.05).Correlation analysis showed that the proximal and distal esophageal MNBI value were negatively correlated with DeMeester score,acid exposure time and acid reflux times(P<0.05).According to ROC analysis,for GERD patients with extra-esophageal symptoms,area under curve of the proximal esophagus MNBI value was significantly higher than the area under curve of the distal esophageal MNBI value(P<0.05),the cut-off value for diagnosis was 2484.38 ohms.The sensitivity and accuracy of the proximal esophageal MNBI value in diagnosis GERD patients with extra-esophageal symptoms reached 92.3%and 84%,which were higher than those of the distal esophageal MNBI value.Conclusions Both the proximal and distal esophagus MNBI values negatively correlate with acid exposure.Proximal esophagus MNBI value can improve the detection rate of multi-channel pH-impedance monitoring for patients with extra-esophageal symptoms of GERD,which has important clinical diagnostic value.