基于“里昂共识”对胃食管反流病阻抗-pH 监测参数的分析和比较

Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"

目的 对胃食管反流病(GERD)患者食管pH和阻抗-pH监测反流参数的结果按照“里昂共识”标准进行回顾性分析,并比较传统DeMeester评分(DMS)和酸暴露时间(AET)参数。方法 选取2008年1月—2022年12月北京协和医院胃肠动力中心接受24 h食管pH监测或阻抗-pH监测的GERD患者共1 023例,分别采用DMS和AET标准对检测结果进行重新分析及比较。结果 (1)根据“里昂共识”AET标准,AET的灵敏度为94.7%,特异度为99.0%,DMS的灵敏度为98.1%,特异度为97.2%,DMS较AET灵敏度高,而AET的特异度高于DMS。2种方法监测结果比较具有高度的一致性(P<0.05)。(2)在AET 4%~6%的105例患者中,DMS阳性和DMS阴性2组间酸反流次数、>5 min次数、最长酸反流时间和卧位pH<4的百分比(卧位%)比较差异有统计学意义,提示有必要对AET以外的参数进行考量和分析。(3)105例AET 4%~6%的患者中,有超过50%的患者仍不能确定是否存在病理性反流。结论 “里昂共识”AET标准和DMS标准具有较好的一致性,均能对食管酸暴露提供有力的支持证据,AET的灵敏度低于DMS,而特异度高于DMS。如果将AET>4%定为酸反流阳性,则可提高AET的灵敏度。

Objective This study retrospectively reanalyzed the reflux parameters of patients with gastroesophageal reflux disease(GERD) detected through esophageal pH and impedance pH monitoring,following the "Lyon Consensus".The DeMeester scores(DMS) were compared to the acid exposure time(AET).Methods This study included a total of 1 023 GERD patients who underwent 24-hour esophageal pH monitoring or impedance pH monitoring at the Gastrointestinal Dynamics Center of Peking Union Medical College Hospital from January 2008 to December 2022.The reflux parameters were reanalyzed and compared using DMS and AET,respectively.Results(1) According to the "Lyon Consensus",AET demonstrates 94.7% sensitivity and 99.0% specificity,while DMS shows 98.1% sensitivity and 97.2% specificity.DMS exhibits higher sensitivity than AET,whereas AET has greater specificity than DMS.The monitoring results of the both methods are highly consistent(P<0.05).(2) Among the 105 patients with AET ranging from 4% to 6%,they were divided into DMS(+) and DMS(-) groups.Significant differences were observed between the two groups in terms of the total number of reflux episodes,number of reflux episodes lasting≥5 min,%supine time esophageal pH<4,and longest reflux episode(in minutes).These findings suggest that these parameters should be considered and analyzed in addition to AET.(3) It is worth noting that more than 50% GERD patients with AET ranging from 4% to 6% still cannot determine the presence or absence of pathological reflux.Conclusion Both the diagnostic standards of AET and DMS provide robust supporting evidence for esophageal acid exposure.AET exhibits lower sensitivity but higher specificity compared to DMS.To enhance the sensitivity of AET,considering the hypothesis of AET>4% demonstrates esophageal acid exposure might be beneficial.