平均夜间基线阻抗在胃食管反流病中的应用

Application of mean nocturnal baseline impedance in gastroesophageal reflux disease

目的通过监测胃食管反流病(GERD)患者食管黏膜食管基线阻抗(BI)并探讨其价值。方法对2017年3月至2018年3月在我院诊断为GERD并接受上消化道内镜检查及24 h食道阻抗-pH监测的92例患者,分析不同类型GERD、难治性GERD患者BI特点及GERD症状评分与BI的关系。结果92例患者中有75例诊断为非糜烂性反流病(NERD),9例诊断为糜烂性食管炎(EE),8例诊断为Barrett食管。NERD组在LES上3、5 cm处BI和远端BI均高于EE组。主要表现为胸痛病例其症状评分与LES上3、5、9 cm处BI呈正相关(r=0.420、0.470、0.475,P=0.046、0.024、0.022),主要表现为烧心病例食管BI与其症状评分无相关性。质子泵抑制剂(PPI)有效组在LES上3、5 cm处BI和远端BI均低于难治性烧心组,用于区分PPI有效组与难治性烧心组在LES上3、5 cm处BI的最佳截断值分别为2369,2936Ω。PPI有效组在LES上3、5、7 cm处BI和远端BI均低于难治性胸痛组,用于区分PPI有效组与难治性胸痛在LES上3、5、处BI的最佳截断值分别为3006、3053、3015Ω。结论BI在受损黏膜中BI值降低。NERD胸痛症状评分与BI值呈正相关。BI可预测PPI疗效,BI值较高的NERD患者可能无法从PPI中受益。最佳截断值可作为PPI难治性NERD的诊断指标。

Objective To monitor the esophageal mucosal esophageal baseline impedance(BI)in patients with gastroesophageal reflux disease(GERD)and explore its value.Methods For 92 patients with GERD diagnosed in our hospital from March 2017 to March 2018 and undergoing upper gastrointestinal endoscopy and 24-hour esophageal impedance pH monitoring,the BI characteristics of patients with different types of GERD and refractory GERD were analyzed,and the relationship between GERD symptom score and BI were compared.Results Of the 92 patients,75 were diagnosed with non-erosive reflux disease(NERD),9 were diagnosed with erosive esophagitis(EE),and 8 were diagnosed with Barrett's esophagus.BI at 3 cm and 5 cm and distal Bi above LES in the NERD group were higher than those in the EE group.The symptom score of patients with chest pain was positively correlated with BI at 3 cm,5 cm,and 9 cm on the LES,while the BI of patients with heartburn had no correlation with the symptom score.Bi at 3 cm,5 cm and distal BI above LES in PPI effective group were lower than those in refractory heartburn group.The best cut-off values of BI at 3 cm and 5 cm above LES were 2369Ωand 2936Ω,respectively.Bi at 3 cm,5 cm,7 cm,and distal BI above LES in PPI effective group were lower than those in refractory chest pain group.The best cutoff values for BI at 3 cm,5 cm,and 7 cm on the LES to distinguish the PPI effective group and refractory chest pain are 3006Ω,3053Ω,and 3015Ω,respectively.Conclusion BI decreased in the damaged mucosa. The chest pain symptom score of NERD patients is positively correlated with the BI value. BI canpredict the efficacy of PPI, and NERD patients with higher BI values may not benefit from PPI. The best cutoff value can be used as a diagnostic index for PPI-refractory NERD patients.