儿童胃食管反流病的反流阻抗监测特点分析

Analysis of reflux impedance monitoring characteristics of gastroesophageal reflux disease in children

目的基于24 h食管多通道腔内阻抗-pH(24 h MII-pH)监测技术,分析胃食管反流病(GERD)患儿的反流与反流阻抗特点,探讨可能引起食管外症状的病理损伤机制。方法回顾性分析2019年9月至2023年3月于湖北省妇幼保健院就诊并诊断为GERD的252例患儿临床资料,利用24 h MII-pH监测GERD患者的各项指标,分析其反流特点,包括反流物不同性质(液体、气体、混合)、酸度(酸、弱酸、无酸)、体位(直立位、仰卧位)和最高阻抗位(距贲门15 cm高度)的阻抗监测数据。结果252例患儿中以呼吸系统症状为首发的有223例(88.5%)。155例患儿成功完成24 h MII-pH监测获取报告,根据Boix-Ochoa综合评分>11.99分和酸暴露时间百分比(AET)>4%将患儿分为酸反流阳性组(GERD组,n=83)和酸反流阴性组(非GERD组,n=72),酸反流阳性率为53.6%。无论有无气体反流,GERD组酸反流阻抗次数多于非GERD组(P<0.05);有气体反流时,GERD组弱酸、无酸反流阻抗次数少于非GERD组(P<0.05)。不同液体、气体、混合及酸度反流时,直立位反流阻抗次数多于仰卧位(P<0.05)。GERD组酸、直立位、仰卧位反流阻抗次数多于非GERD组(P<0.05)。两组总反流阻抗次数比较,差异无统计学意义(P>0.05)。结论气体反流可能在以消化道外症状为主要表现的GERD儿童中起着极为重要的作用。

Objective To analyze the characteristics of reflux and reflux impedance in children patients with gastroesophageal reflux disease(GERD)based on 24 h esophageal multichannel intracavitary impedance-pH(24 h MII-pH)monitoring technology,and to investigate the pathological injury mechanism possibly causing extraesophageal symptoms.Methods The clinical data of 255 children patients with GERD visited and treated in this hospital from September 2019 to March 2023 were analyzed retrospectively.24 h MII-pH was used to monitor the various indexes of children patients with GERD.The reflux characteristics were analyzed,including different natures of reflux objects(liquid,gas,mixture),acidity(acid,weak acid,acid-free),position(upright position,supine position)and impedance monitoring data at highest impedance position(15 cm height from the cardia).Results Among 255 children patients,223 cases(88.5%)had the respiratory symptoms as the initial onset.A total of 155 children patients completed the 24 h MII-pH monitoring and obtained the report.According to the Boix-Ochoa comprehensive score>11.99 points and acid exposure time percentage(AET)>4%,the children patients were divided into the acid reflux positive group(GERD group,n=83)and acid reflux negative group(non-GERD group,n=72),and the gastric acid reflux positive rate was 53.6%.Whether or not having gas reflux,the times of acid reflux impedance in the GERD group were more than those in the non-GERD group(P<0.05);when the gas reflux existed,the reflux impedance times of weak acid and non-acid in the GERD group were less than those in the non-GERD group(P<0.05).When the reflux of different liquids,gases,mixed and acid reflux,the reflux impedance times of the upright position were more than those of supine position(P<0.05).The reflux impedance times of acid,upright position and supine position in the GERD group were more than those in the non-GERD group(P<0.05).The total reflux impedance times had no statistical difference between the two groups(P>0.05).Conclusion Gas reflux may play an extremely important role in GERD children with extragastrointestinal symptoms as the main manifestations.