探讨胃食管反流病与心房颤动、酸反流及食管运动特征的相关性

To explore the correlation between gastroesophageal reflux disease and atrial fibrillation,acid reflux and esophageal motility

目的探讨胃食管反流病(GERD)与心房颤动(AF)、酸反流及食管运动特征的相关性。方法回顾性分析2022年3月至2023年5月在新疆维吾尔自治区人民医院因GERD和AF以及疑似GERD合并AF就诊的患者作为研究对象。根据符合GERD和AF典型症状及诊断标准的患者,进一步分为非GERD组、GERD组、AF组以及GERD合并AF组,每组患者40例。根据样本量估算公式,取95%CI,检验标准α=0.05、检验效能1-β=0.80推算,需要完成有效样本40例。收集4组患者胃食管反流病自测量表(GERD-Q)、Demeester系统评分、高分辨率测压(HRM)、24 h动态心电图和胃食管内镜检查结果。结果GERD组和GERD合并AF组在GERD症状评分,食管近端弱酸反流(%)、食管近端酸反流(%)及DeMeester评分等指标,与非GERD组比较显著升高(P<0.05);高分辨率食管测压分析显示,与非GERD组相比,GERD组和GERD合并AF组食管上段括约肌(UES)静息压、食管下段括约肌(LES)静息压及食管远端收缩积分(DCI)等指标显著下降(P<0.05);GERD组、AF组以及GERD合并AF组心率以及QT离散度(QTd)水平均显著大于非GERD组(P<0.05),且非GERD组心率水平显著小于GERD组(P<0.05);GERD组、AF组以及GERD合并AF组动脉血压(收缩压、舒张压)水平均显著高于非GERD组(P<0.05);GERD组和GERD合并AF组胃食管内镜下黏膜炎症大小均明显大于非GERD组(P<0.01)。结论AF、酸反流和食管运动特征与GERD具有明显相关性,GERD加大了AF发生率、明显增加了食管酸暴露,改变了食管的运动特征。

Objective To investigate the relationship between gastroesophageal reflux disease and Atrial fibrillation,acid reflux and esophageal motility.Methods Retrospective analysis was conducted on patients with gastroesophageal reflux disease(GERD),Atrial fibrillation(AF)and suspected GERD combined with AF in the People's Hospital of Xinjiang from March 2022 to May 2023.According to the typical symptoms and diagnostic criteria of gastroesophageal reflux disease and Atrial fibrillation,patients were further divided into non GERD group(n=40),GERD group(n=40),AF group(n=40)and GERD combined with AF group(n=40).According to the sample size estimation formula,take the 95%CI and test the standardα=0.05.Inspection efficiency 1-β=0.80 calculation requires 40 valid samples to be completed.The gastronesopgageal reflux disease questionnaire(GERD-Q)scale,Demesester system score,high resolution manometry(HRM),24 h Holter monitor and gastroesophageal endoscopy were collected from four groups of patients.Results The analysis results showed that the GERD group and the GERD combined with AF group showed significant increases in GERD symptom score,proximal esophageal weak acid reflux(%),proximal esophageal acid reflux(%),and DeMeester score compared to the non GERD group(P<0.05);High resolution esophageal manometry analysis showed that,compared with the non GERD group,the resting pressure of the upper Sphincter(UES),the resting pressure of the low esophageal sphincter(LES)and the distal esophageal contraction integral(DCI)of GERD group and GERD with AF group decreased significantly(P<0.05);The heart rate and QT dispersion(QTd)levels in the GERD group,AF group,and GERD combined with AF group were significantly higher than those in the non GERD group(P<0.05),and the heart rate levels in the non GERD group were significantly lower than those in the GERD group(P<0.05);The arterial blood pressure(SBP,DBP)levels in the GERD group,AF group,and GERD combined with AF group were significantly higher than those in the non GERD group(P<0.05);The size of mucosal inflammation under gastroesophageal endoscopy in the GERD group and GERD combined with AF group was highly grater than non GERD group(P<0.01).Conclusion Atrial fibrillation,acid reflux and esophageal movement characteristics are significantly related to gastroesophageal reflux disease.GERD increases the incidence of Atrial fibrillation,significantly increases esophageal acid reflux,and changes esophageal movement characteristics.