本文選題：高分辨率食管測壓 + 胃食管反流病�。� 參考：《浙江大學(xué)》2016年碩士論文

【摘要】：背景：胃食管反流病(GERD)是一種常見的消化科疾病,其病理生理機(jī)制尚未完全闡明,目前較多研究認(rèn)為GERD是胃食管動力障礙性疾病。隨著質(zhì)子泵抑制劑(PPI)的出現(xiàn)使GERD的治療得到極大改善,但仍有一部分患者經(jīng)PPI治療后癥狀無改善,被稱為難治性胃食管反流病。有研究發(fā)現(xiàn)近一半的GERD患者食管體部蠕動功能存在障礙,而在難治性GERD患者中食管動力障礙占多少比例尚無報道。高分辨率食管測壓(HRM)是在傳統(tǒng)食管測壓的基礎(chǔ)上發(fā)展而來的一種直觀和準(zhǔn)確的固態(tài)測壓方法。目前臨床上采用10口5m1水吞咽法,然而這種檢測方法不符合正常生理習(xí)慣,難以誘發(fā)出患者食管的動力異常,而且當(dāng)檢測結(jié)果缺乏主要動力障礙時,應(yīng)用常規(guī)飲水吞咽很難解釋患者的食管癥狀和疾病的病因。國外有研究發(fā)現(xiàn)應(yīng)用快速多口水吞咽、固體吞咽進(jìn)行HRM檢測能夠提高食管動力障礙的檢出率。但目前國內(nèi)缺乏應(yīng)用連續(xù)飲水和固體吞咽進(jìn)行高分辨率食管測壓檢測食管動力的研究。目的：應(yīng)用高分辨率食管測壓技術(shù)對難治性胃食管反流病患者進(jìn)行食管測壓,分析胃食管反流病患者不同亞組的食管動力特征,進(jìn)一步分析比較三種試餐(常規(guī)飲水、連續(xù)飲水和固體吞咽)在檢測食管動力障礙中的作用。方法：收集2014年5月至2015年12月于浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院消化內(nèi)科胃腸動力實(shí)驗(yàn)室行高分辨率食管測壓檢查的難治性胃食管反流患者的臨床資料,根據(jù)患者癥狀、胃鏡檢查及24hpH-阻抗聯(lián)合監(jiān)測結(jié)果,將患者分為反流性食管炎(reflux esophagitis, RE)組、非糜爛性反流病(non-erosive reflux disease, NERD)組和癥狀-反流無關(guān)聯(lián)組,應(yīng)用常規(guī)10口5m1飲水、200m1連續(xù)飲水和150g米飯固體吞咽進(jìn)行高分辨食管測壓,比較三種方法在檢測食管動力障礙的價值。食管動力障礙標(biāo)準(zhǔn)分別是,常規(guī)飲水：根據(jù)芝加哥分類V3.0標(biāo)準(zhǔn)；連續(xù)飲水：兩次飲水試餐后均無有效食管收縮；固體吞咽：有效吞咽口數(shù)50%為食管動力障礙。結(jié)果：共納入符合條件的GERD患者51例,其中反流性食管炎(RE)組11例,非糜爛性反流病(NERD)組25例,癥狀-反流無關(guān)聯(lián)組15例。1.RE組遠(yuǎn)端收縮積分(distal contraction integral, DCI)明顯低于NERD組和癥狀-反流無關(guān)聯(lián)組(P=0.039)。RE組食管蠕動率明顯低于其他兩組(P=0.002)。2.RE組和NERD組Demeester評分、酸反流次數(shù)明顯高于癥狀-反流無關(guān)聯(lián)組(P0.001)。RE組和NERD組中位酸暴露時間較癥狀-反流無關(guān)聯(lián)組明顯延長(P=0.001)。3.常規(guī)飲水方法測得共有31.4%(16/51)患者有食管動力障礙,其中11例(68.8%)患者診斷為無效的食管動力(ineffective esophageal motility, IEM);5例(31.2%)患者診斷為完全性失蠕動。4.將51例受試者分為完全性失蠕動組(5例)、無效食管動力組(11例)和無食管動力障礙組(35例),其中完全性失蠕動組的酸反流次數(shù)明顯高于其他兩組(P=0.024)。5.200m1連續(xù)飲水法共檢測出28例(54.9%)食管動力障礙,食管動力障礙檢出率明顯高于常規(guī)10口5m1飲水方法,差異具有統(tǒng)計學(xué)意義(P=0.017)。6.150g米飯固體吞咽法食管動力障礙的檢出率(33/51,64.7%)明顯高于常規(guī)10口5m1飲水方法(P0.001)。其中RE組食管動力障礙檢出率(90.9%)和NERD組(68.0%)明顯高于癥狀-反流無關(guān)聯(lián)組(40.0%)(P=0.024)。RE組固體吞咽有效口數(shù)明顯低于其他兩組(P=0.027)。結(jié)論：難治性胃食管反流病患者中食管動力障礙常見,包括食管蠕動功能減弱、消失以及無效的食管動力,其中無效的食管動力最為常見。在行HRM檢測時應(yīng)用200m1連續(xù)飲水和150g米飯固體吞咽檢測方法食管動力障礙的檢出率明顯高于10口5m1常規(guī)飲水方法,其臨床應(yīng)用價值有待進(jìn)一步評估。
[Abstract]:Background: gastroesophageal reflux disease (GERD) is a common digestive disease. Its pathophysiological mechanism has not been fully elucidated. At present, many studies have shown that GERD is a gastroesophageal motility disorder. With the emergence of proton pump inhibitor (PPI), the treatment of GERD has been greatly improved, but some patients still have no improvement in the symptoms after the treatment of PPI. Studies have found that nearly half of GERD patients have an obstacle to the peristaltic function of the esophagus, while the proportion of esophageal motility disorders in refractory GERD patients is not reported. High resolution esophageal manometry (HRM) is an intuitive and accurate solid-state measurement developed on the basis of traditional esophageal manometry. Pressure method. At present, 10 5m1 water swallowing methods are used clinically. However, this method does not conform to normal physiological habits, and it is difficult to induce the abnormal motility of the esophagus. And when the results lack major dynamic disorders, it is difficult to explain the causes of the patients' esophagus symptoms and diseases by using conventional water swallowing. Rapid multi mouth swallowing and solid swallowing for HRM detection can improve the detection rate of esophageal motility disorders. However, there is a lack of high resolution esophageal manometry for detecting esophageal motility with continuous drinking water and solid swallowing. Objective: high resolution esophageal manometry is applied to patients with refractory gastroesophageal reflux disease. Pressure measurement was used to analyze the esophageal motility characteristics of different subgroups of gastroesophageal reflux disease patients and to further analyze the role of three test meals (regular drinking water, continuous drinking water and solid swallowing) in the detection of esophageal motility disorders. Methods: from May 2014 to December 2015, the gastrointestinal motility in the digestive department of the Sir Run Run Shaw Hospital of the Medical College of Zhejiang University was collected. The clinical data of patients with refractory gastroesophageal reflux with high resolution esophageal manometry were divided into reflux esophagitis (reflux esophagitis, RE) group, non erosive reflux disease (non-erosive reflux disease, NERD) group and symptomatic reflux, according to the patient's symptoms, gastroscopy and 24hpH- impedance monitoring results. Group, using 10 5m1 drinking water, 200m1 continuous drinking water and 150g rice solid swallowing for high resolution esophageal manometry, compared the value of the three methods in detecting esophageal motility disorder. The standard of esophageal motility disorder was the conventional drinking water: according to the Chicago classification V3.0 standard; continuous drinking water: no effective esophageal contraction after two drinking water test meals. Solid swallowing: 50% of the effective swallowing mouth was 50% of the esophageal motility disorder. Results: 51 cases of GERD patients were included, including 11 cases of reflux esophagitis (RE) and 25 cases of non erosive reflux disease (NERD) group. The distal contraction integral (distal contraction integral, DCI) in the symptom reflux non association group (distal contraction integral, DCI) was significantly lower than that of the NERD group and the disease. The rate of esophageal peristalsis in group P=0.039.RE group was significantly lower than that of other two groups (P=0.002).2.RE group and NERD group Demeester score, acid reflux frequency was significantly higher than that of symptomatic reflux non associated group (P0.001).RE group and NERD group. 1.4% (16/51) patients had esophageal motility disorder, of which 11 cases (68.8%) were diagnosed as ineffective esophageal motility (ineffective esophageal motility, IEM); 5 (31.2%) patients were diagnosed as complete lost peristaltic.4., 51 cases were divided into complete non peristalsis group (5 cases), ineffective esophageal motility group (11 cases) and no esophageal motility disorder group (35 cases). The number of acid reflux in the complete lost peristaltic group was significantly higher than that of the other two groups (P=0.024).5.200m1 continuous drinking water method. The esophageal motility disorder was detected in 28 cases (54.9%), and the detection rate of esophageal motility disorder was significantly higher than that of the conventional 10 mouth 5m1 drinking water method. The difference was statistically significant (P=0.017) the detection rate of esophageal motility disorder in.6.150g rice swallowing method (P=0.017). 33/51,64.7%) was significantly higher than the conventional 10 mouth 5m1 drinking water method (P0.001). The detection rate of esophageal motility disorder in group RE (90.9%) and NERD group (68%) were significantly higher than that in the symptom reflux group (40%) (P=0.024) the number of solid swallowing in the.RE group was significantly lower than that of the other two groups (P= 0.027). Conclusion: the esophageal motility barrier in patients with refractory gastroesophageal reflux disease Obstruction of the esophageal peristalsis, including diminished esophageal peristalsis, and ineffective esophageal motility, is the most common of the esophageal motility. In the case of HRM detection, the detection rate of esophageal motility with 200m1 continuous drinking water and 150g rice solid swallowing detection is significantly higher than that of 10 5m1 conventional drinking water methods, and its clinical value needs to be further studied. Assessment.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R571

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