非糜爛性反流病食管黏膜屏障功能及酸敏感性的研究
發(fā)布時間：2019-06-29 12:54
【摘要】：摘要一食管多通道腔內(nèi)阻抗-pH監(jiān)測結(jié)合酸灌注試驗(yàn)評價非糜爛性反流病食管黏膜屏障功能目的：聯(lián)合酸灌注試驗(yàn)和24h食管多通道腔內(nèi)阻抗-pH (MII-pH)監(jiān)測,研究非糜爛性反流病(NERD)患者酸誘導(dǎo)的食管阻抗動態(tài)變化及其與反流癥狀和食管上皮細(xì)胞間隙增寬之間的關(guān)系。對象和方法：選取2013年9月至2014年7月我院的NERD患者35例和健康志愿者20例,行24h MII-pH監(jiān)測、酸灌注試驗(yàn)和胃鏡檢查。胃鏡下在齒狀線上2cm,前、后壁各取一塊黏膜組織,用軟件測量食管上皮細(xì)胞間隙。結(jié)果：(1)NERD患者食管遠(yuǎn)端阻抗基線和阻抗恢復(fù)速率顯著低于健康對照組(2998±701 Ω vs.3880±1054 Ω, P0.01; 30.1±14.0 Ω/min vs.53.0±14.5 Ω/min, P0.01)。(2)阻抗基線與阻抗恢復(fù)速率呈顯著正相關(guān)(r=0.71,P0.01),阻抗基線、阻抗恢復(fù)速率分別與AET顯著負(fù)相關(guān)(r=-0.58,P0.01；r=-0.61,P0.01)。(3)酸灌注試驗(yàn)陽性的NERD患者食管阻抗基線和阻抗恢復(fù)速率顯著低于酸灌注試驗(yàn)陰性的患者(2755±680 Ω vs.3411±536 Ω, P 0.01; 24.9±13.3 Ω/min vs.33.7±10.3 Ω/min,P0.05).。(4)NERD患者食管上皮細(xì)胞間隙較健康對照組顯著增寬(1.03±0.20 μm vs.0.66±0.14μm, P0.01).阻抗基線、阻抗恢復(fù)速率分別與上皮細(xì)胞間隙顯著負(fù)相關(guān)(r=-0.68, P0.01;r=-0.67, P0.01). (5) NERD患者食管上皮細(xì)胞間隙與燒心和總的癥狀積分呈顯著性正相關(guān)(r=0.42, P0.05; r=0.59, P0.05)結(jié)論：反復(fù)的反流損傷和黏膜修復(fù)減慢可能是NERD患者食管黏膜完整性受損的原因。食管阻抗基線的變化一定程度上可反映食管黏膜完整性受損的程度。摘要二非糜爛性反流病食管黏膜組織學(xué)結(jié)構(gòu)改變及蛋白酶激活受體-2的表達(dá)目的：通過胃鏡下黏膜組織活檢,研究NERD患者食管上皮組織學(xué)結(jié)構(gòu)的改變。運(yùn)用免疫組織化學(xué)的方法,研究蛋白酶激活受體-2(PAR-2)在NERD患者食管黏膜中的表達(dá),分析其與DIS的相關(guān)性。對象和方法：選取2013年8月至2014年7月我院的NERD患者59例和健康志愿者20例,行胃鏡檢查并于齒狀線上2cm,食管前、后壁各取一塊黏膜組織,蘇木精伊紅(HE)染色觀察食管黏膜組織學(xué)形態(tài)學(xué)改變,包括基底層細(xì)胞增生、上皮乳頭延長、炎性細(xì)胞浸潤、上皮細(xì)胞氣球樣變、細(xì)胞間隙增寬等；用免疫組織化學(xué)的方法檢測上皮組織中PAR-2的表達(dá)。結(jié)果：(1)NERD組和HS組基底層細(xì)胞增生檢出率分別為84.7%和30.0%,上皮乳頭延長分別為49.2%和15.0%,上皮細(xì)胞氣球樣變分別為76.3%和5.0%,炎性細(xì)胞浸潤分別為35.6%和10.0%。(2)NERD組PAR-2廣泛表達(dá)于食管上皮細(xì)胞。NERD組食管上皮細(xì)胞間隙顯著增寬(1.00±0.21μm vs.0.67±0.13μm, P0.01),且PAR-2的表達(dá)顯著高于對照組(6.97±1.73vs.1.45±0.99,P0.01). (3) DIS與PAR-2的表達(dá)呈顯著正相關(guān)(r=0.65,P0.01)。結(jié)論：NERD患者食管黏膜存在著一系列組織學(xué)結(jié)構(gòu)的改變。PAR-2介導(dǎo)的通路可能通過重新分配緊密連接蛋白引起細(xì)胞間隙增寬,參與了NERD的發(fā)病機(jī)制。摘要三非糜爛性反流病和反流性食管炎癥狀譜及其相關(guān)因素分析目的：通過問卷調(diào)查了解NERD和RE患者的一般人口學(xué)特點(diǎn)、反流癥狀譜、飲食習(xí)慣、生活質(zhì)量和精神心理狀態(tài)等,分析比較兩組患者的臨床特點(diǎn),為進(jìn)一步探討GERD的發(fā)病機(jī)制和有效治療提供依據(jù)。對象和方法：本研究納入105例GERD患者,其中NERD患者60例(男18例,女42例,年齡44.1±13.4歲),RE患者45例(男22例,女23例,年齡46.5±9.9歲)。采用問卷調(diào)查的形式對NERD和RE患者的一般人口學(xué)特征、癥狀學(xué)特點(diǎn)、飲食和生活習(xí)慣、生活質(zhì)量、精神心理等方面進(jìn)行分析比較。結(jié)果：(1)NERD組反食癥狀評分和反食癥狀發(fā)生率均低于RE組[0 (0,2) vs.2.0 (0, 3.0),P0.05; 45.0% vs.64.4%, P0.05],兩組癥狀總評分無顯著性差異[8.0(6.0,11.0) vs.10.0(7.0,13.0),?0.05]。(2) NERD患者牙痛和齲齒的發(fā)生率高于RE組(41.7% vs.8.3%, P0.01; 55.0% vs.8.3%, P0.01),次要癥狀和食管外癥狀評分顯著高于RE組[4.0(2.0,5.0) vs.2.0(1.0,5.0), P0.05]。 (3) NERD組反流癥狀的飲食誘因的前五位依次是：奶制品、辛辣飲食、蔥或韭菜、甜食、酸奶,除飲食外的其他誘因的前五位依次是：情緒、進(jìn)食過飽、著涼、餐后彎腰、睡眠不好。(4)NERD合并心理異常組的反流癥狀積分顯著高于無心理異常組(10.9±4.7 vs.8.3±2.8,P0.05)。(5)NERD患者焦慮、抑郁評分與反流癥狀積分相關(guān)(r-0.42,P0.01；r=0.29,P0.05),反流癥狀積分與GERD-HRQL顯著相關(guān)(r=0.49,P0.01)。結(jié)論：NERD組反食癥狀較RE組輕,但兩組癥狀總評分無顯著性差異。飲食和不良生活習(xí)慣在NERD癥狀發(fā)生中起一定作用。NERD患者反流癥狀和生活質(zhì)量、精神心理狀態(tài)顯著相關(guān)。
[Abstract]:an esophageal multi-channel internal impedance-pH monitoring and acid-perfusion test was used to evaluate the function of non-erosive reflux disease esophageal mucosa barrier: the combined acid-perfusion test and the 24-hour esophageal multi-channel intra-chamber impedance-pH (MII-pH) monitoring, To study the relationship between the dynamic changes of the esophageal impedance induced by acid in the patients with non-erosive reflux disease (NERD) and the relationship between the reflux symptoms and the widening of the gap between the esophageal epithelial cells. Methods:35 cases of NERD and 20 healthy volunteers in our hospital from September 2013 to July 2014 were selected, with 24 h MII-pH monitoring, acid-perfusion and gastroscopy. In the gastroscope,2 cm on the tooth-like line, a mucosal tissue was taken from each of the anterior and posterior walls, and the esophageal epithelial cell gap was measured by software. Results: (1) The baseline and impedance recovery rate of the esophageal far-end impedance of the NERD patients was significantly lower than that in the healthy control group (2998-701惟 vs.3880-1054惟, P0.01; 30.1-14.0 惟/ min vs. 53.0-14.5 惟/ min, P0.01). (2) The impedance baseline and the impedance recovery rate were positively correlated (r = 0.71, P0.01), and the impedance baseline and the impedance recovery rate were negatively correlated with the AET (r =-0.58, P0.01; r =-0.61, P0.01). (3) The baseline and impedance recovery rate of the esophageal impedance of the NERD patients in the acid-perfusion test was significantly lower than those in the negative acid-perfusion test (2755-680惟 vs.3411-536惟, P 0.01; 24.9-13.3 惟/ min vs. 33.7-10.3惟/ min, P0.05). (4) The clearance of the esophageal epithelial cells in the NERD patients was significantly widened in the healthy control group (1.03 to 0.20. mu.m vs. 0.66, 0.14. mu.m, P0.01). Impedance baseline and impedance recovery rate were negatively correlated with the clearance of epithelial cells (r =-0.68, P0.01; r =-0.67, P0.01). (5) There was a significant positive correlation between the esophageal epithelial cell gap (r = 0.42, P0.05; r = 0.59, P0.05) in the NERD patients. The change in the impedance of the esophageal impedance may, to a certain extent, reflect the degree of damage to the integrity of the esophageal mucosa. Objective: To study the changes of the histological structure of the esophageal mucosa and the expression of the protease-activated receptor-2 in the second non-erosive reflux disease. The changes of the structure of the esophageal epithelium of the patients with NERD were studied by the submucosal tissue biopsy under the gastroscope. The expression of protease-activated receptor-2 (PAR-2) in the esophageal mucosa of the patients with NERD was studied by immunohistochemistry, and its correlation with DIS was analyzed. Methods:59 cases of NERD and 20 healthy volunteers from August,2013 to July,2014 were selected. The histological and morphological changes of the esophageal mucosa were observed with hematoxylin and eosin (HE). Including basal layer cell proliferation, epithelial papilla extension, inflammatory cell infiltration, epithelial cell ballooning, cell gap broadening, and the like, and the expression of PAR-2 in the epithelial tissue was detected by immunohistochemistry. Results: (1) The positive rates of cell proliferation in the basal layer of the NERD group and the HS group were 84.7% and 30.0%, respectively. The extension of the epithelial papilla was 49.2% and 15.0%, respectively, and the cell infiltration of the epithelial cells was 76.3% and 5.0%, respectively, and the infiltration of the inflammatory cells was 35.6% and 10.0%, respectively. (2) The PAR-2 in the NERD group is widely expressed in the esophageal epithelial cells. The expression of PAR-2 was significantly higher in the NERD group (1.00-0.21. mu.m vs. 0.67-0.13. mu.m, P0.01), and the expression of PAR-2 was significantly higher than that in the control group (6.97-1.73 vs. 1.45-0.99, P0.01). (3) The expression of DIS and PAR-2 was positively correlated (r = 0.65, P0.01). Conclusion: There is a series of histological changes in the esophageal mucosa of the NERD patients. PAR-2-mediated pathways may be involved in the pathogenesis of NERD by redistributing the close-connexin-inducing cell gap broadening. Objective: To study the general demographic characteristics, reflux symptom spectrum, dietary habit, quality of life and mental state of patients with NERD and RE by questionnaire. The clinical characteristics of the two groups were compared, and the basis for further investigation of the pathogenesis and effective treatment of GERD was provided. Objects and Methods: The study included 105 GERD patients, of which 60 (18 males,42 females, 44.1 to 13.4 years) and 45 RE patients (22 males and 23 females, and 46.5 to 9.9 years) were included in the study. The general demographic characteristics, symptoms, diet and living habits, quality of life and mental psychology of the patients with NERD and RE were compared in the form of questionnaire. Results: (1) The incidence of anti-food symptoms and anti-food symptoms in the NERD group was lower than that of the RE group[0 (0,2) vs. 2.0 (0, 3.0), P0.05; 45.0% vs. 64.4%, P0.05], and there was no significant difference between the two groups (8.0 (6.0, 11.0) vs. 10.0 (7.0, 13.0),? 0.05]. (2) The incidence of toothache and dental caries in the NERD patients was higher than that in the RE group (41.7% vs. 8.3%, P0.01; 55.0% vs. 8.3%, P0.01), and the secondary and out-of-esophageal symptoms were significantly higher than that in the RE group[4.0 (2.0, 5.0) vs. 2.0 (1.0, 5.0), P0.05]. (3) The first five factors of the diet cause of the reflux symptom of the NERD group are: dairy product, spicy food, scallion or leek, sweet, and sour milk, the first five of the other factors other than the diet are: the mood, the eating, the food, the cold, the post-meal stooping, the sleep is not good. (4) The integration of the reflux symptoms in the NERD group was significantly higher than that of the non-psychological abnormality group (10.9% 4.7 vs. 8.3, 2.8, P0.05). (5) The scores of anxiety and depression in the patients with NERD were related to the integration of reflux symptoms (r-0.42, P0.01; r = 0.29, P0.05), and the integration of reflux symptoms was significantly related to GERD-HRQL (r = 0.49, P0.01). Conclusion: The NERD group is lighter than the RE group, but there is no significant difference between the two groups. Diet and bad habits play a role in the occurrence of NERD symptoms. There was a significant correlation between the symptoms of reflux and the quality of life and the mental state of the patients with NERD.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R571
本文編號：2507831
[Abstract]:an esophageal multi-channel internal impedance-pH monitoring and acid-perfusion test was used to evaluate the function of non-erosive reflux disease esophageal mucosa barrier: the combined acid-perfusion test and the 24-hour esophageal multi-channel intra-chamber impedance-pH (MII-pH) monitoring, To study the relationship between the dynamic changes of the esophageal impedance induced by acid in the patients with non-erosive reflux disease (NERD) and the relationship between the reflux symptoms and the widening of the gap between the esophageal epithelial cells. Methods:35 cases of NERD and 20 healthy volunteers in our hospital from September 2013 to July 2014 were selected, with 24 h MII-pH monitoring, acid-perfusion and gastroscopy. In the gastroscope,2 cm on the tooth-like line, a mucosal tissue was taken from each of the anterior and posterior walls, and the esophageal epithelial cell gap was measured by software. Results: (1) The baseline and impedance recovery rate of the esophageal far-end impedance of the NERD patients was significantly lower than that in the healthy control group (2998-701惟 vs.3880-1054惟, P0.01; 30.1-14.0 惟/ min vs. 53.0-14.5 惟/ min, P0.01). (2) The impedance baseline and the impedance recovery rate were positively correlated (r = 0.71, P0.01), and the impedance baseline and the impedance recovery rate were negatively correlated with the AET (r =-0.58, P0.01; r =-0.61, P0.01). (3) The baseline and impedance recovery rate of the esophageal impedance of the NERD patients in the acid-perfusion test was significantly lower than those in the negative acid-perfusion test (2755-680惟 vs.3411-536惟, P 0.01; 24.9-13.3 惟/ min vs. 33.7-10.3惟/ min, P0.05). (4) The clearance of the esophageal epithelial cells in the NERD patients was significantly widened in the healthy control group (1.03 to 0.20. mu.m vs. 0.66, 0.14. mu.m, P0.01). Impedance baseline and impedance recovery rate were negatively correlated with the clearance of epithelial cells (r =-0.68, P0.01; r =-0.67, P0.01). (5) There was a significant positive correlation between the esophageal epithelial cell gap (r = 0.42, P0.05; r = 0.59, P0.05) in the NERD patients. The change in the impedance of the esophageal impedance may, to a certain extent, reflect the degree of damage to the integrity of the esophageal mucosa. Objective: To study the changes of the histological structure of the esophageal mucosa and the expression of the protease-activated receptor-2 in the second non-erosive reflux disease. The changes of the structure of the esophageal epithelium of the patients with NERD were studied by the submucosal tissue biopsy under the gastroscope. The expression of protease-activated receptor-2 (PAR-2) in the esophageal mucosa of the patients with NERD was studied by immunohistochemistry, and its correlation with DIS was analyzed. Methods:59 cases of NERD and 20 healthy volunteers from August,2013 to July,2014 were selected. The histological and morphological changes of the esophageal mucosa were observed with hematoxylin and eosin (HE). Including basal layer cell proliferation, epithelial papilla extension, inflammatory cell infiltration, epithelial cell ballooning, cell gap broadening, and the like, and the expression of PAR-2 in the epithelial tissue was detected by immunohistochemistry. Results: (1) The positive rates of cell proliferation in the basal layer of the NERD group and the HS group were 84.7% and 30.0%, respectively. The extension of the epithelial papilla was 49.2% and 15.0%, respectively, and the cell infiltration of the epithelial cells was 76.3% and 5.0%, respectively, and the infiltration of the inflammatory cells was 35.6% and 10.0%, respectively. (2) The PAR-2 in the NERD group is widely expressed in the esophageal epithelial cells. The expression of PAR-2 was significantly higher in the NERD group (1.00-0.21. mu.m vs. 0.67-0.13. mu.m, P0.01), and the expression of PAR-2 was significantly higher than that in the control group (6.97-1.73 vs. 1.45-0.99, P0.01). (3) The expression of DIS and PAR-2 was positively correlated (r = 0.65, P0.01). Conclusion: There is a series of histological changes in the esophageal mucosa of the NERD patients. PAR-2-mediated pathways may be involved in the pathogenesis of NERD by redistributing the close-connexin-inducing cell gap broadening. Objective: To study the general demographic characteristics, reflux symptom spectrum, dietary habit, quality of life and mental state of patients with NERD and RE by questionnaire. The clinical characteristics of the two groups were compared, and the basis for further investigation of the pathogenesis and effective treatment of GERD was provided. Objects and Methods: The study included 105 GERD patients, of which 60 (18 males,42 females, 44.1 to 13.4 years) and 45 RE patients (22 males and 23 females, and 46.5 to 9.9 years) were included in the study. The general demographic characteristics, symptoms, diet and living habits, quality of life and mental psychology of the patients with NERD and RE were compared in the form of questionnaire. Results: (1) The incidence of anti-food symptoms and anti-food symptoms in the NERD group was lower than that of the RE group[0 (0,2) vs. 2.0 (0, 3.0), P0.05; 45.0% vs. 64.4%, P0.05], and there was no significant difference between the two groups (8.0 (6.0, 11.0) vs. 10.0 (7.0, 13.0),? 0.05]. (2) The incidence of toothache and dental caries in the NERD patients was higher than that in the RE group (41.7% vs. 8.3%, P0.01; 55.0% vs. 8.3%, P0.01), and the secondary and out-of-esophageal symptoms were significantly higher than that in the RE group[4.0 (2.0, 5.0) vs. 2.0 (1.0, 5.0), P0.05]. (3) The first five factors of the diet cause of the reflux symptom of the NERD group are: dairy product, spicy food, scallion or leek, sweet, and sour milk, the first five of the other factors other than the diet are: the mood, the eating, the food, the cold, the post-meal stooping, the sleep is not good. (4) The integration of the reflux symptoms in the NERD group was significantly higher than that of the non-psychological abnormality group (10.9% 4.7 vs. 8.3, 2.8, P0.05). (5) The scores of anxiety and depression in the patients with NERD were related to the integration of reflux symptoms (r-0.42, P0.01; r = 0.29, P0.05), and the integration of reflux symptoms was significantly related to GERD-HRQL (r = 0.49, P0.01). Conclusion: The NERD group is lighter than the RE group, but there is no significant difference between the two groups. Diet and bad habits play a role in the occurrence of NERD symptoms. There was a significant correlation between the symptoms of reflux and the quality of life and the mental state of the patients with NERD.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R571
【參考文獻(xiàn)】
相關(guān)期刊論文 前5條
1 山田哲夫 ,谷仁燁;胃食管反流病的病理組織學(xué)──反流性食管炎與賁門炎[J];日本醫(yī)學(xué)介紹;2002年01期
2 徐兆軍;張振玉;黃文斌;王勁松;姜宗丹;羅新華;;胃食管反流病患者食管上皮Occludin的表達(dá)及細(xì)胞間隙的改變[J];世界華人消化雜志;2009年27期
3 潘國宗,許國銘,郭慧平,柯美云,韓少梅,李兆申,方秀才,鄒多武,魯素彩,劉婧;北京上海胃食管反流癥狀的流行病學(xué)調(diào)查[J];中華消化雜志;1999年04期
4 Tiing-Leong Ang;Kwong-Ming Fock;Tay-Meng Ng;Eng-Kiong Teo;Tju-Siang Chua;Jessica Tan;;A comparison of the clinical, demographic and psychiatric profiles among patients with erosive and non-erosive reflux disease in a multi-ethnic Asian country[J];World Journal of Gastroenterology;2005年23期
5 ;Risk factors for gastroesophageal reflux disease,reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination[J];World Journal of Gastroenterology;2007年45期
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