固态和水灌注高分辨率测压系统检测食管功能一致性的研究

背景:固态高分辨率测压(SHRM)和水灌注高分辨率测压(WHRM)系统的物理性能特征和测压原理有着本质上的不同,两种HRM对食管测压结果的一致性尚未清楚。目的:比较两种HRM检测食管功能的一致性,并探讨基于SHRM的芝加哥标准是否适用于WH-RM。方法:对健康志愿者和有反流、烧心、胸痛等症状的患者分别行SHRM和WHRM检查。比较两种HRM的食管动力学参数和单次吞咽蠕动类型变化。结果:除上食管括约肌静息压(UESP)外(P=0.086),SHRM的食管动力学指标均明显高于WHRM(P<0.05)。Bland-Altman法表明两种HRM的测压结果一致性差,在临床上不能互相替代。WHRM较SHRM能诊断更多的无蠕动、小缺损和大缺损弱收缩类型(P<0.05)。在所有380次吞咽中,6次吞咽被SHRM判断为高幅蠕动,而WHRM判断为正常蠕动。结论:两种HRM检测食管功能的一致性欠佳,目前基于SHRM的芝加哥标准并不适用于WHRM技术,因此有必要制定基于WHRM数据的食管动力障碍性疾病的诊断标准。

Consistency between Solid-state and Water-perfused High-resolution Manometry in Testing Esophageal Function

The physical performance characteristics and manometry principle are completely different between solid-state high-resolution manometry （SHRM） and water-perfused high-resolution manometry （WHRM）. The consistency between SHRM and WHRM in esophageal manometry has not yet been known. Aims： To investigate the consistency between SHRM and WHRM in testing esophageal function and to explore whether the Chicago classification based on SHRM is also suitable to WHRM. Methods： Both SHRM and WHRM were performed in a same group of healthy volunteers and patients with regurgitation, heartburn or chest pain on 2 separate days. Changes of esophageal motility parameters and esophageal peristalsis subtype of individual swallows were compared between SHRM and WHRM. Results ： All esophageal motility parameters detected by SRHM except upper esophageal sphincter pressure （UESP） （P = 0. 086） were significantly more higher than those detected by WHRM （ P 〈 0.05 ）. Bland-Ahman assay showed that the consistency between SHRM and WHRM was low, and the two methods could not be interchangeable in clinical practice. The diagnosis rates of falied contraction and week contraction with small break or large break in WHRM were significantly than those in SHRM （P 〈 0.05）, while WHRM missed 6 hypercontractile contractions which were detected by SHRM in 380 contractions. Conclusions： Manometric results obtained by SHRM and WHRM have poor consistency. The Chicago classification is not suitable to WHRM, therefore it is needed to establish a diagnostic criteria for esophageal motility disorders based on WHRM.