24小时食管pH值监测在小儿支气管哮喘诊治中的应用

目的探讨胃食管返流（ＧＥＲ）与小儿支气管哮喘的关系，了解２４小时食管ｐＨ值监测在小儿哮喘诊治中的作用。方法用便携式２４小时ｐＨ自动记录仪，监测３８例支气管哮喘患儿食管下端ｐＨ值变化，３０例无症状儿为对照组，对１５例合并病理性ＧＥＲ患儿进行抗返流治疗，复查８例。结果哮喘组８项返流指标均显著大于对照组（Ｐ＜０．０１），其病理性ＧＥＲ的检出率为３９％（１５／３８），显著高于对照组（１／３０）（Ｐ＜０．０１）；小儿哮喘合并病理性ＧＥＲ者其返流以卧位和夜间时严重；经雷尼替丁抗返流治疗后，各项返流指标除了立位ｐＨ＜４时间百分比外，均显著下降（Ｐ＜０．０１或＜０．０５），近期随访结果显示，哮喘得到有效控制。结论ＧＥＲ是诱发小儿哮喘发作的一个重要因素，哮喘合并病理性ＧＥＲ的患儿对制酸药物抗返流治疗有良好的反应，２４小时食管ｐＨ值监测在小儿哮喘的病因诊断和疗效观察上有重要的应用价值。

The usefulness of 24 hours esophageal pH monitoring in diagnosing and in assessing the efficacy of treatment in asthmatic children

Objective To study the relationship between gastroesophageal reflux (GER) and bronchial asthma in children and to understand the usefulness of 24 hours esophageal pH monitoring in diagnosing and in assessing the efficacy of treatment in asthmatic children. Methods The distal esophageal pH monitoring was performed in 38 children with bronchial asthma using a Synectics Digitrapper System for ambulatory pH recording. Thirty asymptomatic children served as controls. The pH monitoring was repeated in 8 cases of pathological GER after antireflux treatment. Results All parameters were significantly higher in patients with asthma than those in controls ( P <0.01). Fifteen cases in 38 asthmatic children (39%) were considered to be pathological GER, while 1 out of 30 control subjects had pathological GER (3%) ( P <0.01). The degree of reflux was more serious at lying position or in nighttime than at standing position or in daytime. All parameters except for the percentage of time of pH<4 at standing position decreased significantly and the symptoms were controlled obviously after antireflux treatment with oral ranitidine for asthmatic children with pathological GER ( P<0.01 or 0.05). Conclusion GER is a specific etiologic factor of asthma in children. A favorably therapeutical response to antireflux drug was obtained in asthmatic children with pathological GER. 24 hours esophageal pH monitoring plays a significant role in etiologic diagnosis and in the evaluation of efficacy of treatment for children with bronchial asthma.