反流性食管炎和非糜烂性反流病患者的食管动力、酸暴露与胃动素结果的分析

目的通过对胃食管反流病（GERD）患者的酸暴露情况,食管动力和胃动素结果的比较,探讨反流性食管炎（RE）和非糜烂性反流病（NERD）的不同状况,为临床治疗提供科学依据。方法健康对照18例,RE和NERD各30例参与试验,经症状评估、内镜诊断、24 h食管pH动态监测和质子泵抑制剂试验诊断入组。检测上食管括约肌静息压力（UESP）、食管体部蠕动压力（即食管近段、中段、远段压力指标）、食管蠕动波推进速度、下食管括约肌静息压力（LESP）。放射免疫方法检测血浆胃动素水平。结果 RE组、NERD组和正常对照组患者LESP、食管体部蠕动压力和蠕动波推进速度相比无统计学意义,而RE组和NERD组患者UESP低于正常对照组,差异有统计学意义（P〈0.05）。RE组和NERD组患者食管24 h pH监测指标的差异无统计学意义。NERD组和RE组胃动素水平低于正常对照组（P〈0.01）。结论 RE组和NERD组患者食管动力学和酸暴露指标无明显差异,两组胃动素水平低于正常对照组,提示胃动素在GERD的发病机制中可能起一定作用。

Analysis of esophageal acid exposure,esophageal pressure and motilin in reflux esophagitis and non-erosive reflux disease

Objective To explore the pathogenesis of reflux esophagitis（RE） and non-erosive reflux disease（NERD）,and to study their scientific basis in clinical treatment by comparing the clinical characteristics of esophageal acid,esophageal pressure and motilin in NERD and RE. Methods 30 NERD patients diagnosed by symptom evaluation,endoscope,ambulatory 24 h pH monitoring and proton pump inhibitor trial,and 48 control subjects including 30 patients with reflux esophagitis and 18 normal volunteers were enrolled in this study.Upper esophageal sphincter pressure（UESP）,peristaltic pressure of esophageal body,esophageal peristaltic driving velocity and low esophageal sphincter pressure（LESP） were detected as the evaluation index. Blood plasma of motilin（MTL） was tested by radioimmunity method.Results There was no difference of LESP,peristaltic pressure of esophageal body and esophageal peristaltic driving velocity in these three groups.Patients in RE and NERD group had a lower pressure monitoring than the patients in control group at UESP（P0.05）.There was no difference of 24 h esophageal pH monitoring points between RE and NERD.MTL level of patients in RE and NERD group was decreased compared with normal controls（P0.01）.Conclusion The findings suggest that the motilin may play an important role in the pathogenesis of GERD.