胆汁和胃泌素在小儿胃食管反流病中的作用

目的：探讨酸和胆汁反流在小儿胃食管反流病(GERD)中的发生情况以及胆汁和胃泌素在小儿GERD中的作用。方法：根据内镜检查结果将GERD分为反流性食管炎(RE)组和非糜烂性反流病(NERD)组,共检测42例。同时应用便携式食管pH监测仪及胆汁监测仪对其进行24hpH监测及胆汁联合监测,对相应病例采用放射免疫测定法进行空腹血清胃泌素(GS)测定,同期检测13例无胃食管反流症状并排除了消化道及严重全身器质性疾病的儿童作为对照。结果：42例患儿中24例为RE(内镜检查存在食管下段黏膜充血等病损),18例为NERD(内镜检查黏膜正常)。GERD患儿pH<4及胆红素吸收值≥0.14的总时间百分比、酸及胆汁反流的总次数和反流>5min的次数均明显高于正常对照组(P<0.05),RE组的食管酸暴露时间(pH<4)及胆红素吸收值≥0.14的时间百分比较NERD组明显增高(P<0.05)。NERD组6例(33.3%)、RE组16例(66.7%)出现酸和胆汁混合反流(P<0.01)。RE组和NERD组血清GS浓度均明显高于正常对照组(P<0.01,P<0.05),且RE组的血清GS浓度明显高于NERD组(P<0.05)。结论：小儿GERD中以混合反流为主,胆汁反流在小儿GERD的发病中起一定作用,GS的分泌异常可能参与了小儿GERD的发病过程。在小儿GERD的发展过程中,GS和胆汁反流可能起正性协同作用。     

儿童非糜烂性反流病与反流性食管炎症状及酸反流比较

目的比较非糜烂性反流病（NERD）与反流性食管炎（RE）临床症状及食管酸暴露特点。方法将127例胃食管反流病（GERD）患儿根据内镜检查结果分为NERD组和RE组,分别对两组的临床症状及食管24hpH值监测结果进行比较。结果127例中NERD79例（62.2%）,RE48例（37.8%）,RE组Ⅰ、Ⅱ、Ⅲ级分别为34、10和4例。NERD组和RE组pH监测阳性者分别为51例（64.6%）和30例（62.5%）,两组阳性率差异无统计学意义（χ^2=0.05,P〉0.05）。NERD组呕吐/反食、腹痛及食管外症状的发生率较RE组高,差异有统计学意义（P〈0.05）,而反酸、烧心/胸骨后痛的发生率两组差异无统计学意义（P〉0.05）。RE组总反流次数及pH值〈4的百分比显著高于NERD组（P〈0.05）;pH值监测阳性的RE组各项酸反流指标均大于pH监测阳性的NERD组,差异均有统计学意义（P〈0.05）;Ⅰ级、Ⅱ级和Ⅲ级RE患儿之间的各项pH监测指标差异无统计学意义（P〉0.05）。结论儿童NERD患者的不典型反流症状和食管外症状发生率更高。GERD的发生与胃酸反流密切相关,酸暴露持续时间延长及反流频率增加可能是导致RE的重要因素,酸反流量与RE的严重程度无明确关系。     

动态胃、食管双pH监测小儿胃食管反流

目的 判断小儿胃食管反流病（GERD）的类型,提高GERD的诊断率。方法 采用晶体锑双pH微电极对临床疑诊GERD患儿65例进行食管下段和胃底部pH值24h动态监测。结果 29例（44．6％）有酸性胃食管反流,4例（6．1％）有碱性胃食管反流,总检出率50．7％,两组各项反流指标与对照组相比差异有显著意义。结论 动态胃、食管双pH监测能较准确地判定反流的有无及其类型,并提高GERD的诊断率。     

近端食管胃酸反流与胃食管反流患儿呼吸道症状的关系

目的了解胃食管反流(GER)患儿近端食管胃酸反流与呼吸道症状发生的关系。方法采用食管双pH动态监测法，对31例单纯性呕吐、23例伴有反复呼吸道症状的GER患儿同时监测食管近端和远端pH值的变化，以35例健康儿作为对照组。结果单纯呕吐组远端食管各项酸反流指标、近端食管酸反流指标除最长反流时间外均大于对照组，差异有显著性；呼吸道症状组远端食管、近端食管各项酸反流指标均大于对照组，差异有显著性；但单纯呕吐组与呼吸道症状组相比较，无论在近端食管还是在远端食管，各项指标的差异无显著性；病例组远端食管各项酸反流指标均大于近端食管，差异有显著性。结论近端食管酸反流并不是GER患儿发生呼吸道症状的主要因素，而远端食管酸反流是小儿GER的主要反流形式。     

儿童胃食管反流病与血浆促胃液素、胃动素的关系

目的 了解儿童胃食管反流病(GERD)与血浆促胃液素、胃动素的相关性,探讨儿童GERD的发病机制。方法 对30例有明显胃食管反流症状患儿作24 h食管动态pH监测的同时测定血浆促胃液素、胃动素浓度,并与正常对照组进行比较。结果 观察组血浆促胃液素浓度较对照组有所下降,经统计学处理无显著性差异。观察组血浆胃动素浓度较对照组浓度有所升高,经统计学处理,差异也无显著性。结论 儿童GERD患者血浆促胃液素水平变化不大,酸反流发生并不是由于胃酸分泌增加而是抗反流的防御机制下降所致。     

24小时食管动态pH-阻抗联合监测评估小儿胃食管反流性咳嗽的临床特征

目的 探讨24 h食管动态pH-阻抗联合监测对以慢性咳嗽为主要表现的胃食管反流病（GERD）患儿的临床表现及反流特征的评估价值。方法 对2012年2月至2013年7月40例南京医科大学附属南京儿童医院门诊及住院的可疑胃食管反流性咳嗽（RERC）患儿,利用24 h食管pH-阻抗联合监测GERD患者的各项指标。结果 40例慢性咳嗽患儿中,单纯用24 h食管pH监测符合GERD的患儿有23例（57.5%）,利用24 h食管动态pH-阻抗联合监测符合GERD的患儿有34例（85.0%）,明显高于单纯用24 h食管pH监测的结果。且在小儿慢性咳嗽中主要是在直立时弱酸反流和酸反流为主（P＜0.05）,同时发生频率最高的在直立状态下的混合反流（P＜0.05）,而食团清除时间在直立与仰卧时差异无统计学意义（P＞0.05）,近端反流是以仰卧位为主（P＜0.05）。总反流次数与症状指数（SI）呈正相关（r = 0.818,P＜0.05）。结论 利用24 h食管动态pH-阻抗联合监测技术可以检出酸反流、弱酸反流和非酸反流,使GERD的诊断更精确,对以慢性咳嗽为主要表现的GERD有着重要的诊断价值,具有较好的临床应用前景。     

小儿慢性咳嗽与胃食管反流的关系

目的探讨小儿慢性咳嗽与胃食管反流(GER)的关系。方法对170例慢性咳嗽患儿进行24h食管pH监测,32例无症状小儿作为对照。结果病例组各项食管酸反流指标如酸反流次数、反流≥5min次数、最长反流时间、酸性反流指数及Boix-Ochoa综合评分均高于对照组,差异有统计学意义(Z=3.025～4.661,P均<0.01)。根据GER诊断标准,病例组GER检出率为37.1%(63/170例),高于对照组的3.1%(1/32例),差异有统计学意义(χ2=14.327,P<0.01)。2个月～1岁组、～3岁组和>3岁组的GER阳性率分别为47.4%(27/57例)、41.5%(17/41例)和26.4%(19/72例),差异有统计学意义(χ2=6.453,P<0.05)。结论GER与小儿慢性咳嗽关系密切,尤其是3岁以下的婴幼儿;食管pH监测对于明确小儿慢性咳嗽的原因有重要的临床价值。     

小儿胃食管反流病24小时食管pH监测1160例体会

为探讨24h 小时pH监测在小儿胃食管反流病（GERD）诊治中的作用,本院应用例携式24hpH自动记录仪对临床疑诊GERD患儿1160例进行1252次监测,报告如下。     

小儿胃食管反流病104例分析

目的　探讨小儿胃食管反流病 (GERD)的临床特点与诊断。方法　对 10 4例GERD患儿的临床资料进行回顾性分析。结果　小儿GERD以新生儿期和婴幼儿发病较多 ,<3岁者占 75 0 % (78/ 10 4)。临床表现除有呕吐、溢乳等反流症状外 ,80 8%具呼吸道症状表现。部分患儿仅表现呼吸道症状 ,反流症状反而不明显。 91例监测 2 4h食管 pH ,89例异常 ,检出率 97 8%。卧位时各项反流指标均大于立位时。 2 8例行食管钡剂造影阳性2 3例 ,诊断阳性率 82 1%。 10例食管内镜检查 3例有食管炎 ,其中 1例食管溃疡伴Barrett食管。结论　小儿胃食管反流临床表现复杂 ,缺乏特异性 ;2 4h食管 pH监测是首选的诊断方法 ,不仅可以发现反流 ,还可以了解反流程度 ;食管X线检查仍可作为小儿GER常用的诊断方法 ;内镜检查和食管粘膜病理检查有助于尽早发现食管病变 ,增加食管炎的检出率     

婴幼儿胃食管反流与呼吸道感染的关系探讨

目的探讨婴幼儿阶段胃食管反流与呼吸道感染的关系。方法用便携式24h食管pH监测仪记录食管下端pH值变化。观察组89例,平均年龄(10.5±0.9)个月,系因下呼吸道感染在呼吸科病房住院患儿,符合下述3条件之一①3个月内有下呼吸道感染史≥1次;②咳嗽喘息经过治疗≥半个月仍不愈;③溢乳史。对照组为26例健康儿,平均年龄(13.7±2.1)个月。结果观察组5项反流指标均高于对照组,差异有显著性(P均<0.001)。观察组病理性GER的检出率为79.8%(71/89例),显著高于对照组(χ2=49.554,P<0.01)。呼吸道感染合并GER的患儿在总反流次数、反流时间≥5min的次数和最长反流时间上婴儿高于幼儿,差异有显著性(P<0.01或<0.05);总pH<4时间百分比和综合评分也是婴儿较幼儿高(P<0.01)。呼吸道感染合并GER的患儿体重偏重眼体重大于第80百分位(P80)演占40.8%(29/71例)。婴儿GER患儿中体重偏重者占一半,与幼儿GER相比,差异有显著性。结论在婴儿期胃食管反流症状较幼儿期常见,溢乳和体重偏重有关;婴幼儿时期胃食管反流病与反复呼吸道感染、呼吸道炎症不愈以及部分哮喘有关。     

Reflux nephropathy

This article reviews current concepts of reflux nephropathy, including the pathophysiology, diagnosis, relationship to infection, role in causing end-stage renal disease, and appropriate treatment and management. The condition is defined from a epidemiologic point of view herein, and attention also is given to possible progressions this condition can take.     

尿道膀胱反流的临床研究

目的 探讨人体是否存在尿道膀胱反流及其临床意义。方法 首次应用同位素检查方法对９例反复下尿路感染患儿和正常对照组３例儿童进行研究。结果 证实人体中尿道膀胱反流（ＵＶＲ）的存在。结论 尿道器质或功能性异常所引起的尿流改变及尿道外括约肌（ＥＵＳ）异常收缩是产生ＵＶＲ的重要机制。ＵＶＲ不但能诱发尿道感染（ＵＴＩ），并且是ＵＴＩ迁延不愈的重要因素。     

Reflux uropathy

Although much remains to be learned, most pediatric nephrologists and urologists are now in comfortable agreement with the following assumptions: (1) Most reflux (primary reflux) is due to a congenital anatomic abnormality of the bladder trigone. (2) In many instances this anomaly improves with growth and development of the child so that the reflux may cease spontaneously. In low-grade (I-II) reflux with undilated ureters, approximately 75 to 85 per cent will stop refluxing. In higher grades (III-V) with dilated ureters, the cessation rate is in the range of only 25-30 per cent. (3) Although radiologic grading is helpful in predicting the likelihood of spontaneous cessation, it is possible to improve that predictability by cystoscopic evaluation of the size, configuration, and position of the ureteral orifice plus the length of the submucosal tunnel. (4) Reflux in combination with bacteriuria can and does lead to renal scarring. (5) Renal scarring probably does not occur in patients with primary reflux and normal voiding pressures in the absence of bacteriuria. (6) Renal growth may proceed normally despite sterile reflux. (7) A few refluxing patients, perhaps 10 per cent, will have bacteriuria despite continuous antimicrobials, and these "breakthrough" infections may cause renal scars. (8) Other patients prove either unwilling or unable to comply with continuous medications and are also vulnerable to scars. (9) A successful antireflux operation may not change the recurrence rate of urinary tract infections per se, but it almost eliminates the likelihood of pyelonephritic episodes and the necessity for further continuous antibiotics. Unfortunately, in patients with intermediate grades of reflux, it is not presently known whether an early surgical correction might be more effective in allowing normal renal growth, in avoiding renal scars, and in preventing eventual hypertension, which is present as a late complication in almost 20 per cent of the patients. The data to answer this important question should ultimately be forthcoming from the current International Collaborative Reflux Study.     

Reflux nephropathy

Vesicoureteral reflux may be associated with abnormalities of the renal parenchyma. The purpose of this review is to define what the parenchymal abnormalities are histologically, what their etiologies may be, how they are identified and what their long-term clinical impact may be. Two categories are recognized, renal dysplasia and post-infection, chronic pyelonephritis. The diagnostic gold standard is microscopic evaluation of biopsy specimens but renal scintigraphy can be used in the diagnosis of renal dysplasia versus chronic pyelonephritis. Potential long-term sequelae of reflux nephropathy include hypertension and renal insufficiency although these may occur infrequently. A review of the current literature is provided.     

Der gastro-oesophageale Reflux

Summary Five children who were operated upon for esophageal atresia, were examined by lateral fluoroscopy with TV control, because they were suffering from recurring bronchitis and bronchopneumonia. In all these cases we found a normal anastomotic side, which showed frequently a barrier for passage of the bolus. This happened also without any manifested stenoses at the anatomotic level. Therefore the former upper esophageal pouch constituted a little reservoir. In all these cases we also observed a very manifest esophageal reflux. With each refluxwave the former upper pouch was refilled again, and reflux was seen from this part into the oro and laryngopharynx with cough and occasional aspiration. We are convinced that these phaenomena are responsible to the recurring bronchitis and bronchopneumonia. For treatment we suggest no eating, 2–3 hours before sleeping and elevating of the cranial upper part of the bed. It is possible, that an antireflux operation like fundoplicatio may be indicated.     

小儿膀胱输尿管返流的临床研究

目的　探讨小儿膀胱输尿管返流的临床特征、治疗和预后。方法　对 5 8例小儿膀胱输尿管返流的临床资料进行回顾性研究。结果　原发性膀胱输尿管返流 31例 (5 3 % ) ,继发性返流 2 7例 (4 7% ) ;大多数在婴幼儿期发病 (5 5 % ) ,无特异性临床表现 ;返流越严重 ,肾瘢痕形成率越高 ,蛋白尿及高血压与肾功能损害有关 ;持续小剂量抗菌药物预防性治疗对返流治疗有效率达 71%。结论　早期诊断、及时治疗对小儿膀胱输尿管返流预后十分重要。