上海地区成年人胃食管反流病流行病学调查 Ⅱ: 症状与胃食管反流病的关系

在对上海地区成年人胃食管反流症状流行病学调查的基础上，对有烧心、反酸及反食等胃食管反流症状者，按症状轻重记分，根据总分将有症状者分为低分组（６～９分）、中分组（１０～１２分）及高分组（≥１３分），并按随机原则分别抽取２０、１０及１０例，进行２４ｈ食管ｐＨ监测及胃镜检查。结果发现：各有症状组异常胃食管反流（ＡＧＥＲ）及胃食管反流病（ＧＯＲＤ）发生率均明显高于对照组（Ｐ＜０．０５），高分组反流性食管炎（ＲＥ）发生率亦明显高于对照组（Ｐ＜０．０５），但各症状组间无明显差异（Ｐ＞０．０５）。４６．６７％ＡＧＥＲ患者存在ＲＥ，７７．７８％ＲＥ患者证实有ＡＧＥＲ。ＡＧＥＲ、ＲＥ及ＧＯＲＤ患病率分别为３．５８％、２．２７％及２．８６％。     

胆汁反流与胃内pH值的关系

研究胆汁反流性胃炎患者胃内 pH值与胆汁反流的关系。胆汁反流性胃炎患者 2 2例 ,应用便携式pH及胆汁监测仪同步监测胃内 2 4h的 pH值及胆红素吸收值。结果发现 ,胆汁反流时 ,胃内pH值与胆红素吸收值无相关性 (r=- 0 0 6 ,P >0 0 5 ) ;胃内pH值增高时 ,胆红素吸收值与 pH值亦无相关性 (r =0 17,P >0 0 5 )。可见 ,胃内 pH值和胆汁反流无关。因此 ,根据胃内 2 4h的pH值监测判断有无胆汁反流是不科学的 ,需监测胃内胆汁吸收值来证实胆汁反流的存在     

胃食管反应流的胃排空功能研究

目的探讨胃食管反流病（ＧＦＲＤ）胃液体、固体排空情况与ＰＨ值监测结果的相关性。方法１５例ＧＥＲＤ患分别进行胃镜检查、２４ｈ食管Ｐ 和放射性核素胃排空功能测定，与对照组液体和固体胃排空率、胃半排空时间进行比较，分析ＧＥＲＤ患液体，固体排空率与食管炎及２４ｈ ｐＨ值监测指标之间的关系。结果ＧＥＲＤ组液体胃排空率在１５、３０ｍｉｎ明显低于对照组（Ｐ〈０．０５），固体胃排空率在各时间点均低于对照组（Ｐ     

上海地区成年人胃食管反流病流行病学调查：II.症状与胃食管…

在对上海地区成年人胃食管反流症状流行病学调查的基础上，对有烧心，反酸及反食管等胃食反流症状者，按症状轻重记分，根据总分将有症状者分为低分组（６～９分）中分组（１０～１２分）从高分组（≥１３分），并按随机原则分别抽取２０，１０及１０例，进行２４ｈ食管ｐＨ监测及胃镜检查，结果发现：各有症状组异常胃食管反流（ＡＧＥＲ）及胃食管反流病（ＧＯＲＤ）发生率均明显高于对照组（Ｐ〈０．０５）。高分组反流性食管炎（     

反流性食管炎患者食管壁内NO能,VIP以神经的改变和相互关系

为探讨反流性食管炎（ＲＥ）患者食管运动障碍的发生机制，应用免疫组织化学（ＩＨＮ－Ｅｎｖｉｓｉｏｎ法）结合ＩＭＳ型彩色图像分析综合系统，对３９例ＲＥ患者及１４例正常人食管壁内一氧化氮（ＮＯ）能及血管活性肠肽（ＶＩＰ）能神经进行了定位、定量研究。结果发现，ＲＥ组食管粘膜内一氧化氮合酶（ＮＯＳ）和ＶＩＰ阳性产物与正常组相比显著增多（Ｐ〈０．０１），ＲＥ组ＮＯＳ及ＶＩＰ阳性区域的面积比和阳性强度均值与正常     

肾综合征出血热患者血清及尿液中TNF与SIL－2R的动态研究

采用双抗体夹心ＥＬＩＳＡ法，对３０例肾综合征出血热（ＨＦＲＳ）患者９６份血清及９６份尿液中肿瘤坏死因子（ＴＮＦ）及可溶性白细胞介素２受体（ＳＩＬ－２Ｒ）水平进行了动态检测。结果显示：ＨＦＲＳ患者各期尿液及血清ＴＮＦ与ＳＩＬ－２Ｒ水平均高于正常对照组（Ｐ＜０．０１），且与临床病程密切相关，尿液与血清变化水平有密切的正相关性（γ＝０．５７５２，Ｐ＜０．００１；γ＝０．５４２７，Ｐ＜０．０１），尿液中含量与尿蛋白含量呈正相关（γ＝０．３４２５，Ｐ＜０．０１；γ＝０．４４８５，Ｐ＜０．０１），血、尿中ＴＮＦ与血、尿中ＳＩＬ－２Ｒ的变化呈正相关（γ＝０．６４２５，Ｐ＜０．０１，γ＝０．６５９６，Ｐ＜０．０１）。提示：ＴＮＦ及ＳＩＬ－２Ｒ是参与ＨＦＲＳ发病机理的重要介质。     

上海地区成年人胃食管反流病流行病学调查 I:胃食管反流症状及相关因素调查

按随机原则对上海市不同地区共２５００名成年人，用当面填写问卷方式进行胃食管反流相关症状及其影响因素的流行病学调查。将烧心、反酸及反食作为提示胃食管反流病的主要症状，并根据上述三种症状轻重进行症状记分。记分≥６分为病例组，≤５分为对照组。结果发现，上海地区胃食管反流相关症状发生率为７．６８％，男女间发生率无明显差异，但不同年龄、不同职业症状发生率相差显著（Ｐ＜０．０５）。病例组中呃逆、咳嗽、喘息等症状发生率及口腔溃疡、咽喉炎、肺炎、糖尿病等疾病的发生率均高于对照组（Ｐ＜０．０５），且常有进食过饱、饮用酸性饮料等生活习惯，并常患便秘（Ｐ＜０．０５）。提示上海地区胃食管反流相关症状并非少见，且症状发生与多种因素有关。     

放射性核素显像评价心肌梗塞对心功能影响的探讨

以４０例正常人为对照，用放射性核素显像研究５０例急性或陈旧性心肌梗塞（ＭＩ）病人的左室ＭＩ部位、心肌梗塞面积（ＭＩＳ）及其对左、右心室功能的影响．方法：以左、右室射血分数（ＬＶＥＦ、ＲＶＥＦ）、最大射血率（ＰＥＲ）及最大充盈率（ＰＦＲ）作为心功能指标，用角度法测算ＭＩＳ．根据左室ＭＩ部位不同分为Ⅰ组（前壁及心尖部）、Ⅱ组（侧壁）和Ⅲ组（下壁及后壁）．并进行统计学分析．结果：Ⅰ组及Ⅱ组中ＬＶＥＦ重度下降者分别为８１．５％和６０．０％，Ⅰ组及Ⅲ组中ＲＶＥＦ重度下降者分别为２０．０％和５７．２％．Ⅰ组及Ⅱ组中ＭＩＳ与ＬＶＥＦ呈负相关（ｒ＝-０．６８），Ⅲ组中ＭＩＳ与ＲＶＥＦ呈负相关（ｒ＝-０．５１）．其中２０例大面积ＭＩ（ＭＩＳ５３．８３％±９．７４％）病人ＭＩＳ与ＬＶＥＦ呈负相关（ｒ＝-０．７２），而与ＲＶＥＦ呈正相关（ｒ＝０．６４）．结论：了解ＭＩ部位及ＭＩＳ可对心功能作出较为客观的估价．同时，了解心功能状态可初步估算ＭＩＳ的大小，有利于诊断和治疗疾病及判断病情的预后．关键词     

下体负压致兔意识丧失的监测

目的用下体负压（ＬＢＮＰ）技术建立兔意识丧失（ＬＯＣ）的模型，旨在找出一些切实可行的ＬＯＣ监测指标。方法按阶梯下降的方法，将８只兔暴露于不同的负压值下（－１．３３ｋＰａ、－２．６７ｋＰａ、－４．００ｋＰａ、－５．３３ｋＰａ和－６．６７ｋＰａ），每种负压值持续作用１ｍｉｎ，观察兔发生ＬＯＣ的动态过程，并记录有关生理指标。结果ＬＢＮＰ可致兔发生ＬＯＣ、ＥＥＧ拉平，但滞后于颈总动脉血流量（ＣＢＦ）降到零后３９．７５±６．４０ｓ；ＣＢＦ与动脉血压的变化关系密切（ｒ＝０．９７１，Ｐ＜０．０１），其直线回归方程为Ｑ＝１．４０ＢＰ－４．７２（Ｑ为ＣＢＦ，Ｑ＝０时，ＢＰ＝３．３７ｋＰａ）。结论可选用ＣＢＦ降为零作为发生ＬＯＣ的监测指标；以ＥＥＧ拉平作为监测指标，会夸大ＬＯＣ的病理损害性；离心机实验时，眼水平动脉血压降为０ｋＰａ似乎可代替ＣＢＦ作为ＬＯＣ的监测指标。     

原发性高血压患者血浆β—EP,Dyn和LEK含量变化及其临床意义

采用放射免疫分析测定对照组和原发性高血压（ＥＨ）组其治疗前后血浆阿片肽含量变化，并观察阿片肽含量变化与血压值变化间的相互关系。结果表明，与对照组相比，ＥＨ组β－内啡肽－（β－ＥＰ）和亮氨酸脑啡肽（ＬＥＫ）含量显著下降（Ｐ＜０．０１），强啡肽（Ｄｙｎ）含量显著上升（Ｐ＜０．０１），ＥＨ组经用硝苯吡啶治疗后，三种阿片肽含量显著上升，其中ＬＥＫ含量变化与平均动脉压（ＭＡＰ）变化之间有显著相关性（ｒ＝－０     

胆汁反流与胃黏膜损伤程度关系的研究

 目的 通过对不同程度黏膜损伤患者胃内胆汁反流情况的监测,研究胃内胆汁反流与黏膜损伤程度之间的关系.方法 分别对11例无黏膜病变患者,16例浅表黏膜病变患者,17例溃疡病患者进行胃内24 h胆汁监测.分析胆汁反流总时间百分比＜20%或≥20%、反流面积＜20或≥20、反流次数＜20次或≥20次、长反流次数＜10次或≥10次等指标.结果 以总反流时间百分比20%为界限 ,各组中低于或超过此标准的病例数之间,无显著差异;以总反流面积20为界限,各组中低于或超过此标准的病例数之间,溃疡病组与无黏膜病变组及浅表黏膜病变组之间差异有统计学意义(P<0.05);以总反流次数20次为界限,各组中低于或超过此标准的病例数之间无显著差异;以长反流次数10次为界限,各组中低于或超过此标准的病例数之间,溃疡病组及浅表黏膜病变组与无黏膜病变组之间差异有统计学意义(P<0.05).结论 胃内胆汁反流强度的大小以及长反流次数的多少,与形成不同程度的胃黏膜损伤具有一定关系.     

海勤人员胃食管反流发生与发病探讨

目的 探讨海勤人员胃食管反流(gastroesophageal reflux,GER)发生与胃食管反流病(gastreesophageal reflux disease,GERD)发病情况.方法 (1)航行前任意2 h、航行开始2 h后,对63名在舰艇工作的健康志愿者,连续2 h实时监测食管下端pH值;同时计算烧心感、胸骨后疼痛、反酸、反食等4种症状的程度和频度积分(symptomatic core,Sc).(2)对某部177名海勤人员和139名陆勤人员进行反流症状问卷调查(reflux diagnostic questionnaire,RDQ),按烧心感、胸骨后疼痛、反酸、反食等4种症状统计、计算RDQ积分.RDQ≥20分者为GERD组,≤15分者为非GERD组,剔除16～19分者(海勤人员39例,陆勤人员31例).(3)对2004年1月至2007年12月我科门诊患者作胃镜检查,Sc积分≥8分者入选为研究对象,胃镜检查排除食管狭窄、消化性溃疡、胃食管肿瘤等疾病后,最终入选的海勤人员187人,陆勤人员251人.结果 (1)航行前Sc积分、pH<4的总时间百分数、反流持续>5 min次数及pH<4的反流次数均显著高于航行2 h时段,症状程度及频度亦同步增加.(2)同卷调查显示:海勤人员组反流症状发生率显著高于陆勤人员组;舰龄>3年者,反流发生率明显增加;(3)Sc症状积分≥8分者,海勤人员反流性食管炎(reflux esophagitis,RE)发病率显著高于陆勤人员组;舰龄>1年者,RE发生率明显增加.结论 (1)航行时较非航行时胃食管酸反流明显增加,症状也明显加重;(2)经常航海的海勤人员反流症状发生率显著高于陆勤人员;(3)海勤人员RE发生率显著高于陆勤人员.     

胆汁反流在大鼠急性颅脑损伤后应激性溃疡中的作用

目的　探讨胆汁反流在大鼠急性颅脑损伤后应激性溃疡中的作用。方法　采用改良的Allen法建立大鼠颅脑损伤模型 ,检测应激后 1、3、6、2 4h胃液、血胆汁酸含量 ,胃液pH值与溃疡指数 ,并与假手术组对照比较。结果　应激组与假手术组相应时段比较 ,胃液胆汁酸含量明显增高 (P <0 .0 5～0 .0 1 ) ,随着应激时间的延长 ,胃内胆汁酸的含量逐渐增加 (P <0 .0 5 ) ,胃黏膜的损伤亦逐渐加重 (P <0 .0 5 ) ,其 6、2 4h组与假手术组相应时段比较差异有统计学意义 (P <0 .0 1 ) ,且胃胆汁酸含量与溃疡指数呈正相关 (r =0 .5 5 ,P <0 .0 1 ) ,而应激组与假手术组血中胆汁酸含量及胃内pH值的变化则不大 (P >0 .0 5 ) ,它们与溃疡指数之间亦无相关性 (P >0 .0 5 )。结论　胆汁反流参与颅脑损伤应激性溃疡的发病 ;胆汁反流程度与胃黏膜损伤程度呈正相关     

Brain processing of visceral sensation upon esophageal chemical stimulation in different types of GERD

We designed to investigate the cortical response to esophageal acid exposure in different types of gastroesophageal reflux disease (GERD) by functional magnetic resonance imaging (fMRI). Fifteen healthy volunteers, 13 with reflux esophagitis (RE), 12 with non-erosive reflux disease with abnormal acid reflux (NERD+) and nine with non-erosive reflux disease with normal acid reflux (NERD−) received intraesophageal perfusion with isotonic saline followed by 0.1 N hydrochloric acid. Modified block-design model of fMRI scanning was performed simultaneously to the intraesophageal perfusion. The sensitized regions in different types of GERD were not completely identical but were more widely distributed compared to the sensitized regions in the healthy individuals. The activated intensity of the ACC was significantly higher in the healthy volunteers compared to the GERD patients (P < 0.001). Nevertheless, healthy volunteers exhibited a significantly lighter intensity in the right side of the DLPFC (P < 0.001) and a lower intensity in the left side of the insula than the GERD patients (P < 0.05). In conclusion, the underlying central mechanisms of esophageal visceral sensation in different types of GERD patients are quite different. The deactivation of the ACC, the activation of the right side of the DLPFC and the right side of the insula may play an important role in the occurrence of GERD.     

一种改进的可连续检测肠胃返流的便携式光纤传感器

目的：改进了一种可在临床检测中在线长时间监测肠胃返流的方法。方法：改进了一种可供内科医生使用的改进了的光纤传感器。该传感器原理主要基于被分析物质(胆红素)在分析波长下的特征吸收。整个测量系统由两个发光二极管做光源，一个分叉的光纤柬和检测电路组成。结果：该传感器可达到10mg／dl的线性范围，应用该传感器研究了pH对样品检测影响。离体实验表明，该传感器更加适合在酸性条件下使用，也可在胆汁条件下使用。结论：该传感器具有良好的准确性和灵敏度。随着进一步的发展，传感器可制作得容易携带，紧凑和更加经济，以利于生物医学检测分析。     

Gastroesophageal reflux: comparison of barium studies with 24-h pH monitoring

OBJECTIVE: To determine the correlation between massive gastroesophageal reflux (GER) on barium studies and pathologic acid reflux on 24-h pH monitoring. METHODS: A search of hospital records from January 1997 to January 2001 revealed 28 patients who underwent both barium studies and 24-h pH monitoring. The radiologic reports were reviewed to determine the presence and degree of GER. Patients with reflux to or above the thoracic inlet either spontaneously or with provocative maneuvers in the recumbent position were classified as having massive reflux, whereas the remaining patients with reflux below the thoracic inlet or no reflux comprised the control group. The pH monitoring reports were also reviewed to determine if pathologic acid reflux was present in the recumbent position. The findings on these studies were then compared to determine the frequency of pathologic acid reflux in the recumbent position on pH monitoring in patients with massive reflux on barium studies compared with the control group. RESULTS: Massive GER was observed on barium studies in 11 (39%) of the 28 patients and reflux below the thoracic inlet or no reflux in the remaining 17 patients (61%) who comprised the control group. All 11 patients (100%) with massive reflux on barium studies had pathologic acid reflux on pH monitoring in the recumbent position compared with six (35%) of 17 patients in the control group (P = 0.0009). The pH in the distal esophagus on pH monitoring was less than 4.0 for 13.1% of the recumbent period for patients with massive GER on barium studies compared with 6.2% of the recumbent period for the control group (P = 0.0076). CONCLUSION: Although 24-h pH monitoring remains the gold standard for the detection of GER, our experience suggests that patients with massive reflux on barium studies are so likely to have pathologic acid reflux in the recumbent position that these individuals can be further evaluated and treated for their gastroesophageal reflux disease (GERD) without need for pH monitoring.     

胃食管反流病24小时食管pH监测分析

目的探讨24小时食管pH的监测对胃食管反流的诊断价值及内镜阴性患者是否存在反流。方法对95例有胃食管反流症状者进行24小时pH监测，根据检测结果，分析得出Johnson DeMeester计分。用pH〈4．0的总时间百分比、Johnson DeMeester计分进行分析。结果食管黏膜酸暴露pH〈4．0的总时间百分比越长、Johnson DeMeester计分越高，临床症状及食管炎程度就越重；Johnson DeMeester计分内镜阳性（食管炎）组明显高于内镜阴性组（P〈0．05）内镜阴性组食管黏膜酸暴露异常仅为36．59％（15／41）。结论食管炎患者有明显的胃食管反流，且反流症状的发生、程度、镜下食管炎表现与食管酸反流密切相关，部分内镜阴性患者反流症状的发生不伴有酸反流。     

Gastroesophageal reflux--the acid test: scintigraphy or the pH probe?

The best established technique for diagnosing gastroesophageal reflux in children is the 24 hr esophageal pH probe test. No simultaneous comparison of this technique with radionuclide scans has been reported. Therefore, simultaneous 1 hr pH monitoring and gastroesophageal scintigraphy were performed in 49 infants and children with suspected gastroesophageal reflux. Forty-seven of these patients also were later monitored by the 24 hr pH probe test. Upper gastrointestinal series were performed on all patients. All patients with a positive 1 hr pH monitoring also had positive simultaneous scintigraphy. All patients with positive scintigraphy and pH probe monitoring also had a positive upper gastrointestinal series for reflux. The sensitivity of gastroesophageal scintigraphy, when compared to the 24 hr probe as a standard, was 79%; its specificity was 93%. The sensitivity of the upper gastrointestinal series was 86%, when compared to the 24 hr pH probe test. However, it specificity was only 21%.     

Barium study associated with water siphon test in gastroesophageal reflux disease and its complications

PURPOSE: The aim of this study was to evaluate the role of digital cineradiography associated with the water siphon test (WST) in the diagnosis of gastroesophageal reflux and to compare the results with oesophageal motility study, pH monitoring and endoscopy associated with biopsy and histology. MATERIALS AND METHODS: One hundred and sixty consecutive patients underwent digital cineradiography with WST, motility study, pH monitoring and endoscopy with biopsy. The presence of gastroesophageal reflux, oesophagitis, Barrett's oesophagus and intestinal metaplasia was evaluated. RESULTS: WST vs. pH monitoring showed sensitivity of 71%, specificity of 31%, positive predictive value (PPV) of 53% and negative predictive value (NPV) of 50%; when middle-proximal refluxes only were considered, sensitivity decreased to 45% and specificity increased to 55%. Furthermore, the association between reflux and oesophagitis demonstrated by the chi-square (chi(2)) test proved to be statistically significant both for WST and pH monitoring, whereas the association between reflux and Barrett's oesophagus was not significant for either WST or for pH monitoring. With regard to intestinal metaplasia, WST (middle-proximal refluxes) showed higher sensitivity (64% vs. 58%) and specificity (63% vs. 51%) than pH monitoring, whereas the statistical association between reflux and metaplasia proved to be significant for WST but not for pH monitoring. CONCLUSIONS: WST is a simple, inexpensive and reliable test that might be useful in the diagnosis of gastroesophageal reflux disease (GERD). A positive WST might be an additional indication for endoscopy with biopsy.