24h食管pH-阻抗联合监测诊断胃食管反流病的价值评估

目的评估24 h食管pH-阻抗联合监测在诊断胃食管反流病（GERD）中的价值。方法纳入具有典型症状（反酸、烧心）或具有不典型症状（咽喉炎、咳嗽、胸痛等）但怀疑与胃食管反流相关的患者,共计142例,均进行上消化道内镜、24 h食管pH-阻抗联合监测。其中以内镜下发现反流性食管炎、DeMeester积分≥14.72及SI≥50%者定义为GERD组（59例）,余83例为非GERD组,比较两组的24 h食管pH-阻抗联合监测结果。结果 （1）24 h食管pH监测的各指标中,DeMeester积分、pH〈4的总时间（%）、pH〈4长于5 min反流次数对诊断GERD有较好的敏感性和特异性。（2）腔内阻抗监测的各项指标单独诊断GERD的敏感性一般（均在45%以下）,但酸反流合计（97.59%）、液体反流合计（97.59%）、食团清除时间（98.80%）、近端反流百分比（98.80%）等指标特异性较好。（3）与24 h食管pH监测比较,24 h食管pH-阻抗联合监测可发现更多异常反流情况（χ2=14.65,P〈0.000）。结论 pH〈4的总时间（%）、pH〈4长于5 min反流次数这两个参数指标结合DeM eester积分是判断GERD的重要指标。单独腔内阻抗监测的各项指标对诊断GERD的敏感性一般,但24 h食管pH-阻抗联合监测可弥补单纯pH监测的不足,识别更多异常反流情况。内镜＋24 h食管pH-阻抗联合监测是诊断GERD的选择。

The value of 24 h ambulatory impedance-pH in diagnosis of gastroesophageal reflux disease

Objective To investigate the value of 24h ambulatory impedance-pH in diagnosis of gastroesophageal reflux disease（GERD）.Methods One hundred and forty two patients with typical reflux symptoms or suggestive of gastroesophageal reflux were included.All patients underwent endoscopy and 24 h ambulatory impedance-pH monitoring.Among them,those with reflux esophagitis or DeMeester score ≥14.72 and SI ≥50% were defined as GERD＋ group;others were defined as GERD-group.The parameters of 24h ambulatory impedance-pH were compared between two groups.Results Among all parameters of 24h esophageal pH monitoring,DeMeester score,the total time of pH 4 and time of reflux with pH 4 for 5min had better sensitivity and specificity for diagnosis of GERD.The single parameter of multichannel intraluminal impedance had a low sensitivity（ 45%） in diagnosis of GERD.Compared to 24h esophageal pH monitoring,24h ambulatory impedance-pH detected more abnormal reflux episodes（χ2=14.65,P0.000）.Conclusion The results suggest that endoscopy combined with 24h ambulatory impedance-pH may be a better choice for diagnosis of gastroesophageal reflux disease.