胃食管反流病不同亚型食管酸暴露及发病机制的差异

目的比较反流性食管炎（reflux esophagitis，RE）和非糜烂性反流病（nonerosive reflux disease，NERD）不同亚型食管酸暴露情况，探计其发病机制的差异。方法115例具有典型反流症状的患者进行胃镜及24小时食管pH监测。结果①115例中26例（22．6％）为RE，89例（77．4o．4）为NERD，RE中pH监测阳性率高于NERD92．3％（24／26）VS74．2％（66／89）（P〈0．05），包括DeMeester积分[64．55（128．28）VS26．60（59．11）]在内的全部pH监测指标均高于NERD（P〈0．05或〈0．01）。②REPH监测阳性组（RE＋）与NERDpH监测阳性组（NERD＋）的24小时pH〈4时间百分比[17．6％（38．8％）VS9．0％（20．3％）]，卧位pH〈4时间百分比[18．3％（49．3％）VS6．5％（18．4％）]，pH〈4长于5分钟的次数[15．00（19．00）次VS5．00（8．25）次]及DeMeester积分[69．70（120；47）分VS35．58（64．97）分]，（P〈0．05或〈0．01）。③中重度RE包括DeMeester积分[151．70（124．24）分VS49．93（57．92）分]在内的多项pH监测指标均高于轻度RE（Pd0．05或〈0．01）。轻度RE多项pH值监测指标的中位数比NERD＋高。④NERDpH监测阴性组（NERD-）症状的发生与病理性酸反流无关。结论病理性酸反流是导致RE黏膜损害的主要因素，食管酸暴露程度越重，食管炎症越重。NERD＋症状发生与病理性酸反流相关。NERD＋和RE可能为同一疾病谱中程度递增的病变。在NERD-组中，内脏高敏感是症状指数（symptomindex，SI）阳性组症状发生的主要机帝】_，而SI阴性组症状的发生与酸无关。

Differences of esophageal acid exposure and pathogenesis for different subtypes of gastroesophageal reflux disease

Objective To compare the characteristics esophagitis（RE） and non-erosive reflux disease（NERD） and of esophageal acid exposure among subtypes of reflux to explore their pathogenesis. Methods A total of 115 patients with typical reflux symptoms underwent gastroscopy and esophageal pH monitoring. Results （1） 26 cases （22.6%） of 115 patients were RE, the other 89 cases were NERD. The abnormal pH monitoring rate （92.3% vs 74.2%） and all parameters of pH monitoring including DeMeester score （64. 55[128.28] vs 26.60[59.11]） in the RE group were significantly higher than those in the NERD group （ P 〈 0.05 or 〈 0.01）. （2） RE with positive pH monitoring（RE＋） subgroup had more the percentage of time that pH〈4 in 24 hours（17.6%[38.8%] vs 9.0% [20.3%]） ,the percentage of time that pHi4 in recumbent position（18.3%[49.3%] vs 6.5%[18.4%]） ,long reflux episodes（15. 00119.00] times vs 5.00[8.25] times） and DeMeester score（69.70[120.47] marks vs 35.58[64.97] marks） compared to NERD with positive pH monitoring（NERD＋） subgroup（ P〈0.05 or 〈0.01）. （3）The majority of parameters of pH monitoring in the moderate and severe RE were significantly higher than those in the mild（ P 0.05 or 〈0.01）. The medians of most parameters of pH monitoring in the mild RE were higher than those in the NERD＋ subgroup, though without significant difference. （4）Reflux symptoms were unrelated to abnormal acid reflux in the NERD with negative pH monitoring（NERD--） subgroup. Conclusion Abnormal acid reflux is a major factor in the mucosaI injury of RE. The acid exposure of esophagus is heavier, the inflammation is more severe. Reflux symptoms are related to abnormal acid reflux in NERD＋ subgroup. NERD＋ may be a milder form,while RE may be a more severe one in the same spectrum of disease. Visceral hypersensitivity plays a primary role in the pathogenesis of NERD--SI＋ subgroup. Reflux symptoms are unrelated to acid in the NERD- SI- subgroup.