胃食管反流阈值诊断食管反流性疾病

目的研究区别生理性和病理性胃食管反流性的 pH 值变化。方法胃食管反流症状患者400名及键康对照者100名接受食管内24 h 连续 pH 监测和纤维内镜检查。结果 24 h 内 pH 波动的百分时间分别是:食管炎组12.7%;非食管炎组9.5%;健康对照组2.8%。24内反流发作的百分时间为:食管炎组3.12%;非食管炎组2.04%;健康对照组0.18%。应用接受—生效—特征曲线分析法,将 pH 波动<6.7%和反流发作<0.1%确定为诊断生理性反流和病理性反流的复合阈值。应用该复合阈值对反流性食管炎的诊断敏感性为96.7%,对非食管炎的胃食管反流患者的诊断敏感性为90%;其诊断异常胃一食管反流的特异性为100%。结论将 pH 波动与反流发作两个指标作为复合闽值用于诊断胃—食管反流患者,很有价值,在诊断胃—食管反流患者时具有较高的精确度。

Thresholds of gastroesophagea reflux i the diagnosis of esophageal reflux diseases

AIMS To establish optimal thresholds of pH variation(pH fluc- tuations and reflux episodes)in separating physiological and pathological gastroesophageal reflux(GER),and to evaluate their significance in the diagnosis of GER disease. METHODS Twenty-four-hour intraesophageal pH monitoring and endoscopy were performed in 400 patients with GER symptoms and in 100 healthy controls. RESULTS The results showed that the percentages of the time with pH fluctuations in patients with and without esophagitis,and in healthy controls were,on average,12.65%,9.5% and 2. 76% in 24h,respectively,and the respective percentages of the time with reflux episodes in the same groups in 24h were,on average,3.12%,2.04% and 0.18%,respectively.Using a receiver-operating-characteristic curve analysis,<6.7% of the time with pH fluctuations and<0.1% of the time with reflux episodes were defined as the combined thresholds for physiologi- cal versus pathological reflux.The sensitivity of the combuned thresholds for the detection of GER patients with and without esophagitis was 96.7% and 90.0%,respectively,and their specificity for the diagnosis of patients with abnormal GER disease was 100%. CONCLUSIONS pH flucuations and reflux episodes,when e- valuated together,are more useful for classifying patients with GER and their combined thresholds yield higher diagnostic accura- cy in assessing patients with GER disease.