胃食管反流病pH联合阻抗监测与单纯pH监测效果的对比研究

 目的 探讨pH联合阻抗监测(multiple channel intraluminal pH-impedance reflux monitoring,MII-pH)相对于单纯pH监测在胃食管反流病(gastroesophageal reflux disease,GERD)评估中的优点,及胃食管反流病患者反流事件的特征。方法 纳入2015-06至2017-06火箭军特色医学中心胃食管反流病中心首次行MII-pH监测的成年GERD患者,分析MII-pH监测的pH通道和阻抗通道的各主要反流指标的阳性率,以及各反流指标之间的统计学关系。结果 共纳入GERD患者1780例,男889例,女891例,年龄(51.6±12.9)岁,有反酸、烧心、嗳气、胸痛、咳嗽、哮喘和咽部异物感等症状的患者分别为1026、1045、462、258、448、370、540例。pH通道的阳性率为26.3%,其中DeMeester积分的阳性率为25.4%,酸反流时间百分比的阳性率为25.4%。阻抗通道监测的阳性率为69.0%,其中反流总次数的阳性率为21.5%,液体酸反流和非酸反流次数相比有统计学差异(P＜0.001),液体酸反流和气体反流次数相比有统计学差异(P＜0.001);食团暴露时间百分比的阳性率为40.3%;症状相关性的阳性率为53.0%。MII-pH监测的总阳性率为71.3%。阻抗通道和pH通道的酸反流次数相比有统计学差异(P＜0.001)和相关性(r=0.904＞0.9,P＜0.001)。反流总量阳性率和症状相关性阳性率的McNemar卡方检验P＜0.001,Kappa=0.15;pH通道阳性率和症状相关性阳性率的McNemar卡方检验P＜0.001,Kappa=0.120。结论 MII-pH监测与单纯pH监测相比对酸反流事件的检出一致性非常高,并且更为敏感。MII-pH监测通过阻抗通道对非酸反流和气体反流的检测可显著提高GERD的检出率,并通过症状相关性分析可进一步提高GERD乃至反流高敏感(食管和气道)的检出率。

Comparative study of multiple channel intraluminal pH-impedance reflux monitoring and single pH monitoring for gastroesophageal reflux disease

Objective To explore the advantages of multiple channel intraluminal pH-impedance reflux monitoring (MII-pH) over single pH monitoring for the diagnosis of gastroesophageal reflux disease (GERD), and the characteristics of reflux episodes in patients with gastroesophageal reflux disease. Methods The data of adult GERD patients under MII-pH monitoring for the first time in our center between June 2015 and June 2017 was included. The positive rate of the main indicators of the pH channel and impedance channel of MII-pH monitoring, and the statistical relationships between the reflux indicators were analyzed. Results A total of 1780 patients with GERD were included, 889 of whom were males and 891 females, (51.6±12.9) years old. There were 1026, 1045, 462, 258, 448, 370, and 540 cases of acid reflux, heart burning, belching, chest pain, cough, asthma, and globus sensation symptom, respectively. The positive rate of the pH channel was 26.3%, of which the positive rate of DeMeester score was 25.4%, and that of acid exposure time (AET) was 25.4%. The positive rate of the impedance channel was 69%, where the positive rate of total reflux volume was 21.5%, the numbers of liquid acid reflux episodes and non acid reflux episodes were statistically different (P<0.001), and there was statistically significant difference between the number of liquid acid reflux episodes and that of gas reflux episodes (P<0.001). The positive rate of bolus exposure time (BET) was 40.3%, and the positive rate of symptom reflux association was 53%. The total positive rate of MII-pH monitoring was 71.3%. There was statistically significant difference (P＜0.001) and a statistically significant correlation (r=0.904＞0.9,P＜0.001) between the number of acid reflux episodes of the impedance channel and that of the pH channel. The difference in McNemar chi square test of the positive rate of total reflux volume and symptom reflux association was statistically significant (P<0.001, Kappa=0.15), so was the difference in McNemar chi square test of the positive rate of pH channel and symptom reflux association (P<0.001, Kappa=0.120). Conclusions MII-pH monitoring is highly consistent and more sensitive for detecting acid reflux episodes compared with single pH monitoring. Non-acid reflux and gas reflux episodes detected by the impedance channel of MII-pH monitoring can significantly improve the detection rate of GERD. Analysis of symptom reflux association can improve the detection rate of GERD and even reflux hypersensitivity (esophagus and airway).