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投稿时间：2018-09-15 网络发布日期：2019-06-21
投稿时间：2018-09-15 网络发布日期：2019-06-21
中文摘要: 目的 运用食管高分辨率测压(HRM)观察胃食管反流病(GERD)患者胃食管交界处(EGJ)形态分型与食管运动功能的关系,探讨GERD发生机制,为GERD的诊治提供依据。方法 收集2013年1月至2015年12月确诊为GERD且接受HRM检查的患者,根据芝加哥标准3.0将EGJ形态分为Type-Ⅰ型、Ⅱ型、Ⅲ型,对各亚型的一般资料、体部蠕动动力参数、有效收缩率、食管上括约肌(UES)处压力特点进行比较。结果 共纳入196例GERD患者,EGJ形态各亚型例数分别为Type-Ⅰ型142例、Ⅱ型33例、Ⅲ型21例。三型年龄分别为(47.7±11.01)岁、(53.3±13.19)岁、(55.0±14.01)岁,组间差异有统计学意义(F=4.812,P=0.009)。三型BMI值分别为(22.09±3.33)kg/m2、(23.72±3.17)kg/m2、(25.68±4.60)kg/m2,比较组间差异有统计学意义(F=9.547,P=0.000)。三型男女比例比较差异均无统计学意义(χ2=4.987,P=0.083)。三型食管下括约肌（LES）上11 cm处收缩波幅分别为(54.08±29.59)mm Hg、(37.43±26.88)mm Hg、(33.39±17.56)mm Hg,比较差异有统计学意义(F=8.339,P=0.001)；EGJ形态分型与LES上11 cm处波幅呈负相关(相关系数r=-0.236,P=0.002)。三型DCI、LES上3 cm处收缩波幅、LES上7 cm处收缩波幅、有效收缩率等参数比较差异均无统计学意义(P>0.05)。三型UES静息压、UES残余压、UES松弛至最低点时间、UES松弛持续时间及松弛恢复时间,比较差异均无统计学意义(P>0.05)。结论 EGJ形态分型与年龄、BMI有关,与性别无关。EGJ形态改变使LES上11 cm处食管动力发生变化,但并不影响食管体部远段和食管上括约肌的收缩功能。
中文关键词: 食管高分辨率测压 胃食管反流病 胃食管交界处 食管动力；食管下括约肌；收缩；松弛
Abstract:ObjectiveTo observe the relationship between esophagogastric junction(EGJ) typing and esophageal motor function under high resolution manometry (HRM) in patients with gastro-esophageal reflux disease (GERD),and to explore the mechanism of GERD and to provide evidence for the diagnosis and treatment of GERD. Methods The patients who were diagnosed as GERD and examined by HRM in Liyuan Hospital from January 2013 to December 2015 were selected as study object.According to Chicago Standard 3.0,the morphology of EGJ was classified into Type-Ⅰ,Type-Ⅱ and Type-Ⅲ.The general data,body peristaltic dynamic parameters,effective contraction rate and pressure characteristics of upper esophageal sphincter (UES) of each subtype were compared. Results A total of 196 patients with GERD were enrolled.The number of EGJ subtypes was 142 cases of Type-Ⅰ,33 cases of Type-Ⅱ and 21 cases of Type-Ⅲ,respectively.There were significant differences between the three groups in age ［(47.7 ±11.01)years vs (53.3 ±13.19) years vs (55.0 ±14.01) years,F= 4.812,P=0.009］ and BMI ［(22.09±3.33) kg/m2 vs (23.72±3.17) kg/m2 vs (25.68±4.60) kg/m2,F=9.547,P=0.000］.There was no significant difference in the ratio of male to female among the three groups (χ2=4.987，P=0.083).There was significant difference between the three groups in the contraction amplitudes at 11cm of low eslophi sphincter(LES)［(54.08±29.59)mmHg vs (37.43±26.88)mmHg vs (33.39±17.56)mmHg,F=8.339，P=0.001］,and the EGJ typing was negatively correlated with the amplitude at 11 cm above LES (r=-0.236，P=0.002).There was no significant difference in distal contractile integral(DCI),contraction amplitude at 3 cm and 7 cm of LES and effective contraction rate in three groups (all P>0.05).There were no significant differences between three groups in rest pressure,residual pressure,relaxation time to the lowest point,relaxation duration and recovery time of UES (all P>0.05). Conclusions The morphological classification of EGJ may be related to age and BMI,but not to sex.The morphological changes of EGJ may influence esophageal motility at 11 cm above LES,but not affect the contractile function of distal esophageal body and upper esophageal sphincter.
keywords: High resolution manometry Gastro-esophageal reflux disease Esophagogastric junction Esophageal motility Low esophageal sphincter Contraction Relaxation
文章编号： 中图分类号：R 571 文献标志码：B
基金项目:
| 作者 | 单位 |
| 王晓林1 | 1.华中科技大学同济医学院附属梨园医院消化内科,湖北 武汉 430077 |
| 曹仕琼1 | 1.华中科技大学同济医学院附属梨园医院消化内科,湖北 武汉 430077 |
| 任冉冉1 | 1.华中科技大学同济医学院附属梨园医院消化内科,湖北 武汉 430077 |
| 吴玉文2 | 2.武汉大学中南医院内分泌科，湖北 武汉 430071 |
引用文本：
王晓林,曹仕琼,任冉冉,等.食管高分辨率测压下胃食管交界处形态分型与食管运动功能的关系[J].中国临床研究,2019,32(6):799-802.
王晓林,曹仕琼,任冉冉,等.食管高分辨率测压下胃食管交界处形态分型与食管运动功能的关系[J].中国临床研究,2019,32(6):799-802.