摘要
目的:研究不同中医证候的胃食管反流病(GERD)患者的食管动力及酸暴露特点。方法:选取2015年4月-2019年12月就诊的具有典型反流症状的189例患者,按照中医证候分为肝胃郁热证、胆胃郁热证、气郁痰阻证、中虚气逆证、脾虚湿热证5型,同时完成胃镜、食管高分辨率测压(HRM)、24 h多通路阻抗联合pH监测。记录相关数据,比较不同证候之间食管动力及pH阻抗结果之间的差异,采用SPSS 16.0软件进行统计分析。结果:上食管括约肌静息压(UESP)比较:气郁痰阻证UESP最低;远端收缩积分(DCI)积分、无效食管动力(IEM)例数、弱蠕动及失蠕动百分率比较:肝胃郁热证、胆胃郁热证DCI积分低于其他证候组,IEM例数、弱蠕动及失蠕动百分率高于其他证候组(P<0.05);远端收缩延迟(DL)及食管胃连接部(EGJ)分型比较差异无统计学意义(P>0.05);下食管括约肌静息压(LESP)比较:中虚气逆证LESP最低,其次为脾虚湿热证。在酸暴露方面:脾虚湿热证在DeMeester评分、总反流时间、总反流次数、总AET%、立位AET%、卧位AET%方面均高于其他证候组(P<0.05);肝胃郁热证及胆胃郁热证在DeMeester评分、总反流时间、总AET%、立位AET%方面高于中虚气逆证(P<0.05);食管近端反流总计、食管近端酸反流、食管近端弱酸反流比较,气郁痰阻证均高于其他证候组(P<0.05)。结论:不同中医证候的GERD患者的食管动力学指标存在明显差异,气郁痰阻证更多出现上食管括约肌屏障功能下降,肝胃郁热证及胆胃郁热证更多见食管体部蠕动功能障碍,中虚气逆证及脾虚湿热证更多的是EGJ抗反流屏障功能下降。在酸暴露方面,脾虚湿热证的酸暴露各项指标得分更高,气郁痰阻证在食管近端酸暴露各项指标得分更高。GERD中医证候与食管动力及酸暴露有一定相关性。
Objective:To study esophageal motility and acid exposure in patients with gastroesophageal reflux disease(GERD)with different Traditional Chinese Medicine(TCM)syndromes.Methods:One hundred and eighty-nine patients with typical reflux symptoms were selected from April 2015 to December 2019,divided into five types according to the TCM syndromes:stagnation of heat in liver and stomach,stagnation of heat in gallbladder and stomach,stagnation of Qi and phlegm,middle deficiency and Qi inversion,spleen deficiency and dampness heat.At the same time,gastroscopy,high resolution esophageal manometry(HRM),24 h multi-channel impedance combined with pH monitoring were completed.The relevant data were recorded,and the differences of esophageal motility and pH impedance between different syndromes were compared.SPSS 16.0 software was used for statistical analysis.Results:In the aspect of esophageal motility:upper esophageal sphincter pressure(UESP)comparison:UESP was the lowest in stagnation of Qi and phlegm syndrome;distal contractile integral(DCI)score,ineffective esophagus motility(IEM)cases,percentage of weak peristalsis and loss of peristalsis:the DCI score was lower than other syndrome groups in stagnation of heat in liver and stomach syndrome and stagnation of heat in gallbladder and stomach syndrome.The number of IEM cases,percentage of weak peristalsis and loss of peristalsis were higher than other syndrome groups(P<0.05);Comparison of distal latency(DL)and esophagogastric junction(EGJ)typing:no significant difference between the two groups(P>0.05);Lower esophageal sphincter pressure(LESP)comparison:the lowest LESP was in the syndrome of middle deficiency and Qi inversion,followed by the syndrome of spleen deficiency and dampness heat.In terms of acid exposure:the demeester score,total reflux time,total reflux times,acid exposure time(AET),standing AET%and decubitus AET%in spleen deficiency and dampness heat syndrome were higher than those of in other syndrome groups(P<0.05);The demeester score,total reflux time,total AET%and standing AET%in stagnation of heat in liver and stomach syndrome and stagnation of heat in gallbladder and stomach syndrome were higher than those of in middle deficiency and Qi inversion syndrome(P<0.05);Compared with other syndrome groups,the total amount of proximal esophageal reflux,acid reflux and weak acid reflux of proximal esophagus were all higher stagnation of Qi and phlegm syndrome(P<0.05).Conclusion:There are significant differences in esophageal dynamic indexes among GERD patients with different TCM syndromes.The upper esophageal sphincter barrier function is decreased more in stagnation of Qi and phlegm syndrome,the esophageal body peristalsis dysfunction is more common in liver stomach heat stagnation syndrome and gallbladder stomach heat stagnation syndrome,and the anti-reflux barrier function of EGJ is decreased more in middle deficiency and Qi inversion syndrome,and spleen deficiency and dampness heat syndrome.In terms of acid exposure,the index scores of acid exposure of spleen deficiency and dampness heat syndrome were higher.The index scores of stagnation of Qi and phlegm syndrome in acid exposure of proximal esophagus were higher.There is a certain correlation between TCM syndromes of gastroesophageal reflux disease and esophageal motility and acid exposure.
作者
沈晨
陶琳
张声生
丁洋
侯亚男
王小丽
SHEN Chen;TAO Lin;ZHANG Shengsheng;DING Yang;HOU Yanan;WANG Xiaoli(Digestive Disease Center,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing,100010,China)
出处
《中国中西医结合消化杂志》
CAS
2021年第9期605-609,共5页
Chinese Journal of Integrated Traditional and Western Medicine on Digestion
基金
首都卫生科研发展专项(No:首发2018-2-2231)。
关键词
胃食管反流病
中医证候
食管动力
酸暴露
gastroesophageal reflux disease
Traditional Chinese Medicine syndrome
esophageal motility
acid exposure
