Stretta射频治疗反流性哮喘的疗效及机制分析

发布时间：2018-02-14 10:43

  本文关键词： Stretta射频治疗 胃食管反流病 哮喘　出处：《辽宁医学院》2012年硕士论文　论文类型：学位论文

【摘要】：目的 通过分析比较单纯胃食管反流病（GERD）、反流性哮喘和过敏性哮喘（AS）合并胃食管反流病三组病人的Stretta射频治疗效果，，探讨反流性哮喘的射频治疗的作用机制。 方法 选取我院2010年8月至2011年05月的入住我院胃食管反流病中心的患者为实验初选对象，收集患者的临床资料，包括年龄、性别等一般项目，进行症状评分、胃镜、阻抗、食管测压等检查，选出确诊为GERD患者60例，且分为单纯GERD组即消化道症状组20例、反流性哮喘组20例、AS合并GERD组20例。分析比较三组患者的痰液嗜酸性粒细胞及中性粒细胞比例、外周血嗜酸性粒细胞百分比、肺功能最大呼气流量（PEF）；三组患者均行Stretta射频治疗，且于治疗后半年复查胃镜、阻抗、食管测压，对各复查的客观项目行统计分析。 结果 1.诱导痰细胞学检查中，反流性哮喘组和AS合并GERD组中性粒细胞、嗜酸性细胞百分率较单纯GERD组明显增高。反流性哮喘组与AS合并GERD组比较，中性粒细胞百分率明显增高，嗜酸性细胞百分率减低，差异均有统计学意义。 2．外周血检查中，AS合并GERD组嗜酸性粒细胞百分率较单纯GERD组及反流性哮喘组明显增高，差异有统计学意义。 3．Stretta射频治疗后半年随访，反流性哮喘患者症状评分的下降程度和缓解的总有效率显著优于其它两组（P0.05）。复查项目的比较中，三组的阻抗检查Z2通道（即LES上15cm）反流占总反流次数百分比、DeMeester积分、pH≤4所占总检测时间百分比均明显减少（P0.05），三组下食管括约肌压力有轻度升高、食管炎发生率不同程度降低，但差异无统计学意义（P＞0.05）。反流性哮喘组及AS合并GERD组PEF均明显改善，且反流性哮喘组改善程度显著优于后组（P0.05）。 结论 1．反流性哮喘的气道炎症是以中性粒细胞为主的炎性浸润，明显区别于以嗜酸性细胞浸润为主的过敏性哮喘；可以将诱导痰细胞学检查中的细胞学分类及外周血的嗜酸性粒细胞的百分率用于反流性哮喘和过敏性哮喘的鉴别。 2．胃镜下Stretta射频治疗通过降低反流的高度、阻断神经机制和减少一过性下食管括约肌松弛等机制有效控制胃食管反流，是治疗反流性哮喘的一种安全、有效的方法。
[Abstract]:Purpose. To explore the mechanism of radiofrequency (RF) therapy of reflux asthma (GERD), reflux asthma and allergic asthma (ASA) combined with gastroesophageal reflux disease (GERD), the effects of Stretta radiofrequency (RF) on gastroesophageal reflux disease (GERD) were analyzed and compared. Method. Patients admitted to gastroesophageal reflux disease center from August 2010 to May 2011 in our hospital were selected as primary subjects. Clinical data, including age, sex and other general items, were collected for symptom score, gastroscopy, impedance, and so on. By esophageal manometry and other examinations, 60 patients with GERD were selected and divided into GERD group (n = 20) and digestive tract symptom group (n = 20). The ratio of eosinophils and neutrophils in sputum, the percentage of eosinophils in peripheral blood and the maximal expiratory flow rate of lung function were analyzed and compared in 20 patients with reflux asthma combined with GERD. Gastroscopy, impedance and esophageal manometry were performed half a year after treatment. Results. 1. In induced sputum cytology, the percentage of eosinophil in reflux asthma group and as combined with GERD group was significantly higher than that in simple GERD group, and the percentage of neutrophil in reflux asthma group was significantly higher than that in as combined with GERD group. The percentage of eosinophilic cells decreased, and the difference was statistically significant. 2. The percentage of eosinophil in as combined with GERD group was significantly higher than that in GERD group and reflux asthma group. 3. After half a year follow-up of Stretta radiofrequency therapy, the degree of symptom score decline and the total effective rate of remission in patients with reflux asthma were significantly higher than those in the other two groups (P 0.05). The percentage of reflux in the total reflux times of the three groups (i.e. 15 cm above LES) and the percentage of the total detection time of de Meester integral pH 鈮

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