慢性咳嗽为主要症状胃食管反流病患者的多因素分析

发布时间：2018-02-04 07:57

本文关键词： 慢性咳嗽胃食管反流病食管高分辨测压动态24h-pH-阻抗监测　出处：《首都医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：胃食管反流病(GERD)是一种常见的消化道功能性疾病,随着社会发展,本病的发病率逐年上升。本病的临床表现可分为典型症状、非典型症状;典型症状主要包括烧心、反流;非典型症状主要包括咳嗽、咽下困难、癔球症等;咳嗽是胃食管反流病患者临床上较为常见的非典型症状,其严重影响着患者的生活质量。本临床研究对同时行食管高分率测压(HRiM)及动态24h-pH-阻抗监测的以慢性咳嗽为主要症状的GERD患者的动力学及反流参数进行多因素分析,旨在进一步明确以咳嗽为主要症状胃食管反流病患者的动力学及反流特征。方法:(1)选取2010.5-2015.4就诊于首都医科大学附属北京朝阳医院消化科同时行食管高分辨率测压(HRiM)及动态24h-pH-阻抗监测的胃食管反流病(GERD)患者254例,健康对照组62例:根据临床症状将GERD患者分为以慢性咳嗽为主要症状GERD组(简称:咳嗽GERD组)及非咳嗽GERD组(反酸、烧心为主要症状的典型症状组)(2)回顾性分析入组人员性别、年龄、临床症状、食管高分辨率测压及动态24h-pH-阻抗监测各项数据;(3)统计学分析:采用SPSS20.0统计软件对数据进行分析,p0.05认为有统计学意义。结果:咳嗽GERD组患者年龄范围在24-84(53.15±14.91)岁之间,经分析咳嗽GERD组患者发病呈双峰,分别为30-34岁和55-64岁两个年龄段;咳嗽GERD组与对照组相比在液体清除率、粘性清除率、远端食管蠕动波幅、IRP、UES残余压等总共45个指标存在统计学差异,p0.05;咳嗽GERD组IRP(5.94±5.70)mmHg较非咳嗽GERD组(7.22±6.84)mmHg明显降低,p0.05;咳嗽GERD组粘性清除率29.92%(20.0%,50.0%)较非咳嗽GERD组39.05%(10.0%,70.0%)明显下降,p0.05;咳嗽GERD组近端卧位非酸返流次数2.14(0,3.0)较非咳嗽GERD组1.16(0,2.0)明显增加,p0.05;咳嗽GERD组立位非酸食团暴露时间1.59(0.5,2)、卧位非酸食团暴露时间0.41(0,0.5)较非咳嗽GERD组1.22(0,2.0)、0.18(0,0)均明显延长,p0.05;咳嗽GERD组、非咳嗽GERD组及对照组近端立位酸返流次数分别为9.02(3.0,15.0)、11.67(4.0,16.0)、5.74(2.0,9.0),咳嗽GERD组较非咳嗽GERD组明显减少,与对照组相比明显增多,均存在统计学差异(p0.05);Logistic回归分析表明,与典型症状胃食管反流病患者相比,食管下括约肌压力明显降低、粘性食团清除障碍、卧位非酸食团暴露时间增加、卧位非酸返流次数增加是慢性咳嗽为主要症状胃食管反流病患者的主要食管动力学异常及反流特征。结论:与典型症状胃食管反流病患者相比,食管下括约肌压力明显降低、粘性食团清除障碍、卧位非酸食团暴露时间增加、卧位非酸返流次数增加是慢性咳嗽为主要症状胃食管反流病患者的主要食管动力学异常及反流特征。
[Abstract]:Gastroesophageal reflux disease (GERD) is a common functional disease of digestive tract. With the development of society, the incidence of GERD increases year by year. The clinical manifestations of GERD can be divided into typical symptoms and atypical symptoms. Typical symptoms include heartburn, reflux; Atypical symptoms include cough, dysphagia, globus sensation and so on. Cough is a common atypical symptom in patients with gastroesophageal reflux disease. It seriously affects the quality of life of patients. In this clinical study, HRiM was performed at the same time with high score of esophagus manometry. The dynamic and reflux parameters of patients with GERD with chronic cough as the main symptom were analyzed by multivariate analysis. To further clarify the dynamics and reflux characteristics of patients with gastroesophageal reflux disease (GERD) with cough as the main symptom. Methods: 1). HRiM was selected from Beijing Chaoyang Hospital affiliated to Capital Medical University from May to April, 2010.5-2015.4 to perform esophageal high resolution manometry (HRiM) at the same time. And 254 patients with gastroesophageal reflux disease (GERD) with dynamic 24 h-pH impedance monitoring. 62 healthy control group: according to clinical symptoms, GERD patients were divided into chronic cough as the main symptom of GERD group (abbreviated as cough GERD group) and non-cough GERD group (regurgitated acid). The data of sex, age, clinical symptoms, esophageal high resolution manometry and dynamic 24h-pH impedance monitoring were analyzed retrospectively. Statistical analysis: SPSS20.0 software was used to analyze the data. Results: the age range of patients with cough GERD was 24-84 卤53.15 卤14.91 years old. There were two peaks in cough GERD group, 30-34 years old and 55-64 years old. Compared with the control group, 45 indexes of cough GERD group, such as fluid clearance rate, viscous clearance rate, distal esophageal peristalsis amplitude and IRPU es residual pressure, were significantly different (P 0.05). IRP(5.94 卤5.70 mm Hg in cough GERD group was significantly lower than that in non-cough GERD group (7.22 卤6.84 mm Hg). The viscosity clearance rate of cough GERD group (29.92%) was significantly lower than that of non-cough GERD group (P 0.05). The frequency of non-acid reflux in the proximal recumbent position of cough GERD group was 2.14 0 ~ 3.0), which was significantly higher than that in non-cough GERD group (1. 160 ~ 0 ~ 2. 0) (P < 0. 05). The exposure time of standing non-acid food group and lying position non-acid food group in cough GERD group was 1.59 and 0.5,0.41 and 0.50 respectively) compared with that in non-cough GERD group. (2) 0. 18 (0. 0)) (P < 0. 05, P < 0. 05); The times of acid reflux at the proximal end of the cough GERD group, the non-cough GERD group and the control group were 9.02 ~ 3.0 ~ 15.0 ~ 11.67 ~ 4.0 ~ 16.0). 5.74A 2.0 ~ 9.0%, cough GERD group was significantly lower than non-cough GERD group, and significantly increased compared with the control group, there was statistical difference between the two groups (P 0.05). Logistic regression analysis showed that the pressure of lower esophageal sphincter was significantly lower than that of patients with typical symptoms of gastroesophageal reflux disease (GERD). The increase of non-acid reflux in supine position is the main characteristic of abnormal esophageal dynamics and reflux in patients with chronic cough as the main symptom of gastroesophageal reflux disease. Conclusion: compared with the patients with typical symptom gastroesophageal reflux disease. The pressure of lower esophageal sphincter was decreased obviously, the sticky food mass was removed and the exposure time of non-acid food mass in lying position was increased. The increase of non-acid reflux in supine position was the main characteristic of abnormal esophageal dynamics and reflux in patients with chronic cough as the main symptom of gastroesophageal reflux disease.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R571

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