非糜烂性反流病发病特点及治疗的研究

发布时间：2018-04-04 09:17

本文选题：非糜烂性反流病　切入点：饮食习惯　出处：《北京协和医学院》2016年博士论文

【摘要】：非糜烂性反流病和反流性食管炎症状谱及其相关因素分析目的：通过问卷调查了解NERD和RE患者的一般人口学特点、反流症状谱、饮食习惯、生活质量和精神心理状态等,为进一步探讨GERD的发病机制和有效治疗提供依据。对象和方法：本研究纳入95例GERD患者,其中NERD患者50例(男18例,女32例,年龄44.1±13.4岁),RE患者45例(男22例,女23例,年龄46.5±9.9岁)。采用问卷调查的形式对NERD和RE患者的一般人口学特征、症状学特点、饮食和生活习惯、生活质量、精神心理等方面进行分析比较。结果：(1)NERD组反食症状评分和反食症状发生率均低于RE组[0(0,2)vs.2.0(0,3.0),P0.05；45.0% vs.64.4%,P0.05],两组症状总评分无显著性差异[8.0(6.0,11.0)vs.10.0(7.0,13.0),P0.05]。(2)NERD组反流症状的饮食结构的诱因前五位依次是：牛奶、辛辣饮食、葱或姜、巧克力、酸奶,除饮食外的生活方式前五位依次是：情绪、进食过快、着凉、锻炼少、睡眠差。(3)NERD合并心理异常组的反流症状积分显著高于无心理异常组(10.9±4.7 vs.8.3±2.8, P0.05)。(4) NERD患者焦虑、抑郁评分与反流症状积分相关(r=0.42,P0.01;r=0.29,P0.05),反流症状积分与GERD-HRQL显著相关(r=0.49,P0.01)。结论：NERD组反食症状较RE组轻,但两组症状总评分无显著性差异。饮食和不良生活习惯在NERD症状发生中起一定作用。NERD患者反流症状和生活质量、精神心理状态显著相关。MII-pH监测结合酸灌注试验评价NERD远端食管功能及NERD患者的生活质量观察与评价目的：24h食管多通道腔内阻抗-pH (MII-pH)监测及酸灌注试验研究非糜烂性反流病(NERD)患者食管功能。同时通过SF-36生活量表评价NERD患者的生活质量。对象和方法：选取2014年9月至2015年7月我院的NERD患者45例和健康志愿者30例,行24h MII-pH监测、酸灌注试验及和SF-36生活量表测评。一、结果： (1)NERD组24 h MII-pH监测DeMeester评分6.7(3.6-10.1),酸反流27.8(13.9-43.2)次,非酸反流26.8(18.0-42.6)次,均显著高于健康对照组(1.4(0.2-3.2),0.4(0.2-0.7)%,5.0(2.2-10.7),5.7(3.6-9.1),P0.01)。(2)NERD患者食管远端阻抗基线和阻抗恢复速率显著低于健康对照组(2996±701 Ω vs.3880±1054 Ω, P0.01; 30.1±14.0 Ω/min vs.53.0±14.5 Ω/min,P0.01)。(3)酸灌注试验阳性的NERD患者食管阻抗基线和阻抗恢复速率显著低于酸灌注试验阴性的患者(2758±660 Ω vs. 3410±536 Ω, P 0.01; 24.9±13.3 Ω/min vs.33.7±10.3 Ω/min, P0.05)。(4)与HS相比,NERD在所有8个维度和2个综合评分均明显低于HS(P0.05),尤其是在生理职能(RP)、情感职能(RE)和总体健康(GH)的维度下降更突出。结论：1.NERD患者教健康者比较存在明显的食管功能异常。2.NERD患者生活质量评价中精神心理健康受损比较明显,3.临床诊治中都应注意患者有无异常的精神心理因素,并给予心理支持。非糜烂性反流病的特异性治疗目的：非糜烂性反流病患者随机分为经验治疗组和特异治疗组,观察特异性治疗非糜烂性食管炎的治疗效果,对NERD的治疗有积极的指导作用。对象和方法：2014年1月至2015年12月期间,多家医院消化内科门诊的非糜烂性食管炎患者48例。所有纳入观察的NERD患者,签署知情同意书,采用问卷形式调查患者性别、年龄、身高、体量、病程、家族史。RDQ记录患者临床症状程度积分,HAM-D/HAM-A记录患者焦虑抑郁状况；食管动力监测及24 h MII-pH监测。随机分为特异治疗组和经验治疗组各24例。结果：(1)特异治疗组中,动力异常10例(占41.7%),心理精神异常14例(占58.3%)。经验治疗组中,动力异常11例(占45.7%),心理精神异常13例(占54.3%)。(2)治疗前两组患者RDQ症状程度积分比较,差异无统计学意义(P0.05)；治疗后两组患者临床症状程度总评分均显著低于同组治疗前,症状积分降低程度比较,特异治疗组低于经验治疗组,差异均有统计学意义(P0.05)。(3)治疗前两组的焦虑、抑郁评分比较,差异无统计学意义；治疗后两组的焦虑、抑郁评分均低于同组治疗前,评分降低程度比较,特异治疗组低于经验治疗组,差异均有统计学意义(P0.05)。结论：在NERD的治疗方案中,特异性的治疗可增强疗效,有效缓解疾病的临床症状,增加患者机体耐受性,值得临床推广应用。
[Abstract]:Objective : To investigate the general demographic characteristics , reflux symptoms , dietary habits , quality of life and mental state of NERD and RE patients by questionnaire . The general demographic characteristics , symptoms , diet and living habits , quality of life and mental state of NERD and RE patients were analyzed by questionnaire . Results : ( 1 ) The incidence of anti - food symptom scores and anti - food symptoms in NERD group were lower than that in RE group ( 0 , 2 ) vs . 2.0 ( 0 , 3.0 ) , P0.05 ;
( 3 ) The scores of anti - reflux symptoms in NERD patients were significantly higher than those in the group without psychological abnormality ( 10.9 卤 4.7 vs . 8.3 卤 2.8 , P0.05 ) . The results were as follows : ( 1 ) The results were as follows : ( 1 ) In NERD patients , 45 patients with NERD and 30 healthy volunteers were evaluated . The results were as follows : ( 1 ) The results were as follows : ( 1 ) The control group NERD patients were monitored by pH monitoring and acid perfusion . The results showed that the baseline and impedance recovery rate of NERD patients was significantly lower than those in healthy controls ( P 0.01 ; 30.1 卤 14.0 惟 / min vs . 53.0 卤 14.5 惟 / min , P0.01 ) . Conclusion : Compared with HS , NERD significantly lower than HS ( P0.05 ) , especially in physiological function ( RP ) , emotional function ( RE ) and overall health ( GH ) . Conclusion : 1 . Patients with non - erosive reflux disease have obvious mental health impairment .
Results : ( 1 ) There were 10 cases ( 45.7 % ) in the specific treatment group and 14 cases ( 58.3 % ) of mental disorders .
The scores of clinical symptoms were significantly lower in the two groups after treatment than that before treatment ( P0.05 ) . ( 3 ) There was no significant difference in the anxiety and depression scores between the two groups before treatment .
Conclusion : In the treatment of NERD , the specific treatment can enhance the curative effect , effectively alleviate the clinical symptoms of the disease , increase the tolerance of the patient , and is worthy of clinical application .

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R571

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