难治性胃食管反流病发病机制的研究

发布时间：2018-06-20 06:23

本文选题：24小时食管PH-阻抗监测 + 高分辨率食管测压　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:应用24小时食管PH-阻抗监测、高分辨率食管测压、焦虑抑郁评分以及反流性疾病问卷评分检查,对难治性胃食管反流病(Refractory gastroesophageal reflux disease,RGERD)患者进行了分析,探讨RGERD的发病机制。方法:随机选择84例难治性胃食管反流病患者,选取92例同期经PPI治疗后症状消失的胃食管反流病患者(Gastroesophageal reflux disease,GERD)作为对照组,所有研究对象均进行24小时食管PH-阻抗监测、高分辨率食管测压、并完成焦虑抑郁评分以及反流性疾病问卷评分,记录各组患者酸反流、非酸反流、弱酸反流、长酸反流、近端反流的次数,食管上、下括约肌及食管体部相关参数,焦虑抑郁评分以及反流性疾病问卷评分,比较各组之间的参数差别。结果:1.RGERD组较GERD对照组弱酸反流次数增多,差异有统计学意义(P0.05);RGERD组较GERD对照组长酸反流次数增多,差异有统计学意义(P0.05);RGERD组较GERD对照组近端反流次数增多,差异有统计学意义(P0.05);RGERD组较GERD对照组酸反流次数无明显差异,差异无统计学意义(P0.05);RGERD组较GERD对照组非酸反流次数无明显差异,差异无统计学意义(P0.05)。2.RGERD组较GERD对照组气体反流次数增多,差异有统计学意义(P0.05);RGERD组较GERD对照组液气混合反流次数增多,差异有统计学意义(P0.05);RGERD组较GERD对照组液体反流次数无明显差异,差异无统计学意义(P0.05)。3.RGERD组较GERD对照组食管下括约肌长度(LESL)更短,差异有统计学意义(P0.05);RGERD组较GERD对照组食管下括约肌压力(LESP)更低,差异有统计学意义(P0.05)。4.RGERD组较GERD对照组食管上括约肌压力(UESP)更低,差异有统计学意义(P0.05);RGERD组较GERD对照组食管上括约肌长度(UESL)无明显差异,差异无统计学意义(P0.05)。5.RGERD组较GERD对照组一过性食管下括约肌每小时松弛次数、每次松弛时间无明显差异,差异无统计学意义(P0.05)。6.RGERD组较GERD对照组食管体部参数DCI无明显差异,差异无统计学意义(P0.05);RGERD组较GERD对照组PB、DL无明显差异,差异无统计学意义(P0.05)。7.RGERD组较GERD对照组存在焦虑、抑郁的发病率均显著高于对照组,差异有统计学意义(P0.05);RGERD组较GERD对照组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均显著高于对照组,差异有统计学意义(P0.05);RGERD组较GERD对照组反流性疾病问卷(RDQ)评分均显著高于对照组,差异有统计学意义(P0.05)。结论:1、RGERD组较GERD对照组弱酸反流次数增多、长酸反流次数增多、近端反流次数增多,均可导致PPI抑制不完全。2、RGERD组较GERD对照组气体反流次数和液气混合反流次数增多,加重反流症状感知。3、RGERD组的食管下括约肌长度(LESL)较GERD对照组更短,且食管下括约肌压力(LESP)更低,食管上括约肌压力(UESP)更低,表明在RGERD的发病机制中,食管下括约肌的长度、压力以及食管上括约肌压力起到了重要作用。4、RGERD组较GERD对照组存在焦虑、抑郁倾向,提示精神心理因素参与RGERD的发病。
[Abstract]:Objective: 24 hours esophageal PH- impedance monitoring, high resolution esophageal manometry, anxiety and depression score and reflux disease questionnaire were used to analyze the patients with refractory gastroesophageal reflux disease (Refractory gastroesophageal reflux disease, RGERD) and to explore the pathogenesis of RGERD. Methods: 84 cases of refractory Gastroesophagus were selected randomly. Patients with reflux disease were selected 92 cases of Gastroesophageal reflux disease (GERD) which disappeared after PPI treatment as control group. All the subjects carried out 24 hours esophageal PH- impedance monitoring, high resolution esophageal manometry, and completed anxiety depression score and reflux disease questionnaire score, and recorded each group of patients. Acid reflux, non acid reflux, weak acid reflux, long acid reflux, the number of near end reflux, the related parameters of the esophagus, the lower sphincter and the esophagus, the anxiety and depression score and the reflux disease questionnaire score were compared. Results: the number of reverse reflux in group 1.RGERD was more than that of GERD group, and the difference was statistically significant (P0.05) The number of acid reflux in group RGERD was higher than that of GERD group (P0.05), and the number of reverse reflux in group RGERD was higher than that in GERD control group, the difference was statistically significant (P0.05), and there was no significant difference between the RGERD group and GERD control group, and the difference was not statistically significant (P0.05), and the number of non acid reflux in RGERD group was less obvious than that in GERD control group. There was no significant difference (P0.05) in group.2.RGERD compared with GERD control group, the number of gas reflux increased, the difference was statistically significant (P0.05), and the number of mixed reflux in RGERD group was more significant than that of GERD control group (P0.05), and there was no significant difference in the number of reflux in RGERD group compared with GERD (P0.0), and there was no significant difference (P0.0). 5) the lower esophageal sphincter length (LESL) in the.3.RGERD group was shorter than that in the GERD control group (P0.05), and the lower esophageal sphincter pressure (LESP) in the RGERD group was lower than that in the GERD control group, and the difference was statistically significant (P0.05) in the.4.RGERD group than in the GERD control group (UESP), and the difference was statistically significant (P0.05). There was no significant difference in the upper esophageal sphincter length (UESL) in the RD control group (P0.05), there was no significant difference in the relaxation times of the lower esophageal sphincter per hour in the GERD control group, and there was no significant difference in each relaxation time between the GERD control group and the GERD control group, and the difference was not statistically significant (P0.05) in the.6.RGERD group, there was no significant difference in the volume of the esophageal body parameters between the GERD control group and the GERD control group. There was no statistical significance (P0.05), and there was no significant difference between the group RGERD and the GERD control group, and there was no significant difference between the DL group and the DL group. The difference was not statistically significant (P0.05), and the incidence of depression in the.7.RGERD group was significantly higher than that in the control group, and the incidence of depression was significantly higher than that in the control group (P0.05); the RGERD group was compared with the GERD control group of anxiety scale (SAS) and the self rating depression scale. Significantly higher than the control group, the difference was statistically significant (P0.05), compared with the GERD control group, the reflux disease questionnaire (RDQ) scores were significantly higher than the control group, the difference was statistically significant (P0.05). Conclusion: 1, the number of weak acid reflux increased in the RGERD group and the GERD control group increased, the number of long acid reflux increased and the number of near end reflux increased, which could lead to the inhibition of PPI inhibition. In group RGERD, the number of reflux and the number of reflux of liquid gas in the GERD control group increased and the reflux symptoms increased. The lower esophageal sphincter length (LESL) in RGERD group was shorter than that of the GERD control group, and the lower esophageal sphincter pressure (LESP) was lower, and the upper esophageal sphincter pressure (UESP) was lower, indicating that the esophagus was included in the pathogenesis of RGERD, including the lower esophageal sphincter pressure (UESP). The length of the muscle, pressure and the pressure of the upper esophageal sphincter played an important role in.4. Group RGERD had anxiety and depression in the GERD control group, suggesting that psycho psychological factors were involved in the pathogenesis of RGERD.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R571

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