Correlations between morphological classification of gastroesophageal junction and reflux and esophageal body motor function
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摘要: 目的 运用高分辨率食管测压(HRM)观察胃食管反流病(GERD)患者不同胃食管连接部(EGJ)形态，探讨食管体部运动功能及反流事件与不同EGJ形态的相关性。方法 收集2020年3月—2021年6月期间经胃镜检查、HRM检查及24 h食管pH-阻抗监测明确诊断GERD的患者，将患者EGJ分为Ⅰ、Ⅱ、Ⅲ型，对各型的一般资料、体部动力参数、反流事件以及胃镜结果进行比较。结果 150例GERD患者中，EGJ Ⅰ型96例、Ⅱ型41例、Ⅲ型13例。3型年龄、体质指数比较差异有统计学意义(P< 0.05)；3型食管下括约肌(LES)上11 cm处蠕动波幅度分别为(58.22±30.65)、(39.56±24.46)、(32.12±15.32) mmHg(1 mmHg=0.133 kPa)，差异有统计学意义(P< 0.05)；3型酸反流均发生明显变化，尤以Ⅱ、Ⅲ型明显(P< 0.01)，但Ⅱ、Ⅲ型之间比较差异无统计学意义(P>0.05)；Ⅱ型的反流性食管炎发生率明显高于Ⅰ型(P< 0.05)。结论 胃食管连接部形态各亚型与年龄、体质指数密切相关。LES与膈肌分离超过1 cm，则容易引起反流事件，也使得LES上11 cm处食管体部蠕动功能发生变化，且食管炎发生率明显增加。Abstract: Objective To observe the morphology of different gastroesophageal junctions (EGJ) in patients with gastroesophageal reflux disease (GERD) by high-resolution esophageal manometry (HRM), and to explore the correlation between esophageal body motor function and reflux events and different EGJ.Methods The patients with GERD diagnosed by gastroscopy, HRM and 24-h esophageal pH impedance monitoring from March 2020 to June 2021 were collected. The patients with EGJ were divided into types Ⅰ, Ⅱ and Ⅲ. The general data, body dynamic parameters, reflux events and gastroscopy results of each type were compared.Results Among the 150 GERD patients, there were 96 cases of EGJ type Ⅰ, 41 cases of EGJ type Ⅱ and 13 cases of EGJ type Ⅲ. There were significant differences in age and body mass index among the three types (P< 0.05); The peristaltic wave amplitudes at 11 cm above the lower esophageal sphincter (LES) were (58.22±30.65), (39.56±24.46) and (32.12±15.32) mmHg, respectively (P< 0.05); Acid reflux changed significantly in all three types, especially in types Ⅱ and Ⅲ(P< 0.01), but there was no significant difference between types Ⅱ and Ⅲ (P>0.05); The RE incidence in type Ⅱ was significantly higher than that in type Ⅰ (P< 0.05).Conclusion The morphological of gastroesophageal junction is closely related to age and body mass index. If the separation of LES and CD exceeds 1 cm, it is easy to cause reflux events, change the peristaltic function of esophageal body 11 cm above LES, and the incidence of esophagitis increases significantly.
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表 1 3型一般资料比较
X±S 分型 例数 性别/例 年龄/岁 BMI 男 女 Ⅰ型 96 49 47 44.10±9.86 22.09±3.33 Ⅱ型 41 25 16 55.60±14.23 23.72±3.17 Ⅲ型 13 8 5 55.10±13.55 25.68±4.60 P 0.075 0.014 0.002 
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表 2 3型食管体部蠕动力度等参数比较
X±S 分型 例数 DCI/(mmHg·cm-1) LES上3 cm处波幅/mmHg LES上7 cm处波幅/mmHg LES上11 cm处波幅/mmHg 有效收缩率/% Ⅰ型 96 923.32±563.33 70.13±43.11 63.52±30.28 58.22±30.65 49.96±30.21 Ⅱ型 41 858.26±571.45 65.34±34.22 50.35±26.33 39.56±24.46 43.78±21.60 Ⅲ型 13 636.56±348.14 50.21±29.13 41.98±19.36 32.12±15.32 31.09±19.23 P 0.062 0.071 0.053 0.002 0.083
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表 3 各亚型与酸反流的关系比较
X±S 分型 例数 总反流时间/min 总反流次数/mmHg 最长反流持续时间/min 平均酸清除时间/min Demeester评分/分 Ⅰ型 96 19.25±9.33 18.37±10.12 3.07±2.22 0.46±0.35 4.12±3.98 Ⅱ型 41 26.34±21.09 37.26±19.56 10.21±5.03 0.75±0.46 10.03±8.39 Ⅲ型 13 113.66±68.31 101.34±64.79 16.32±10.78 0.92±0.59 30.21±18.34 P ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
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表 4 各亚型胃镜结果RE、NERD和BE发生例数比较
例 分型 例数 RE NERD BE 发生例数 发生率/% 发生例数 发生率/% 发生例数 发生率/% Ⅰ型 96 41 42.7 50 52.1 5 5.2 Ⅱ型 41 25 61.0 13 31.7 3 7.3 Ⅲ型 13 8 — 2 — 3 — 注：“—”因例数不足20例，故不以%表示。
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