探索唾液胃蛋白酶对胃食管反流病食管外表现的诊断价值。

收集2017年3月至2018年1月就诊于联勤保障部队第九〇〇医院消化内科确诊为胃食管反流病（GERD）食管外表现的患者15例(E组）及无明显反流症状的健康志愿者15例（C组）。所有受试对象均经胃食管反流病量表（GerdQ）评分、咽喉反流症状指数评分量表（RSI）、咽喉反流体征评分量表（RFS）及24 h多通道食管腔内阻抗-pH监测（MII-pH）确诊。所有受试对象分别于晨起空腹、午餐后2 h、晚餐后2 h、症状时4个时间点收集唾液标本，用酶联免疫吸附剂法测定胃蛋白酶的浓度。分别采用单因素方差分析和LSD-t检验比较分析组间、组内各时间点唾液胃蛋白酶浓度的变化。

C组、E组的唾液胃蛋白酶浓度分别为（63.59±14.34）ng/ml、（128.98±17.28）ng/ml，E组唾液胃蛋白酶浓度明显高于C组（P＜0.05）。对比C组、E组间各时间点的唾液胃蛋白酶浓度，发现各时间点E组唾液胃蛋白酶浓度均明显高于C组，（P＜0.05。对比C组、E组内不同时间点的唾液胃蛋白酶浓度，发现C组内不同时间点的唾液胃蛋白酶浓度无显著差异；E组内晨起空腹、午餐后2 h、晚餐后2 h及症状时的唾液胃蛋白酶浓度分别为（124.28±17.50）ng/ml、（143.54±12.60）ng/ml、（122.00±15.77）ng/ml、（126.10±12.60）ng/ml。不同时间点的唾液胃蛋白酶浓度存在显著差异，（P＜0.05)。其中，午餐后2 h的唾液胃蛋白酶浓度最高，将晨起空腹、晚餐后2 h、症状发生时的唾液胃蛋白酶浓度与午餐后2 h比较，（P＜0.05)。而E组其他时间点之间的唾液胃蛋白酶浓度无显著差异。

唾液胃蛋白酶对诊断胃食管反流病食管外表现有较好的临床价值，该类患者各时间点的唾液胃蛋白酶浓度均明显升高。其中，午餐后2 h的唾液标本的诊断价值最高。

We aimed to explore the diagnostic value of salivary pepsin forextra-esophageal manifestations of gastroesophageal reflux disease (GERD).

Studies were performed in fifteen healthy volunteers (groupC)and fifteen patients(group E)confirmed by GerdQ, reflux symptom index(RSI), reflux finding score patients(RFS) and 24-hour multichannel intraluminal impedance pH (24 h MII-pH).Saliva were collected on waking time and 2 hours after lunch and dinner as well as uncomfortableness. Salivary pepsin was analyzed by ELISA. Based on the differences in salivary pepsin, the diagnostic value of it was discussed.

The concentration of salivary pepsin was 63.59±14.34 ng/ml in group C and 128.98±17.28 ng/ml in group E, and the date in group E was significantly higher than that in group C(P=0.000). While comparing the level of salivary pepsin during different timeframes between group C and E, those of group E were always higher than those of group C（p=0.000). To compare the salivary pepsin during different timeframes in group C and E separately, there was no significant difference in group C. But, significant differences were found in group E. The salivary pepsin was 124.28±17.50 ng/ml on waking time, and 143.54±12.60 ng/ml two hours after lunch, and 122.00±15.77 ng/ml two hours after dinner, and 126.10±12.60 ng/ml when uncomfortableness. It was highest when it was collected two hours after lunch. Compared with that on waking time and two hours after dinner as well as uncomfortableness, it was always significantly higher (p=0.003, 0.001, 0.008).

Salivary pepsin has prominent diagnostic value for extra-esophageal manifestations of GERD. The level of salivary pepsin for extra-esophageal manifestations of GERD always increases significantly anytime, but it has the greatest diagnostic significance when the saliva collected two hours after lunch, probably due to the immediate post-lunch nap.