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中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2024, Vol. 11 ›› Issue (01) : 11 -17. doi: 10.3877/cma.j.issn.2095-8765.2024.01.003

论著

内镜下胃食管松弛程度在胃食管反流病筛查中的应用
王文娟1, 张翠1, 高晨1, 文敏1,†()   
  1. 1. 562499　贵州，兴义市人民医院消化内科
  • 收稿日期:2023-11-26 出版日期:2024-02-15
  • 通信作者: 文敏
  • 基金资助:
    2022年度贵州省卫生健康委科学技术基金项目资助(gzwkj2022-321)

The application of endoscopic assessment of gastroesophageal relaxation in screening for gastroesophageal reflux disease

Wenjuan Wang1, Cui Zhang1, Chen Gao1, Min Wen1,†()   

  1. 1. Department of Gastroenterology Xingyi people's Hospital, Xingyi 562400, China
  • Received:2023-11-26 Published:2024-02-15
  • Corresponding author: Min Wen
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王文娟, 张翠, 高晨, 文敏. 内镜下胃食管松弛程度在胃食管反流病筛查中的应用[J]. 中华胃食管反流病电子杂志, 2024, 11(01): 11-17.

Wenjuan Wang, Cui Zhang, Chen Gao, Min Wen. The application of endoscopic assessment of gastroesophageal relaxation in screening for gastroesophageal reflux disease[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2024, 11(01): 11-17.

目的

探讨内镜下胃食管松弛程度在胃食管反流病(GERD)筛查中的应用，从而为GERD的早期诊断提供诊断依据。

方法

选择兴义市人民医院2022年1月至2023年7月就诊于消化内科的198例患者作为研究对象，收集其GERD问卷（GERD-Q）评分、胃镜检查、食管24 h pH阻抗监测、食管高分辨率测压检查，分析内镜下胃食管松弛程度在GERD筛查中的作用。根据是否发生胃食管反流将患者分为2组，其中未发生组82例，发生组116例。

结果

2组年龄比较，差异无统计学意义（P>0.05）；2组体质量指数（BMI）、吸烟、饮酒史、幽门螺杆菌感染情况比较，差异有统计学意义（P<0.05）。发生组患者胃食管弛程度、GERD-Q评分、食管高分辨率测压、食管pH阻抗监测值均高于未发生组，差异有统计学意义（P<0.05）；发生组患者胃食管松弛程度级别、食管炎级别高于未发生组，发生组患者食管裂孔疝发生率高于未发生组患者，差异有统计学意义（P<0.05）。BMI、胃食管松弛程度均为患者胃食管反流是否发生的危险因素（P<0.05）。胃食管松弛程度与GERD-Q评分、食管高分辨率测压、食管pH阻抗监测、食管炎分级显著正相关（P<0.05）。BMI曲线下面积为0.713，P<0.001，灵敏度为0.759，特异度为0.598，临界值为22.445；胃食管松弛程度曲线下面积为0.709，P<0.001，灵敏度为0.750，特异度为0.573，临界值为1.450；联合诊断曲线下面积为0.772，P<0.001，灵敏度为0.586，特异度为0.829。

结论

内镜下胃食管松弛程度与GERD的发生具有明显关系，可用于GERD的筛查。

关键词: 胃食管松弛程度, 胃食管形成程度分级, 胃食管阀瓣, 胃食管反流病
Objective

To explore the application of endoscopic assessment of gastroesophageal relaxation in screening for gastroesophageal reflux disease (GERD), thereby providing diagnostic evidence for early diagnosis of GERD.

Methods

A total of 198 patients who visited the Department of Gastroenterology at Xingyi City People's Hospital from January 2022 to July 2023 were included as the study subjects. The GERD Questionnaire (GERD-Q) score, gastroscopy, 24-hour esophageal pH impedance monitoring, and esophageal high-resolution manometry were collected to analyze the role of endoscopic assessment of gastroesophageal relaxation in GERD screening. Patients were divided into two groups based on the presence or absence of gastroesophageal reflux: a non-occurrence group (82 cases) and an occurrence group (116 cases).

Results

There was no statistically significant difference in age between the two groups (P>0.05). However, there were statistically significant differences in body mass index (BMI) , smoking and drinking history, and Helicobacter pylori infection between the two groups (P<0.05). The occurrence group had higher levels of gastroesophageal relaxation, GERD-Q scores, esophageal high-resolution manometry, and esophageal pH impedance monitoring values compared to the non-occurrence group, with statistically significant differences (P<0.05). The occurrence group also had higher levels of gastroesophageal relaxation and esophagitis grade compared to the non-occurrence group, and the occurrence group had a higher incidence of esophageal hiatus hernia compared to the non-occurrence group, with statistically significant differences (P<0.05). BMI and gastroesophageal relaxation were identified as risk factors for the occurrence of gastroesophageal reflux (P<0.05). Gastroesophageal relaxation was significantly positively correlated with GERD-Q scores, esophageal high-resolution manometry, esophageal pH impedance monitoring, and esophagitis grade (P<0.05). The area under the curve for BMI was 0.713, P<0.001, sensitivity was 0.759, specificity was 0.598, and the critical value was 22.445; the area under the curve for gastroesophageal relaxation was 0.709, P<0.001, sensitivity was 0.750, specificity was 0.573, and the critical value was 1.450; the area under the curve for combined diagnosis was 0.772, P<0.001, sensitivity was 0.586, specificity was 0.829.

Conclusion

Endoscopic assessment of gastroesophageal relaxation is significantly related to the occurrence of GERD and can be used for GERD screening.

Key words: Gastroesophageal relaxation, Gastroesophageal formation degree classification, Gastroesophageal valve, Gastroesophageal reflux disease
图1 食管炎的洛杉矶分级
图2 胃食管阀瓣分级（Ⅰ级-Ⅳ级） 注：GEFV为胃食管阀瓣分级
图3 胃食管松弛程度分级 注：A为Ⅰ级；B为Ⅱ级；C为Ⅲ级；D为Ⅳ级
表1 2组患者临床资料比较
项目 未发生组（82例） 发生组（116例） Z/χ2值 P值
胃食管松弛程度[cm, M(Q1，Q3)] 1.30(1.10,1.60) 1.60(1.43,1.88) -5.040 <0.001
GERD-Q评分[分, M(Q1，Q3)] 5.00(4.00,6.00) 9.00(9.00,11.00) -11.964 <0.001
食管高分辨率测压[mmHg,M(Q1，Q3)] 0.90(0.48,1.31) 1.35(1.00,1.72) -5.130 <0.001
食管pH阻抗监测[分，M(Q1，Q3)] 2.82(0.80,4.82) 15.35(12.88,18.40) -9.294 <0.001
食管下括约肌压力[mmHg,M(Q1，Q3)] 9.10(7.73,10.63) 9.62(8.00,10.59) -1.040 0.298
胃食管松弛程度级别[例（%）] -4.959 <0.001
1级 2(2.4) 6(5.2)
2级 50(61.0) 26(22.4)
3级 29(35.4) 67(57.8)
4级 1(1.2) 17(14.7)
食管炎分级[例（%）] -7.526 <0.001
0级 55(67.1) 24(20.7)
1级 22(26.8) 29(25.0)
2级 4(4.9) 45(38.8)
3级 1(1.2) 15(12.9)
4级 0(0.0) 3(2.6)
是否食管裂孔疝[例（%）] 18.194 <0.001
否 77(93.9) 80(69.0)
是 5(6.1) 36(31.0)
表2 二元Logistic回归分析自变量赋值表
自变量 赋值
BMI（X1） 原值带入
性别（X2） 0=女性，1=男性
饮酒（X3） 0=否，1=是
胃食管松弛程度（X4） 原值带入
表3 影响患者胃食管反流的二元Logistic回归分析
变量 β SE χ2值 P值 OR值 95%CI
BMI 0.210 0.057 13.616 <0.001 1.234 1.104~1.380
性别 0.225 0.379 0.353 0.553 1.253 0.596~2.634
饮酒 0.318 0.416 0.585 0.444 1.374 0.608~3.105
胃食管松弛程度 1.669 0.463 12.981 <0.001 5.309 2.141~13.165
常量 -7.313 1.441 25.746 <0.001 0.001
表4 影响胃食管松弛程度相关性分析（r）
变量 GERD-Q评分 食管高分辨率测压 食管pH阻抗监测 食管下括约肌压力 食管炎分级 胃食管松弛程度
GERD-Q评分 1
食管高分辨率测压 0.324** 1
食管pH阻抗监测 0.649** 0.183** 1
食管下括约肌压力 0.109 0.196** -0.010 1
食管炎分级 0.570** 0.130 0.378** 0.058 1
胃食管松弛程度 0.370** 0.426** 0.178* 0.116 0.278** 1
表5 影响患者胃食管反流因素的受试者操作特征曲线分析
变量 曲线下面积 SE P值 渐近 95%CI 临界值 灵敏度 特异度 约登指数
BMI 0.713 0.038 <0.001 0.639~0.787 22.445 0.759 0.598 0.357
胃食管松弛程度 0.709 0.037 <0.001 0.637~0.782 1.450 0.750 0.573 0.323
预测概率 0.772 0.034 <0.001 0.706~0.838 0.655 0.586 0.829 0.415
图4 影响患者胃食管反流因素的受试者操作特征曲线 注：BMI为体质量指数
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