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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) : 31 -36. doi: 10.3877/cma.j.issn.2095-8765.2024.01.007

论著

探讨胃食管反流病与心房颤动、酸反流及食管运动特征的相关性
古丽尼格尔·吾布力1, 印纹源1, 冯艳1, 买买提·依斯热依力2, 克力木·阿不都热依木2, 夏木西娅·哈德尔1,†()   
  1. 1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院心脏及泛血管医学诊疗中心心电学科
    2. 830001　乌鲁木齐，新疆维吾尔自治区人民医院自治区普外微创研究所
  • 收稿日期:2023-09-17 出版日期:2024-02-15
  • 通信作者: 夏木西娅·哈德尔
  • 基金资助:
    新疆维吾尔自治区人民医院院内项目(20210229)

To explore the correlation between gastroesophageal reflux disease and atrial fibrillation, acid reflux and esophageal motility

Wenyuan Yin1, Yan Feng1   

  1. 1. Electrocardiology of Heart and Panvascular Medical Diagnosis and Treatment Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    2. Research Institute of for Minimally Invasive Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
  • Received:2023-09-17 Published:2024-02-15
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古丽尼格尔·吾布力, 印纹源, 冯艳, 买买提·依斯热依力, 克力木·阿不都热依木, 夏木西娅·哈德尔. 探讨胃食管反流病与心房颤动、酸反流及食管运动特征的相关性[J]. 中华胃食管反流病电子杂志, 2024, 11(01): 31-36.

Wenyuan Yin, Yan Feng. To explore the correlation between gastroesophageal reflux disease and atrial fibrillation, acid reflux and esophageal motility[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2024, 11(01): 31-36.

目的

探讨胃食管反流病（GERD）与心房颤动（AF）、酸反流及食管运动特征的相关性。

方法

回顾性分析2022年3月至2023年5月在新疆维吾尔自治区人民医院因GERD和AF以及疑似GERD合并AF就诊的患者作为研究对象。根据符合GERD和AF典型症状及诊断标准的患者，进一步分为非GERD组、GERD组、AF组以及GERD合并AF组，每组患者40例。根据样本量估算公式，取95%CI，检验标准α=0.05、检验效能1-β=0.80推算，需要完成有效样本40例。收集4组患者胃食管反流病自测量表(GERD-Q)、Demeester系统评分、高分辨率测压（HRM）、24 h动态心电图和胃食管内镜检查结果。

结果

GERD组和GERD合并AF组在GERD症状评分，食管近端弱酸反流(%)、食管近端酸反流(%)及DeMeester评分等指标，与非GERD组比较显著升高（P<0.05）；高分辨率食管测压分析显示，与非GERD组相比，GERD组和GERD合并AF组食管上段括约肌（UES）静息压、食管下段括约肌（LES）静息压及食管远端收缩积分（DCI）等指标显著下降（P<0.05）；GERD组、AF组以及GERD合并AF组心率以及QT离散度（QTd）水平均显著大于非GERD组(P<0.05)，且非GERD组心率水平显著小于GERD组（P<0.05）；GERD组、AF组以及GERD合并AF组动脉血压(收缩压、舒张压) 水平均显著高于非GERD组（P<0.05）；GERD组和GERD合并AF组胃食管内镜下黏膜炎症大小均明显大于非GERD组（P<0.01）。

结论

AF、酸反流和食管运动特征与GERD具有明显相关性，GERD加大了AF发生率、明显增加了食管酸暴露，改变了食管的运动特征。

关键词: 胃食管反流病, 心房颤动, 酸反流, 食管运动特征
Objective

To investigate the relationship between gastroesophageal reflux disease and Atrial fibrillation, acid reflux and esophageal motility.

Methods

Retrospective analysis was conducted on patients with gastroesophageal reflux disease (GERD), Atrial fibrillation (AF) and suspected GERD combined with AF in the People's Hospital of Xinjiang from March 2022 to May 2023. According to the typical symptoms and diagnostic criteria of gastroesophageal reflux disease and Atrial fibrillation, patients were further divided into non GERD group (n=40), GERD group (n=40), AF group (n=40) and GERD combined with AF group (n=40). According to the sample size estimation formula, take the 95%CI and test the standard α= 0.05. Inspection efficiency 1-β=0.80 calculation requires 40 valid samples to be completed. The gastronesopgageal reflux disease questionnaire (GERD-Q) scale, Demesester system score, high resolution manometry (HRM), 24 h Holter monitor and gastroesophageal endoscopy were collected from four groups of patients.

Results

The analysis results showed that the GERD group and the GERD combined with AF group showed significant increases in GERD symptom score, proximal esophageal weak acid reflux (%), proximal esophageal acid reflux (%), and DeMeester score compared to the non GERD group (P<0.05); High resolution esophageal manometry analysis showed that, compared with the non GERD group, the resting pressure of the upper Sphincter (UES), the resting pressure of the low esophageal sphincter (LES) and the distal esophageal contraction integral (DCI) of GERD group and GERD with AF group decreased significantly (P<0.05); The heart rate and QT dispersion (QTd) levels in the GERD group, AF group, and GERD combined with AF group were significantly higher than those in the non GERD group (P<0.05), and the heart rate levels in the non GERD group were significantly lower than those in the GERD group (P<0.05); The arterial blood pressure (SBP, DBP) levels in the GERD group, AF group, and GERD combined with AF group were significantly higher than those in the non GERD group (P<0.05); The size of mucosal inflammation under gastroesophageal endoscopy in the GERD group and GERD combined with AF group was highly grater than non GERD group (P<0.01).

Conclusion

Atrial fibrillation, acid reflux and esophageal movement characteristics are significantly related to gastroesophageal reflux disease. GERD increases the incidence of Atrial fibrillation, significantly increases esophageal acid reflux, and changes esophageal movement characteristics.

Key words: Gastroesophageal reflux disease, Atrial fibrillation, Acid reflux, Esophageal motility characteristics
表1 4组一般临床特证比较
组别 例数 性别 (男性/女性) 年龄 (岁, ) BMI (kg/m2, ) 病程 (个月, )
非GERD组 40 17/23 55.60±7.07 26.01±3.21 3.25±1.02
GERD组 40 21/19 55.57±6.56 26.42±4.05 3.20±0.91
AF组 40 22/18 57.22±7.04 27.81±4.27 3.52±1.17
GERD合并AF组 40 16/24 56.92±6.88 25.96±3.85 3.70±1.34
X2/F值 2.607 0.634 2.003 1.533
P值 0.456 0.594 0.116 0.208
表2 4组患者的酸反流指标比较（）
组别 例数 GERD症状评分（分） 食管近端弱酸反流(%) 食管近端酸反流(%) DeMeester评分（分）
非GERD组 40 8.32±1.23 45.37±4.09 3.46±1.07 12.47±2.11
GERD组 40 13.30±1.93a 63.25±5.13a 25.60±3.45a 41.32±6.81a
AF组 40 7.43±1.15 46.02±4.29 4.56±1.78 14.10±2.43
GERD合并AF组 40 14.55±2.14a,b 67.82±8.36a,b 32.43±4.87a,b 48.47±10.05a,b
F值 156.000 163.835 909.664 346.839
P值 0.000 0.000 0.000 0.000
表3 4组患者的食管运动功能指标的比较（）
组别 例数 UES静息压 (mmHg) LES静息压 (mmHg) CFV (cm/s) IBP (mmHg)
非GERD组 40 98.30±9.96 18.22.±3.06 7.17±1.35 14.30±1.96
GERD组 40 47.57±9.16 8.65±1.74 6.94±1.48 15.00±1.82
AF组 40 83.22±9.140ab 21.80±4.18 6.76±1.41 13.92±1.90
GERD合并AF组 40 53.57±6.84 8.32±1.80 6.95±1.67 14.20±2.31
F值 314.253 223.647 0.512 2.075
P值 0.000 0.000 0.674 0.106
表4 4组患者心率及QTd比较（）
组别 例数 心率(次/min) QTd(ms)
非GERD组 40 68.95±8.16 37.75±5.20
GERD组 40 87.42±8.22 56.40±5.35
AF组 40 110.92±12.70 63.25±5.13
GERD合并AF组 40 117.60±15.60 74.87±7.49
F值 147.870 279.389
P值 0.000 0.000
1
Linz D, Hohl M, Vollmar J, et al. Atrial fibrillation and gastroesophageal reflux disease: the cardiogastric interaction[J]. Europace, 2017, 19(1):16-20.
2
Mohamed A, Ochoa Crespo D, Kaur G, et al. Gastroesophageal reflux and its association with atrial fibrillation: a traditional review[J]. Cureus, 2020, 12(9):e10387.
3
何权瀛. 对于心房颤动、胃食管反流病和阻塞性睡眠呼吸暂停三者关系的认识[J]. 临床内科杂志,2020,37(4):313-316.
4
Jin H, Zhu K, Wang L, et al. Efficacy and safety of non-vitamin K anticoagulants for atrial fibrillation in relation to different renal function levels: a network meta-analysis[J]. Cardiovasc Ther, 2020, 2020:2683740.
5
中华医学会消化病学分会. 2020年中国胃食管反流病专家共识[J]. 中华消化杂志, 2020, 40(10): 649-663.
6
Turagam MK, Flaker GC, Velagapudi P, et al. Atrial fibrillation in athletes: pathophysiology, clinical presentation, evaluation and management[J]. J Atr Fibrillation, 2015, 8(4):1309.
7
Maruyama T, Fukata M, Akashi K. Association of atrial fibrillation and gastroesophageal reflux disease: Natural and therapeutic linkage of the two common diseases[J]. J Arrhythm, 2018, 35(1):43-51.
8
买买提·依斯热依力, 阿孜古丽·阿力木江, 李义亮, 等. NADPH氧化酶-4和酸敏感受体在心理应激小鼠食管中的表达及作用[J]. 中国医师杂志, 2020, 22(7): 1000-1004.
9
Coutinho EL, Herbella FAM, Lovato CAV, et al. Objective evaluation of gastroesophageal reflux disease in patients with paroxysmal atrial fibrillation[J]. World J Surg, 2018, 42(5):1458-1462..
10
Malik V, Lau DH, Linz D, et al. Is the stomach a way to one's heart? Gastric autonomic activity and AF susceptibility in gastroesophageal reflux disease[J]. J Cardiovasc Electrophysiol, 2019, 30(11): 2271- 2273.
11
吴俊, 曾龙欢, 郑永科, 等.老年心房颤动患者合并胃食管反流病的现状及临床症状的调查[J]. 浙江临床医学,2016(1):71-72.
12
Xu L, Zhang Y, Xie J, et al. Association between gastroesophageal reflux disease and atrial fibrillation: a systematic review and meta-analysis[J]. Rev Esp Enferm Dig, 2019, 111(11):874-879.
13
李金贤, 程新春. 胃食管反流病合并心房颤动患者的临床特点及危险因素[J/OL]. 中华胃食管反流病电子杂志,2022, 9(1):6-11.
14
买买提艾力·艾则孜, 买买提·依斯热依力, 张总刚, 等. 胃食管反流病与心房颤动的研究进展[J/OL]. 中华胃食管反流病电子杂志, 2019, 6(2):97-100.
15
Adukauskaite A, Stühlinger M. Vorhofflimmern beim sportler: häufigkeit, diagnose und therapie [Atrial fibrillation in athletes: prevalence, diagnosis, and treatment][J]. Herzschrittmacherther Elektrophysiol, 2023, 34(1):39-44. German.
16
Floria M, Bărboi O, Grecu M, et al. Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease[J]. Turk J Gastroenterol, 2017, 28(2):88-93.
17
Huang TC, Lo LW, Yamada S, et al. Gastroesophageal reflux disease and atrial fibrillation: Insight from autonomic cardiogastric neural interaction[J]. J Cardiovasc Electrophysiol, 2019, 30(11):2262-2270.
18
Jiang Y, Damiris K, Suero-Abreu G, et al. Reflux esophagitis is associated with higher risks of acute stroke and transient ischemic attacks in patients hospitalized with atrial fibrillation: A nationwide inpatient sample analysis[J]. Medicine (Baltimore), 2021, 100(25):e26502.
19
买买提艾力·艾则孜, 买买提·依斯热依力, 张总刚, 等. 炎症反应介导胃食管反流病诱发心房颤动的机制研究[J].中国心血管病研究杂志, 2019, 17(4): 345-350.
20
Armaganijan L, Patel D, Lopes RD, et al. Gastroesophageal reflux and atrial fibrillation: is there any correlation? [J].Expert Rev Cardiovasc Ther, 2012, 10(3):317-22.
21
买买提艾力·艾则孜, 买买提·依斯热依力, 杜宇奎, 等. 胃食管反流病合并房颤患者采用盐酸胺碘酮联合艾司奥美拉唑治疗效果及对炎症因子的影响[J/OL]. 中华胃食管反流病电子杂志,2022, 9(1):23-29.
22
亚力坤·吐尔洪, 买买提·依斯热依力, 克力木·阿不都热依木.胃食管反流病发病分子机制研究进展[J]. 中国医师杂志,2022,24(9):1425-1428.
23
Lin K, Chen X, Zhang L, et al. Proton pump inhibitors as also inhibitors of atrial fibrillation[J]. Eur J Pharmacol, 2013, 718(1-3):435-440.
24
Hwang JJ, Lee DH, Yoon H, et al. Is Atrial fibrillation a risk factor for gastroesophageal reflux disease occurrence?[J] Medicine (Baltimore), 2015, 94(43): e1921.
25
买买提·依斯热依力, 赵新胜, 艾克拜尔·艾力, 等. 慢性束缚应激对小鼠食管上皮细胞间距增宽及炎症发生的研究[J/OL]. 中华胃食管反流病电子杂志,2019,6(4):182-187.
26
Turagam MK, Flaker GC, Velagapudi P, et al. Atrial fibrillation in athletes: pathophysiology, clinical presentation, evaluation and management[J]. J Atr Fibrillation, 2015, 8(4):1309.
27
Velagapudi P, Turagam MK, Leal MA, et al. Atrial fibrillation and acid reflux disease[J]. Clin Cardiol, 2012, 35(3):180-186.
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