【摘 要】
：
目的:研究不同中医证候的胃食管反流病(GERD)患者的食管动力及酸暴露特点.方法:选取2015年4月-2019年12月就诊的具有典型反流症状的189例患者,按照中医证候分为肝胃郁热证、胆胃郁热证、气郁痰阻证、中虚气逆证、脾虚湿热证5型,同时完成胃镜、食管高分辨率测压(HRM)、24 h多通路阻抗联合pH监测.记录相关数据,比较不同证候之间食管动力及pH阻抗结果之间的差异,采用SPSS 16.0软件进行统计分析.结果:上食管括约肌静息压(UESP)比较:气郁痰阻证UESP最低;远端收缩积分(DCI)积分、无
【机 构】
：
首都医科大学附属北京中医医院消化中心 北京,100010
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目的:研究不同中医证候的胃食管反流病(GERD)患者的食管动力及酸暴露特点.方法:选取2015年4月-2019年12月就诊的具有典型反流症状的189例患者,按照中医证候分为肝胃郁热证、胆胃郁热证、气郁痰阻证、中虚气逆证、脾虚湿热证5型,同时完成胃镜、食管高分辨率测压(HRM)、24 h多通路阻抗联合pH监测.记录相关数据,比较不同证候之间食管动力及pH阻抗结果之间的差异,采用SPSS 16.0软件进行统计分析.结果:上食管括约肌静息压(UESP)比较:气郁痰阻证UESP最低;远端收缩积分(DCI)积分、无效食管动力(IEM)例数、弱蠕动及失蠕动百分率比较:肝胃郁热证、胆胃郁热证DCI积分低于其他证候组,IEM例数、弱蠕动及失蠕动百分率高于其他证候组(P＜0.05);远端收缩延迟(DL)及食管胃连接部(EGJ)分型比较差异无统计学意义(P＞0.05);下食管括约肌静息压(LESP)比较:中虚气逆证LESP最低,其次为脾虚湿热证.在酸暴露方面:脾虚湿热证在DeMeester评分、总反流时间、总反流次数、总AET％、立位AET％、卧位AET％方面均高于其他证候组(P＜0.05);肝胃郁热证及胆胃郁热证在DeMeester评分、总反流时间、总AET％、立位AET％方面高于中虚气逆证(P＜0.05);食管近端反流总计、食管近端酸反流、食管近端弱酸反流比较,气郁痰阻证均高于其他证候组(P＜0.05).结论:不同中医证候的GERD患者的食管动力学指标存在明显差异,气郁痰阻证更多出现上食管括约肌屏障功能下降,肝胃郁热证及胆胃郁热证更多见食管体部蠕动功能障碍,中虚气逆证及脾虚湿热证更多的是EGJ抗反流屏障功能下降.在酸暴露方面,脾虚湿热证的酸暴露各项指标得分更高,气郁痰阻证在食管近端酸暴露各项指标得分更高.GERD中医证候与食管动力及酸暴露有一定相关性.
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