陈海波 李艳军

[摘要] 目的：探讨胃食管反流病中酸反流、非酸反流的情况及其与烧心的关系。方法：选择收治的临床诊断为反流性食管病患者92例，根据消化内镜检查结果及24 h pH监测指标分为糜烂性食管炎（A组，40例）和非糜烂性反流病（B组，52例），比较两组联合阻抗-pH监测指标。结果：两组阻抗指标酸反流次数、酸反流时间百分比比较，差异有统计学意义（P<0.05）。两组非酸反流次数比率比较，差异有统计学意义（χ2=20.167，P<0.05）；两组非酸反流烧心症状指数阳性率分别为22.5%（A组）、13.5%（B组）。结论：胃食管反流病中，无论糜烂性食管炎还是非糜烂性食管炎，非酸反流症状指数阳性均占相当的比例，提示非酸反流也是引起烧心的一个重要因素。

[关键词] 烧心；酸返流；非酸反流；胃食管反流病；pH监测

[中图分类号] R571 [文献标识码]B[文章编号]1673-7210（2011）11（c）-169-02

Non-acid reflux and its relationship with heart burn in the gastroesophageal reflux disease

CHEN Haibo1,LI Yanjun2

1.The People's Hospital of Ankang City, Shaanxi Province, Ankang 725000, China; 2.Eyes Hospital of Tangshan City, Hebei Province, Tangshan 063000, China

[Abstract] Objective: To investigate the acid reflux, non-acid reflux and its relationship with heart burn in gastroesophageal reflux disease. Methods: 92 patients with gastroesophageal reflux disease in gastroenterology department were divided into erosive esophagitis group (group A of 40 patients) and non-erosive reflux disease group (group B of 52 cases) in base ofdigestive endoscopy and 24 h pH monitoring indicators, combined impedance-pH monitoring indicators of two groups were compaired. Results: The differences of frequency and acid reflux time percentage between two groups was statistically significant (P<0.05). Frequency percentage of non-acid reflux in two groups was significant different (χ2=20.167,P<0.05); the percentage of heart burn symptom positive in two groups was 22.5%, 13.5% separately. Conclusion: In gastroesophageal reflux disease, whether erosive esophagitis or the non-erosive esophagitis, the non-acid reverse flow symptoms index accounted for a significant portion, it prompts that non-acid reverse flow is also an important factor of heartburn.

[Key words] Heart burn; Acid reflux; Non-acid reflux; Gastroesophageal reflux disease; pH monitoring

胃食管反流病（gastroesophageal reflux disease，GERD）是指胃内容物，包括从十二指肠流入胃的胆盐和胰酶等反流入食管，引起食管黏膜损伤及其一系列并发症。胃食管反流病的治疗主要是质子泵抑制剂、H2受体阻滞剂、保护黏膜、促进动力等治疗。但有少部分患者抗酸治疗效果不佳，有研究证实该类患者治疗失败与非酸反流有关[1-2]。本文笔者采用24 h多通道阻抗pH监测，探讨胃食管反流病中非酸反流的分布情况。现报道如下：

1 资料与方法

1.1 一般资料

本组入选92例病例均为2008年2月~2010年10月收治的烧心症状明显的胃食管反流病患者，入组前烧心持续或反复发作大于3个月。排除标准：其他原因引起的食管病变、上消化道肿瘤及手术史、胃十二指肠溃疡、严重的心肝肾疾病及内分泌疾病等。根据消化内镜检查结果分为糜烂性食管炎组（A组）和非糜烂性反流病组（B组），A组40例患者，B组52例患者。

1.2 方法

全部患者给予24 h食管多通道腔内阻抗-pH监测，采用Sleuth系统，包括记录仪、检测管、分析软……