24 h pH-阻抗监测对胃食管反流病患者治疗反应性的预测价值

董培雯; 王琼; 孙恺蒂; 刘丽; 龙彦婵; 林琳

doi:10.3969/j.issn.2096-3882.2024.01.004

24 h pH-阻抗监测对胃食管反流病患者治疗反应性的预测价值

Predictive value of 24 h pH- impedance monitoring on therapeutic responsiveness of GERD patients

摘要

摘要: 目的探讨24 h pH-阻抗监测对胃食管反流病（gastroesophageal reflux disease，GERD）患者治疗反应性的预测价值。方法选取2020年12月-2022年11月成都市第三人民医院接受治疗的286例具有典型反流症状的GERD患者作为研究对象，所有患者均接受质子泵抑制剂（proton pump inhibitors，PPI）治疗，2个月后根据治疗效果，将患者分为有效组和无效组。对比2组患者的日常生活习惯、高分辨率测压结果、24 h pH-阻抗监测结果、症状及量表评分。采用多因素logistic回归分析筛选治疗反应影响因素，构建预测模型，绘制ROC曲线分析其预测价值。结果治疗2个月后，有效组纳入184例，无效组纳入102例。有效组治疗前食管下括约肌（low esophageal sphincter，LES）长度以及LES静息压均低于无效组（P<0.10），远端潜伏期（distal latency，DL）及远端收缩积分（distal contractile integral，DCI）均高于无效组（P<0.10），有效组患者治疗前的酸暴露时间（acid exposure time，AET） ≥ 6%、总反流发作次数、DeMeester评分均低于无效组（P<0.10）；有效组反流后吞咽诱发的蠕动波（post-reflux swallow-induced peristaltic wave，PSPW）指数 ≥ 61%比例、平均夜间基线阻抗（mean nocturnal baseline impedance，MNBI）值 ≥ 2 292 Ω比例高于无效组（P<0.10）。多因素logistic回归分析显示，LES静息压（OR=0.738）、DL（OR=3.643）、DCI（OR=1.124）及24 h pH-阻抗监测综合预测（OR=1.940）水平均可影响GERD治疗反应性（P<0.10）。ROC曲线分析显示，24 h pH-阻抗监测的综合预测水平（AUC=0.969，特异度=90.2%，敏感度=91.3%）高于其他影响因素。结论 24 h pH-阻抗监测的相关参数可高度预测典型的GERD患者对采用PPI后的治疗反应。

Abstract: Objective To explore the predictive value of 24-hour pH-impedance monitoring in assessing the therapeutic response of patients with gastroesophageal reflux disease (GERD).Methods A total of 286 GERD patients with typical reflux symptoms who received treatment at the Third People's Hospital of Chengdu from December 2020 to November 2022 were selected for the study. All patients were treated with proton pump inhibitors (PPI). After two months, according to the treatment effect, the patients were divided into effective group and ineffective groups. A comparison was made between the two groups regarding their daily living habits, high-resolution manometry results, 24-hour pH-impedance monitoring results, symptoms, and scale scores. Multivariate Logistic regression analysis was used to identify factors influencing treatment response, a prediction model was constructed, and the ROC curve was drawn to analyze the prediction value.Results After two months of treatment, 184 cases were included in the effective group and 102 cases in the ineffective group. The length and the resting pressure of the LES in the effective group before treatment were lower than that in the ineffective group (P<0.10). The distal latency (DL) and distal contractile integral (DCI) were higher in the effective group compared to the ineffective group (P<0.10). The patients in the effective group had lower acid exposure time (AET) ≥ 6% and total reflux episodes as well as DeMeester score before treatment than those in the ineffective group (P<0.10). The proportion of the post-reflex swallowed-induced peristaltic wave (PSPW) index ≥ 61% and the mean nocturnal baseline impedance (MNBI) value ≥ 2 292 Ω in the effective group after reflux was higher than that in the ineffective group (P<0.10). Multivariate Logistic regression analysis showed that the LES resting pressure (OR=0.738), DL(OR=3.643), DCI(OR=1.124) and comprehensive 24-hour pH- impedance monitoring prediction (OR=1.940) could affect the treatment response of GERD (P<0.10). ROC curve analysis indicated that the comprehensive prediction based on 24-hour pH-impedance monitoring (AUC=0.969, specificity=90.2%, and sensitivity=91.3%) was higher than other contributing factors.Conclusions Relevant parameters associated with 24-hour pH-impedance monitoring can effectively predict the treatment response of typical GERD patients to PPI therapy.

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