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肥胖与食管动力障碍及酸反流的相关性研究

孙丽   

  1. 天津市海洋石油总医院
  • 收稿日期:2011-06-23 修回日期:2011-08-24 出版日期:2011-10-15 发布日期:2011-10-15
  • 通讯作者: 孙丽

  • Received:2011-06-23 Revised:2011-08-24 Published:2011-10-15 Online:2011-10-15

摘要: 目的:探讨肥胖与下食管括约肌压力(LESP)、食管体部远端收缩压及酸反流之间的关系。 方法:对146例患者进行胃食管反流病(GERD)症状问诊、标准食管测压及24 h食管动态pH监测,分为GERD组和对照组。每组根据体重指数(BMI)又分为非肥胖组(BMI≤27.9 kg/m2)及肥胖组(BMI≥28 kg/m2)。 结果:GERD组中,肥胖者的LESP高于非肥胖者(16.4±4.7 vs. 14.4±3.2 mmHg,P=0.014)。对照组与GERD组两组中的肥胖者的食管体部远端收缩压均显著高于非肥胖者(对照组:107±48 vs. 77±20 mmHg,P=0.04;GERD组:98±44 vs. 79±39 mmHg,P=0.017)。对照组中,肥胖者胡桃夹食管发生率显著高于非肥胖者(25% vs. 0,P=0.031)。GERD组中,肥胖者中无效食管运动(IEM)的发生率显著低于非肥胖者(7% vs. 20%,P=0.035)。两组中肥胖者pH<4时间百分比均高于非肥胖者(对照组:pH<4总时间百分比3.0%(0.9~5.6) vs. 1.3%(0.3~2.7),P=0.003;GERD组:立位pH<4时间百分比13.2%(5.1~19.2) vs. 10.4%(2.9~18.1),P=0.001)。BMI与pH<4时间百分比(P<0.001)、食管体部远端收缩压(P=0.007)、和LESP(P=0.006)呈正相关。 结论:肥胖者与非肥胖者在食管生理学检查中存在多方面差异,肥胖者的食管动力更强,食管pH<4时间百分比更高。

关键词: 体重指数, 食管动力障碍, 胃食管反流病, 肥胖

Abstract: Aim: To study the relationship in obesity,esophageal motor functional disorder and esophageal reflux. Methods: Patients (n = 146) were categorized in GERD and controls after clinical assessment, esophageal manometry, and pH monitoring. Non-obese (BMI≤27.9 kg/m2) and obese (BMI ≥ 28 kg/m2) were compared in laboratory of esophageal physiology. Results: Obese showed higher LESP in GERD patients (16.4±4.7vs. 14.4±3.2 mmHg, P=0.014), higher distal esophageal amplitude in both controls (107±48 vs. 77±20 mmHg, P=0.04) and GERD patients (98±44 vs. 79±39 mmHg, P=0.017) , higher frequency of nutcracker esophagus in controls (25 vs. 0%, p =0.031), lower frequency of ineffective motility in GERD patients (7 vs. 20%, p = 0.035), and higher esophageal acid exposure in both controls [total time percentages of pH<4: 3.0% (0.9~5.6) vs. 1.3% (0.3~2.7),P=0.003] and GERD patients [upright: 13.2% (5.1~19.2) vs. 10.4% (2.9~18.1),P=0.001]. BMI was positively correlated with time percentages of pH<4 (p<0.001), distal esophageal amplitude (p = 0.007),or LESP (p = 0.006). Conclusions: Obese patients differed from non-obese in many aspects when evaluated in laboratory of esophageal physiology. Obese patients showed stronger peristalsis and increased acid exposure in the esophagus.

Key words: Body mass index, Esophageal motility disorders, Gastroesophageal reflux disease, Obesity