天津医药

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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

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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