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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (02) : 97 -102. doi: 10.3877/cma.j.issn.2095-7157.2023.02.004

论著

平均夜间基线阻抗对食管外症状胃食管反流病的临床诊断价值
张继舜, 陈思旭, 钱洁, 尚占民†(), 郝建宇   
  1. 100043　北京，首都医科大学附属朝阳医院消化内科
    100043　北京，首都医科大学附属朝阳医院消化内科；100073　北京，北京电力医院消化内科
  • 收稿日期:2023-05-02 出版日期:2023-05-15
  • 通信作者: 尚占民

The clinical value of mean nocturnal baseline impedance for gastroesophageal reflux disease patients with extra-esophageal symptoms

Jishun Zhang, Sixu Chen, Jie Qian, Zhanmin Shang†(), Jianyu Hao   

  1. Department of Gastroenterology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
    Department of Gastroenterology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China; Department of Gastroenterology, Beijing Electric Power Hospital, Beijing 100073, China
  • Received:2023-05-02 Published:2023-05-15
  • Corresponding author: Zhanmin Shang
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引用本文：

张继舜, 陈思旭, 钱洁, 尚占民, 郝建宇. 平均夜间基线阻抗对食管外症状胃食管反流病的临床诊断价值[J]. 中华胃肠内镜电子杂志, 2023, 10(02): 97-102.

Jishun Zhang, Sixu Chen, Jie Qian, Zhanmin Shang, Jianyu Hao. The clinical value of mean nocturnal baseline impedance for gastroesophageal reflux disease patients with extra-esophageal symptoms[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(02): 97-102.

目的

探讨食管平均夜间基线阻抗(MNBI)对表现为食管外症状的胃食管反流病(GERD)的临床诊断价值。

方法

回顾性分析2018年1月至2019年12月期间以烧心、反流、咳嗽或声音嘶哑等为主要症状就诊于首都医科大学附属北京朝阳医院，并行24 h多通路腔内pH-阻抗监测的210例患者。按照诊断及分组标准将纳入患者分为四组，GERD食管外症状组39例、GERD典型症状组64例、GERD混合症状组52例及对照组55例。分析并比较各组间食管远端及近端平均夜间基线阻抗及其它反流参数。

结果

GERD食管外症状组的近端食管MNBI值、食管下段平均pH值低于典型症状组(P<0.05)。相关性分析显示近端及远端食管MNBI值与DeMeester积分、酸暴露时间和酸反流事件次数呈显著负相关(P<0.05)。食管外症状的GERD患者，近端食管MNBI值的诊断曲线下面积显著大于远端食管MNBI值的诊断曲线下面积(P <0.05)，最佳诊断临界值为2 484.38 Ω，诊断敏感性及准确性分别达92.3%和84%，高于远端食管MNBI值的诊断敏感性及准确性。

结论

近端及远端食管MNBI值均与食管酸暴露相关。近端食管MNBI值可提高多通路pH-阻抗监测对食管外症状的GERD患者的检出率，具有重要的临床诊断价值。

关键词: 平均夜间基线阻抗, 24小时多通路腔内阻抗-pH监测, 胃食管反流病, 食管外症状
Objective

To investigate the clinical significance of esophageal mean nocturnal baseline impedance (MNBI) in patients with extra-esophageal symptoms of gastroesophageal reflux disease (GERD).

Methods

We performed a retrospective study of 210 patients with heartburn, reflux, cough, and hoarseness as their main symptoms who underwent 24-hour multichannel intraluminal impedance and pH monitoring in Beijing ChaoYang hospital from January 2018 to December 2019.According to diagnostic criteria and their main clinical manifestations, patients were divided into four groups, the extra-esophageal symptoms group, the typical symptoms group, the mixed symptom group with both typical and extra-esophageal symptoms, and the control group.We analyzed and compared distal and proximal esophageal MNBI value and other reflux parameters among the four groups.

Results

The proximal esophageal MNBI value and mean pH at distal esophagus in GERD extra-esophageal symptoms group were lower than those in the typical symptom group (P<0.05). Correlation analysis showed that the proximal and distal esophageal MNBI value were negatively correlated with DeMeester score, acid exposure time and acid reflux times (P<0.05). According to ROC analysis, for GERD patients with extra-esophageal symptoms, area under curve of the proximal esophagus MNBI value was significantly higher than the area under curve of the distal esophageal MNBI value (P<0.05), the cut-off value for diagnosis was 2484.38 ohms. The sensitivity and accuracy of the proximal esophageal MNBI value in diagnosis GERD patients with extra-esophageal symptoms reached 92.3% and 84%, which were higher than those of the distal esophageal MNBI value.

Conclusions

Both the proximal and distal esophagus MNBI values negatively correlate with acid exposure. Proximal esophagus MNBI value can improve the detection rate of multi-channel pH-impedance monitoring for patients with extra-esophageal symptoms of GERD, which has important clinical diagnostic value.

Key words: Mean nocturnal baseline impedance, 24-hour multi-channel intraluminal impedance and pH monitoring, Gastroesophageal reflux disease, Extra-esophageal symptoms
表1 四组间pH-阻抗监测相关参数比较(Q1, Q3)
项目 GERD食管外症状组(n＝39) GERD典型症状组(n＝64) GERD混合症状组(n＝52) 对照组(n＝55) P值 Pa值 Pb值
男/女 18/21 34/30 25/27 30/25 0.817 0.546 0.589
中位年龄(岁) 60.0(44.0, 65.0) 53.0(41.25，58.00) 53.5(37.25, 62.75) 57.0(49.00, 65.00) 0.074 0.082 0.625
近端食管MNBI(Ω) 1718.33 (1298.53, 2203.26) 2630.27(2121.17, 2900.39) 1786.20 (1374.63，2554.21) 2757.08c(2513.06, 2997.42) <0.001 <0.001 <0.001
远端食管MNBI(Ω) 2110.48(1209.75, 2735.76) 2374.62(1960.29, 2942.45) 2166.35(1279.56，3161.65) 2763.62c(2290.64, 3655.14) <0.001 0.090 0.470
DeMeester积分 17.30 (3.10, 26.40) 2.70(1.30, 10.65) 9.05(3.23, 16.43) 2.30c(1.00, 5.90) <0.001 <0.001 0.012
总酸暴露时间(%) 4.50 (0.70, 8.00) 0.75(0.20, 3.28) 2.20(0.75, 4.75) 0.50c(0.10, 1.50) <0.001 0.001 0.017
食管下段平均pH值 5.81 (5.51, 6.17) 6.27(6.00, 6.70) 6.18(5.73, 6.48) 6.40c(6.09, 6.80) <0.001 <0.001 0.094
近端酸反流次数(n) 16.00(7.00, 29.00) 9.50(4.00, 19.00) 13.50(7.25, 20.00) 6.00c(2.00, 10.00) <0.001 0.084 0.225
近端非酸反流次数(n) 9.00(6.00, 14.00) 9.50(4.00, 14.75) 12.00(8.00, 17.00) 9.00(6.00, 14.00) 0.089 0.509 0.019
近端总反流次数(n) 27.00(17.00, 42.00) 20.50(11.00, 30.75) 24.50(18.25, 34.00) 16.00c(10.00, 23.00) <0.001 0.015 0.035
远端酸反流次数(n) 31.00(15.00, 43.00) 17.50(9.00, 31.00) 21.50(11.25, 29.50) 9.00c(4.00, 18.00) <0.001 0.030 0.556
远端非酸反流次数(n) 24.00(15.00, 44.00) 23.00(13.00, 32.50) 27.50(17.25, 40.75) 23.00(18.00, 33.00) 0.398 0.371 0.084
远端总反流次数(n) 59.00 (45.00, 75.00) 44.50(30.25, 60.50) 49.00(37.00, 63.50) 36.00c(28.00, 46.00) <0.001 0.001 0.113
表2 Spearman相关性分析结果
项目 近端食管MNBI值 远端食管MNBI值
相关系数 P值 相关系数 P值
DeMeester积分 －0.407 <0.001 －0.573 <0.001
总酸暴露时间 －0.401 <0.001 －0.582 <0.001
近端酸反流次数 －0.275 <0.001 －0.407 <0.001
近端非酸反流次数 0.023 0.746 0.067 0.337
近端总反流次数 －0.196 0.004 －0.289 <0.001
远端酸反流次数 －0.326 <0.001 －0.411 <0.001
远端非酸反流次数 0.098 0.158 0.137 0.048
远端总反流次数 －0.216 0.002 －0.240 <0.001
图1 MNBI参数的诊断ROC曲线注：ROC曲线以敏感性作为纵坐标，1-特异性作为横坐标；各MNBI参数的ROC曲线以不同颜色显示：近端MNBI值(橘色)、远端MNBI值(蓝色)、两者联合诊断的预测概率(绿色)。A：MNBI值对GERD患者的诊断ROC曲线；B：MNBI值对食管外症状GERD患者的诊断ROC曲线
表3 MNBI值对GERD患者的诊断价值
项目 特异性(%) 敏感性(%) 阳性预测值(%) 阴性预测值(%) 诊断符合率(%) 约登指数 AUC
近端食管MNBI 74.5 67.7 88.2 45.1 69.5 0.422 0.714
远端食管MNBI 80.0 51.6 87.9 37.0 59.0 0.316 0.691
二者的预测概率 70.9 71.6 87.4 47.0 71.4 0.425 0.732
表4 MNBI值对表现为食管外症状的GERD患者的诊断价值
项目 特异性(%) 敏感性(%) 阳性预测值(%) 阴性预测值(%) 诊断符合率(%) 约登指数 AUC
近端食管MNBI 78.2 92.3 75.0 93.5 84.0 0.705 0.866
远端食管MNBI 80.0 59.0 67.6 73.3 71.3 0.390 0.736
二者的预测概率 72.7 94.9 71.1 95.2 81.9 0.676 0.863
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