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基于“里昂共识”对胃食管反流病阻抗-pH监测参数的分析和比较

张静 王智凤 柯美云 方秀才 李晓青 章家常 舒柯 孙晓红

张静, 王智凤, 柯美云, 方秀才, 李晓青, 章家常, 舒柯, 孙晓红. 基于“里昂共识”对胃食管反流病阻抗-pH监测参数的分析和比较[J]. 中华全科医学, 2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407
引用本文: 张静, 王智凤, 柯美云, 方秀才, 李晓青, 章家常, 舒柯, 孙晓红. 基于“里昂共识”对胃食管反流病阻抗-pH监测参数的分析和比较[J]. 中华全科医学, 2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407
ZHANG Jing, WANG Zhifeng, KE Meiyun, FANG Xiucai, LI Xiaoqing, ZHANG Jiachang, SHU Ke, SUN Xiaohong. Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the 'Lyon Consensus'[J]. Chinese Journal of General Practice, 2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407
Citation: ZHANG Jing, WANG Zhifeng, KE Meiyun, FANG Xiucai, LI Xiaoqing, ZHANG Jiachang, SHU Ke, SUN Xiaohong. Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"[J]. Chinese Journal of General Practice, 2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407

基于“里昂共识”对胃食管反流病阻抗-pH监测参数的分析和比较

doi: 10.16766/j.cnki.issn.1674-4152.003407
基金项目: 

国家重点研发计划项目 2018YFC2000300

北京协和医院中央高水平医院临床科研专项项目 2022-PUMCH-B-132

详细信息
    通讯作者:

    孙晓红,E-mail:sunxiaoh2010@126.com

  • 中图分类号: R571  R573

Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"

  • 摘要:   目的  对胃食管反流病(GERD)患者食管pH和阻抗-pH监测反流参数的结果按照“里昂共识”标准进行回顾性分析,并比较传统DeMeester评分(DMS)和酸暴露时间(AET)参数。  方法  选取2008年1月—2022年12月北京协和医院胃肠动力中心接受24 h食管pH监测或阻抗-pH监测的GERD患者共1 023例,分别采用DMS和AET标准对检测结果进行重新分析及比较。  结果  (1) 根据“里昂共识”AET标准,AET的灵敏度为94.7%,特异度为99.0%,DMS的灵敏度为98.1%,特异度为97.2%,DMS较AET灵敏度高,而AET的特异度高于DMS。2种方法监测结果比较具有高度的一致性(P < 0.05)。(2)在AET 4%~6%的105例患者中,DMS阳性和DMS阴性2组间酸反流次数、>5 min次数、最长酸反流时间和卧位pH<4的百分比(卧位%)比较差异有统计学意义,提示有必要对AET以外的参数进行考量和分析。(3)105例AET 4%~6%的患者中,有超过50%的患者仍不能确定是否存在病理性反流。  结论  “里昂共识”AET标准和DMS标准具有较好的一致性,均能对食管酸暴露提供有力的支持证据,AET的灵敏度低于DMS,而特异度高于DMS。如果将AET>4%定为酸反流阳性,则可提高AET的灵敏度。

     

  • 表  1  DMS和AET诊断酸反流的一致性比较[例(%)]

    Table  1.   Consistency comparison between DMS and AET in diagnosing acid reflux [cases (%)]

    组别 AET<4% AET 4%~6% AET>6% 合计
    DMS阳性 17(2.8) 77(73.3) 305(98.1) 399(39.0)
    DMS阴性 590(97.2) 28(26.7) 6(1.9) 624(61.0)
    合计 607(59.3) 105(10.3) 311(30.4) 1 023(100.0)
    注:Kappa=0.945,P < 0.001。
    下载: 导出CSV

    表  2  DMS阳性和DMS阴性AET 4%~6%患者监测参数比较[M(P25, P75)]

    Table  2.   Comparison of monitoring parameters in AET 4%-6% patients based on DMS positivity and negativity [M(P25, P75)]

    组别 例数 酸反流次数(次) >5 min次数(次) 最长酸反流时间(min) 立位% 卧位%
    DMS阴性 28 44.5(31.3, 54.5) 1.1(1.0, 2.0) 8.6(6.7, 11.5) 6.3(5.7, 7.0) 0(0, 0.4)
    DMS阳性 77 55.0(36.0, 72.5) 2.0(1.1, 3.6) 11.1(8.0, 18.8) 2.9(5.4, 7.8) 3.2(0.7, 6.9)
    Z -2.229 -2.867 -2.877 -0.518 -5.295
    P 0.026 0.004 0.004 0.604 < 0.001
    下载: 导出CSV

    表  3  不同反流事件次数AET 4%~6%患者DMS评分比较[例(%)]

    Table  3.   Comparison of DMS scores in AET 4%-6% patients with varying reflux events [cases (%)]

    反流事件次数 DMS阴性 DMS阳性 合计
    < 40次/24 h 12(42.8) 20(26.0) 32(30.5)
    40~80次/24 h 15(53.6) 41(53.2) 56(53.3)
    >80次/24 h 1(3.6) 16(20.8) 17(16.2)
    总计 28(26.7) 77(73.3) 105(100.0)
    注:χ2=5.676,P=0.059。
    下载: 导出CSV

    表  4  DMS和AET(最佳截断值为4%时)诊断酸反流的一致性比较[例(%)]

    Table  4.   Consistency comparison in reflux monitoring between DMS and AET (cut off >4%)

    组别 AET≤4% AET>4% 合计
    DMS阳性 20(3.2) 385(94.6) 405(39.6)
    DMS阴性 596(96.8) 22(5.4) 618(60.4)
    合计 616(60.2) 407(39.8) 1 023(100.0)
    注:Kappa=0.914,P < 0.001。
    下载: 导出CSV
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  • 收稿日期:  2023-06-06
  • 网络出版日期:  2024-05-27

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