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目的探讨喘息儿童酸反流发病机制中一过性下食管括约肌松弛及其与胃食管返流的关系。方法选取有典型喘息症状的儿童74例行24h食管pH监测和食管测压。根据pH<4总时间百分比<4%且Boix-Ochoa计分<11.99的标准,将受试者分为胃食管反流组(pH+组)和非胃食管返流组(pH-组)。结果喘息儿童胃食管反流发生率为66.2%(49/74),pH+组儿童食管pH监测的各项参数均明显高于pH-组儿童。pH+组食管下括约肌压力(LESP)明显低于pH-组[(12.1±6.8)Vs(33.5±5.6)mmHg,1mmHg=0.133kPa,P<0.05]。pH+组一过性LES松弛(TLESR)发生频率及TLESR持续时间明显高于pH-组[分别为(5.0±2.2)次/h Vs(2.6±1.3)次/h,(58.1±17.6)s Vs(22.7±15.4)s,均P<0.05]。与吞咽相关的LES松弛后收缩波幅(post-LESRA)在两组间亦存在显著差别[(37.0±18.9)mmHg Vs(71.8±17.2)mmHg,P<0.05]。结论喘息儿童酸反流发生率高,酸反流伴随TLESR发生频率增加,持续时间长。
Objective To investigate the relationship between transient lower esophageal sphincter relaxation and gastroesophageal reflux in the pathogenesis of acid reflux in wheezing children. Methods 74 children with typical wheezing symptoms were selected for 24-hour esophageal pH monitoring and esophageal manometry. Subjects were divided into a gastroesophageal reflux group (pH + group) and a non-gastroesophageal reflux group (pH- group) based on a criterion of pH <4 total time <4% and Boix-Ochoa score <11.99. Results The incidence of gastroesophageal reflux in wheezing children was 66.2% (49/74). The parameters of esophageal pH monitoring in children with pH + were significantly higher than those in children with pH. The lower esophageal sphincter pressure (LESP) of pH + group was significantly lower than that of pH group [(12.1 ± 6.8) vs (33.5 ± 5.6) mmHg, 1 mmHg = 0.133 kPa, P <0.05]. The frequency of TLESR and the duration of TLESR in pH + group were significantly higher than those in pH group [(5.0 ± 2.2) / h Vs (2.6 ± 1.3) / h, (58.1 ± 17.6) s Vs (22.7 ± 15.4) s, all P <0.05]. Post-LESRA amplitude associated with swallowing was also significantly different between the two groups [(37.0 ± 18.9) mmHg Vs (71.8 ± 17.2) mmHg, P <0.05]. Conclusions The incidence of acid reflux in wheezing children is high, and the frequency of acid reflux accompanied with TLESR increases for a long time.