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目的 :探讨食管运动功能检查及兰索拉唑治疗试验对非心源性胸痛患者病因诊断的价值。方法 :对 63例经临床及心血管方面检查明确为非心脏起因的发作性胸痛患者进行内镜、食管测压、2 4 h食管腔内 p H监测及 7天的兰索拉唑治疗试验。结果 :63例中符合胃食管反流病 ( GERD) 4 4例 ( 70 % ) ,非特异性食管运动障碍 6例 ( 10 % ) ,贲门失弛症 3例 ( 5 % ) ,未明原因 10例。兰索拉唑治疗试验对诊断 GERD的敏感性为 91% ( 2 0 /2 2 ) ,而安慰药有效率仅 9% ( 2 /2 2 ) ,差异有显著意义 ( P<0 .0 5 ) ,治疗试验的特异性为 84 %。结论 :食管测压、 2 4 h食管腔内 p H监测有助于发现非心源性胸痛患者的食管动力异常 ,兰索拉唑治疗试验是临床诊断 GERD的简便而实用的方法。
Objective: To investigate the value of esophageal motor function test and lansoprazole treatment in the etiological diagnosis of non-cardiac chest pain patients. Methods: Endoscopy, esophageal manometry, p H monitoring within 24 h esophageal lumen and 7 days of lansoprazole treatment were performed on 63 patients with clinically and cardiologically confirmed episodic chest pain with non-cardiac causes . Results: Of the 63 patients, 44 (70%) had gastroesophageal reflux disease (GERD), 6 had nonspecific esophageal dyskinesia (10%), 3 had cardia achalasia (5%) and 10 had unexplained causes. The sensitivity of lansoprazole to the diagnosis of GERD was 91% (20/22), while that of the placebo was only 9% (2/2 2), with significant difference (P <0.05) , The specificity of the treatment trial was 84%. CONCLUSIONS: Esophageal manometry and 24-h intraparenchymal p H monitoring are helpful in detecting esophageal motility abnormalities in patients with non-cardiac chest pain. Lansoprazole treatment is a simple and practical method for the clinical diagnosis of GERD.