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目的探讨胃食管反流病(gastroesophageal reflux disease,GERD)患者中,影响食管黏膜损伤严重程度的因素。方法将消化专科门诊具有典型反流症状,并经24 h 食管 pH 监测异常或(和)胃镜检查证实的 GERD 患者,分为非糜烂性反流病组、轻度糜烂性食管炎组和重度糜烂性食管炎组。比较3组患者一般情况和食管 pH 监测指标。用 logistic 回归分析年龄、性别、食管裂孔疝、烟酒嗜好、幽门螺杆菌感染和食管酸暴露程度对食管损伤严重程度的影响。结果共有156例患者纳入本次研究,其中非糜烂性反流病组83例,轻度糜烂性食管炎组51例,重度糜烂性食管炎组22例。重度糜烂性食管炎组患者的平均年龄和合并食管裂孔疝比例显著高于轻度糜烂性食管炎组和非糜烂性反流病组(P<0.05)。食管 pH 监测指标中卧位长反流次数在严重的食管黏膜损伤患者中显著增加(P<0.05)。食管裂孔疝是食管黏膜损伤程度的独立相关因素(OR=15.032,95%CI:3.767～22.723,P<0.01)。结论 GERD 患者中高龄、男性、合并食管裂孔疝和卧位反流增加的患者中严重的食管黏膜损伤更加常见,食管裂孔疝在食管黏膜损伤的进展过程中起着重要作用。
Objective To investigate the factors affecting the severity of esophageal mucosal injury in patients with gastroesophageal reflux disease (GERD). Methods The gastroenterology patients with typical reflux symptoms were digested and treated with GERD patients with abnormal esophageal pH monitoring at 24 h and / or gastroscopy. The patients were divided into non-erosive reflux disease group, mild erosive esophagitis group and severe erosions Esophagitis group. The general conditions and esophageal pH monitoring indicators in three groups were compared. Logistic regression analysis of age, gender, hiatal hippocampal hippocampus, alcohol and tobacco preferences, Helicobacter pylori infection and esophageal acid exposure on the severity of esophageal injury. Results A total of 156 patients were enrolled in this study. Among them, 83 were non-erosive reflux disease, 51 were mild esophagitis, and 22 were severe esophagitis. The mean age and the proportion of hiatal hernia in patients with severe erosive esophagitis were significantly higher than those with mild erosive esophagitis and non-erosive reflux disease (P <0.05). Esophageal pH monitoring indicators in the supine position the number of reflux in patients with severe esophageal mucosal injury increased significantly (P <0.05). Hiatal hernia was an independent factor related to the degree of esophageal mucosal injury (OR = 15.032, 95% CI: 3.767-22.723, P <0.01). Conclusions Severe esophageal mucosal injury is more common in elderly patients, men, patients with esophageal hiatal hernia and increased supine reflux in GERD patients. Esophageal hiatal hernia plays an important role in the progression of esophageal mucosal injury.