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目的研究非糜烂性胃食管反流病(NERD)各亚型食管酸暴露特点,探讨雷贝拉唑对其诊断价值。方法 32例 NERD 患者分成3组,异常酸反流组14例,食管对酸高敏组11例,功能性烧心组7例,并以雷贝拉唑10mg,2次/d 治疗2周。结果 (1)各组酸暴露:异常酸反流组酸反流总次数、长反流次数、pH<4时间及其百分比较其他两组明显增加;食管对酸高敏组症状指数显著高于功能性烧心组[(81.0±22.5)%比(8.6±14.8)%,P<0.01]。(2)症状比较:各组间治疗前典型症状积分和总积分相比差异均无统计学意义;食管对酸高敏组患者食管外症状积分显著高于异常酸反流组患者(4.0±3.8比0.9±2.2,P<0.05)。(3)疗效:异常酸反流组、食管对酸高敏组患者在雷贝拉唑治疗1、2周后均有食管外症状积分、总积分的显著下降;而功能性烧心组患者仅有下降趋势,与治疗前比较差异无统计学意义;异常酸反流组与其他两组治疗后2周比较,症状积分差异有统计学意义。(4)雷贝拉唑对 NERD 患者1、2周治疗后总体有效率分别为56.3%、68.8%;雷贝拉唑诊断试验对异常酸反流和食管酸高敏的敏感性和特异性,在1周时分别为64.0%、71.4%,在2周时分别为80.0%、71.4%。结论 (1)异常酸反流组酸暴露主要表现在酸反流的总次数、长反流次数增多,pH<4时间延长。(2)食管对酸高敏患者可能更易发生食管外症状。(3)雷贝拉唑诊断试验对 NERD有较好的诊断和分型价值。
Objective To investigate the characteristics of esophageal acid exposure in non-erosive gastroesophageal reflux disease (NERD) subtypes and to evaluate the diagnostic value of rabeprazole. Methods 32 patients with NERD were divided into three groups: 14 patients with abnormal acid reflux group, 11 patients with esophageal acid sensitivity group and 7 patients with functional heartburn group. The patients were treated with rabeprazole 10 mg twice daily for 2 weeks. Results (1) Acid exposure in each group: The total number of acid reflux, long reflux times, pH <4 time and its percentage in abnormal acid reflux group increased significantly compared with the other two groups; the symptom index in esophageal acid hypersensitivity group was significantly higher than that in function Sexual heartburn group [(81.0 ± 22.5)% vs (8.6 ± 14.8)%, P <0.01]. (2) Symptom comparison: There was no significant difference in the scores of typical symptom scores and total scores before treatment in each group. The score of esophageal symptom in patients with esophageal hypersensitivity was significantly higher than that in patients with abnormal acid reflux (4.0 ± 3.8 0.9 ± 2.2, P <0.05). (3) Efficacy: Patients with abnormal acid reflux group and esophagus with acid-sensitive group had esophageal symptom scores and total scores decreased significantly after treatment with rabeprazole for 1 and 2 weeks. However, patients with functional heartburn group only showed a downward trend, There was no significant difference compared with that before treatment. There was significant difference in symptom score between the two groups after 2 weeks of treatment. (4) The overall effective rates of rabeprazole in patients with NERD after 1 and 2 weeks of treatment were 56.3% and 68.8%, respectively. The sensitivity and specificity of the rabeprazole diagnostic test for abnormal acid reflux and esophageal acid sensitivity in 64.0% and 71.4% at 1 week and 80.0% and 71.4% respectively at 2 weeks. Conclusions (1) The abnormal acid reflux group acid exposure mainly in the total number of acid reflux, increased the number of long reflux, pH <4 prolonged. (2) Esophageal hypersensitivity patients may be more likely to have esophageal symptoms. (3) The diagnostic test of rabeprazole has a better diagnosis and classification value for NERD.