Lee Annemarie L, Button Brenda M, Denehy Linda, Roberts Stuart J, Bamford Tiffany L, Ellis Samantha J, Mu Fi-Tjen, Heine Ralf G, Stirling Robert G, Wilson John W
Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia.
Respirology. 2014 Feb;19(2):211-217. doi: 10.1111/resp.12182. Epub 2013 Dec 25.
The aims of this observational study were (i) to examine the prevalence of symptomatic and clinically silent proximal and distal gastro-oesophageal reflux (GOR) in adults with chronic obstructive pulmonary disease (COPD) or bronchiectasis, (ii) the presence of gastric aspiration, and (iii) to explore the possible clinical significance of this comorbidity in these conditions.
Twenty-seven participants with COPD, 27 with bronchiectasis and 17 control subjects completed reflux symptom evaluation and dual-channel 24 h oesophageal pH monitoring. In those with lung disease, pepsin levels in sputum samples were measured using enzyme-linked immunosorbent assay, with disease severity (lung function and high-resolution computed tomography) also measured.
The prevalence of GOR in COPD was 37%, in bronchiectasis was 40% and in control subjects was 18% (P = 0.005). Of those diagnosed with GOR, clinically silent reflux was detected in 20% of participants with COPD and 42% with bronchiectasis. While pepsin was found in 33% of COPD and 26% of bronchiectasis participants, the presence of pepsin in sputum was not related to a diagnosis of GOR based on oesophageal pH monitoring in either condition. Neither a diagnosis of GOR nor the presence of pepsin was associated with increased severity of lung disease in COPD or bronchiectasis.
The prevalence of GOR in COPD or bronchiectasis is twice that of the control population, and the diagnosis could not be based on symptoms alone. Pepsin was detected in sputum in COPD and bronchiectasis, suggesting a possible role of pulmonary aspiration, which requires further exploration.
本观察性研究的目的是：（i）检查慢性阻塞性肺疾病（COPD）或支气管扩张症成人患者中症状性及临床无症状的近端和远端胃食管反流（GOR）的患病率；（ii）胃内容物吸入情况；（iii）探讨这种合并症在这些疾病中的可能临床意义。
27例COPD患者、27例支气管扩张症患者和17例对照受试者完成了反流症状评估及双通道24小时食管pH监测。对肺部疾病患者，采用酶联免疫吸附测定法测量痰液样本中的胃蛋白酶水平，并测量疾病严重程度（肺功能和高分辨率计算机断层扫描）。
COPD患者中GOR的患病率为37%，支气管扩张症患者中为40%，对照受试者中为18%（P = 0.005）。在诊断为GOR的患者中，20%的COPD患者和42%的支气管扩张症患者检测到临床无症状反流。虽然在33%的COPD患者和26%的支气管扩张症患者痰液中发现了胃蛋白酶，但在这两种情况下，痰液中胃蛋白酶的存在与基于食管pH监测的GOR诊断无关。GOR的诊断和胃蛋白酶的存在均与COPD或支气管扩张症患者肺部疾病严重程度增加无关。
COPD或支气管扩张症患者中GOR的患病率是对照人群的两倍，且不能仅基于症状进行诊断。在COPD和支气管扩张症患者痰液中检测到胃蛋白酶，提示胃内容物吸入可能起作用，这需要进一步探索。
