Livzan M A, Lapteva I V, Krolevets T S, Kiselev I E
Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia.
Omsk Regional Clinical Medical Sanitary Unit Nine, Omsk, Russia.
Ter Arkh. 2016;88(2):21-27. doi: 10.17116/terarkh201688221-27.
To reveal the specific features of gastroesophageal reflux disease (GERD) associated with obesity and overweight, by investigating the clinical and endoscopic manifestations of the disease, 24-hour pH-metry scores, and leptin levels.
A total of 131 patients with GERD were examined. The data about complaints and those from life and medical histories were collected; anthropometric measurements and the results of blood biochemical tests, esophagoduodenoscopy (EPDS), and pH-metry were assessed; and the serum levels of leptin and its receptor were estimated. The patients were allocated into a study group (104 obese and/or overweight patients) and a comparison one (27 normal weight people).
Waist circumference, hip circumference, and blood glucose levels proved to be statistically significantly higher in the study group (p<0.00000, p<0.00002, and p<0.02, respectively). The obese patients were found to have a statistically significantly higher level of leptin and a lower level of its soluble receptors: the median leptin levels were 30.42 (13.42-45.62) ng/ml in the study group and 5.47 (3.35-7.68) ng/ml in the comparison group; the median levels of the receptors were 18.83 (14.98-25.11) ng/ml and 30.93 (24.68-33.53) ng/ml, respectively). This group showed a moderate negative correlation between these indicators (rs=-0.451; p<0.0004). The study group displayed higher pH values in the gastric cardia and body (p<0.05 and p<0.04, respectively). The mucosal contact time with the refluxate having with a low pH value (<4) in the above segments turned out to be longer in the comparison group (p<0.05). There were weight-independent relationships of the leptin level to its spread, aggressiveness quotient, to the highest pH value in the gastric cardia and body, and to the mucosal contact time with the refluxate having a pH below 4.0 (rs=0.543; p<0.006; rs=0.432; p<0.04; rs=0.431; p<0.04; rs=-0.450; p<0.03, respectively), leptin receptors with a pH ratio in the gastric cardia and body, to the number of reflux episodes longer than 5 minutes in the esophagus, and to the De Meester index for this indicator (rs=0.471; p<0.04; rs=-0.455; p<0.04; rs=-0,454; p<0.04, respectively).
Obese and overweight patients develop GERD in the presence of leptin resistance and biliary tract disease, which determines the specific features of the disease (alkaline or mixed refluxate) and the need for individualized therapy.
通过研究胃食管反流病（GERD）的临床和内镜表现、24小时pH值监测评分及瘦素水平，揭示与肥胖和超重相关的胃食管反流病的具体特征。
共检查了131例胃食管反流病患者。收集了有关主诉以及生活史和病史的数据；评估了人体测量数据、血液生化检查结果、食管十二指肠镜检查（EPDS）和pH值监测结果；并测定了血清瘦素及其受体水平。将患者分为研究组（104例肥胖和/或超重患者）和对照组（27例体重正常者）。
研究组的腰围、臀围和血糖水平在统计学上显著更高（分别为p<0.00000、p<0.00002和p<0.02）。发现肥胖患者的瘦素水平在统计学上显著更高，而其可溶性受体水平更低：研究组瘦素水平中位数为30.42（13.42 - 45.62）ng/ml，对照组为5.47（3.35 - 7.68）ng/ml；受体水平中位数分别为18.83（14.98 - 25.11）ng/ml和30.93（24.68 - 33.53）ng/ml。该组这些指标之间呈中度负相关（rs = -0.451；p<0.0004）。研究组胃贲门和胃体部的pH值更高（分别为p<0.05和p<0.04）。对照组上述节段与低pH值（<4）反流物的黏膜接触时间更长（p<0.05）。瘦素水平与其扩散、侵袭性商数、胃贲门和胃体部的最高pH值以及与pH低于4.0的反流物的黏膜接触时间存在与体重无关的关系（分别为rs = 0.543；p<0.006；rs = 0.432；p<0.04；rs = 0.431；p<0.04；rs = -0.450；p<0.03），瘦素受体与胃贲门和胃体部的pH比值、食管中持续超过5分钟的反流发作次数以及该指标的De Meester指数存在与体重无关的关系（分别为rs = 0.471；p<0.04；rs = -0.455；p<0.04；rs = -0.454；p<0.04）。
肥胖和超重患者在存在瘦素抵抗和胆道疾病的情况下发生胃食管反流病，这决定了该疾病的具体特征（碱性或混合反流物）以及个体化治疗的必要性。
