多通道腔内阻抗-pH 与传统 pH 测量食管酸暴露的比较：倾向评分匹配分析。
Comparison of the multichannel intraluminal impedance pH and conventional pH for measuring esophageal acid exposure: a propensity score-matched analysis.
机构信息
Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
出版信息
Surg Endosc. 2017 Dec;31(12):5241-5247. doi: 10.1007/s00464-017-5595-9. Epub 2017 May 18.
BACKGROUND
The modalities for evaluating acid reflux in medical care for gastroesophageal reflux disease (GERD) include conventional pH (C-pH), wireless pH (Bravo) and multichannel intraluminal impedance pH (MII-pH), which have been reported to vary with respect to the duration of acid reflux. In this study, we examined the difference between the acid reflux in C-pH and MII-pH among patients with GERD.
METHODS
Prior to initial laparoscopic fundoplication carried out on 297 cases from December 1994 to April 2016, an upper gastrointestinal endoscopy and C-pH or MII-pH were conducted. A propensity score-matched analysis was carried out about five factors including age, sex, BMI, the extent of reflux esophagitis (Los Angeles classification), and the presence of hiatal hernia (HH), ultimately leading to the creation of a C-pH group (81 cases) and MII-pH group (81 cases) as the subjects.
RESULTS
Concerning pH < 4 holding time (18.9 vs. 7.3%, p < 0.001), DeMeester score (58.5 vs. 24.4, p < 0.001), and the number of times reflux continued for longer than 5 min (8.8 vs. 4.1 times/day, p = 0.002), the C-pH group had significantly higher values for each, while the positive rate of acid reflux (Positive pH) was significantly higher in the C-pH group (p < 0.001), at 80% in the C-pH group and 42% in the MII-pH group. In terms of the correlation between the extent of reflux esophagitis and pH < 4 holding time, a moderate level of positive correlation was seen in both the C-pH group and MII-pH group (r of each = 0.427, r = 0.408); moreover, regardless of the presence of HH, the holding time was significantly higher in the C-pH group than the MII-pH group (p of each <0.001, p = 0.040).
CONCLUSION
While the values of each parameter regarding acid reflux are calculated as lower in MII-pH than in C-pH, there is no difference in the evaluation of the pathology between the two modalities.
背景
胃食管反流病（GERD）的医学治疗中，评估酸反流的方法包括传统 pH 值（C-pH）、无线 pH 值（Bravo）和多通道腔内阻抗 pH 值（MII-pH），这些方法的酸反流持续时间有所不同。在这项研究中，我们检查了 GERD 患者 C-pH 和 MII-pH 之间的酸反流差异。
方法
在 1994 年 12 月至 2016 年 4 月期间对 297 例患者进行初次腹腔镜胃底折叠术之前，进行了上消化道内镜检查和 C-pH 或 MII-pH 检查。对包括年龄、性别、BMI、反流性食管炎程度（洛杉矶分类）和食管裂孔疝（HH）在内的五个因素进行了倾向评分匹配分析，最终创建了 C-pH 组（81 例）和 MII-pH 组（81 例）作为研究对象。
结果
在 pH 值<4 的持续时间（18.9%比 7.3%，p<0.001）、DeMeester 评分（58.5 比 24.4，p<0.001）和反流持续 5 分钟以上的次数（8.8 比 4.1 次/天，p=0.002）方面，C-pH 组的数值明显更高，而 C-pH 组的酸反流阳性率（阳性 pH 值）明显更高（p<0.001），C-pH 组为 80%，MII-pH 组为 42%。在反流性食管炎程度与 pH 值<4 的持续时间之间的相关性方面，C-pH 组和 MII-pH 组均呈中度正相关（每组 r 值分别为 0.427 和 0.408）；此外，无论 HH 是否存在，C-pH 组的持续时间均明显高于 MII-pH 组（每组 p 值均<0.001，p=0.040）。
结论
虽然 MII-pH 计算的酸反流各参数值低于 C-pH，但两种方法在病理评估方面没有差异。
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