Melashchenko Sergii G, Ksenchyn Oleh O
Department of Family And Internal Medicine, National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
Wiad Lek. 2018;71(8):1531-1536.
Introduction: The postreflux swallow-induced peristaltic wave (PSPW) index and methods of baseline impedance estimation are novel parameters proposed to improve diagnostic yield of intraluminal impedance-pH monitoring (MII-pH-M). Measuring intraluminal baseline impedance level (BIL) reflects mucosal integrity of distal esophagus. We offer original approach with automatic generating a histogram of impedance and visual identification of peak (mode) corresponding to BIL. The aim: To check the possibilities of introduction of methods for determining the index of PSPW and the average night basal level of impedance (MNBI), BIL-moda on the domestic MII-pH-M technique.
Materials and methods:Patients were divided on 2 groups: 1st [nonerosive GERD] - 11 women and 11 men, mean age (±S.E.M.) of 48.0±3.1 y.o.; 2nd [Reference] - 11 women and 10 men, mean age 47.9±3.5 y.o. Reference group included patients with non-ulcer dyspepsia. All patients MII-pH-monitoring with measuring current 6 μA at a frequency of 1 kHz and sampling frequency of 50 Hz. BIL was assessed at 3 cm proximal to the lower esophageal sphincter.
Results: In our study we obtained the best cut-off point for PSPW index - 58.2% with sensitivity 86.4% and specificity 81.0% (AUC=0,85). Our BIL-moda parameter demonstrated the best cut-off point <2,65 kΩ with sensitivity 90.9% and specificity 85.7% (AUC=0,89). The MNBI indicator showed accuracy in the best cut-off point - 3,967 kΩ with sensitivity 95.5% and specificity 76.2% (AUC=0,87).
Conclusions: Applying the PSPW index, MNBI and our BIL-moda showed an obvious gain in diagnostic sensitivity - in 10% cases of NERD.
引言：反流后吞咽诱发蠕动波（PSPW）指数和基线阻抗估计方法是为提高腔内阻抗-pH监测（MII-pH-M）的诊断率而提出的新参数。测量腔内基线阻抗水平（BIL）反映了食管远端的黏膜完整性。我们提供了一种自动生成阻抗直方图并直观识别与BIL对应的峰值（众数）的原始方法。目的：检验在国内MII-pH-M技术中引入确定PSPW指数和平均夜间基础阻抗水平（MNBI）即BIL-众数方法的可能性。
材料与方法：患者分为两组：第一组[非糜烂性胃食管反流病]——11名女性和11名男性，平均年龄（±标准误）为48.0±3.1岁；第二组[参照组]——11名女性和10名男性，平均年龄47.9±3.5岁。参照组包括非溃疡性消化不良患者。所有患者均进行MII-pH监测，测量电流为6μA，频率为1kHz，采样频率为50Hz。在食管下括约肌近端3cm处评估BIL。
结果：在我们的研究中，我们获得了PSPW指数的最佳截断点——58.2%，敏感性为86.4%，特异性为81.0%（曲线下面积=0.85）。我们的BIL-众数参数显示最佳截断点<2.65kΩ，敏感性为90.9%，特异性为85.7%（曲线下面积=0.89）。MNBI指标在最佳截断点——3.967kΩ时显示出准确性，敏感性为95.5%，特异性为76.2%（曲线下面积=0.87）。
结论：应用PSPW指数、MNBI和我们的BIL-众数在诊断敏感性方面有明显提高——在10%的NERD病例中。
