难治性胃食管反流病患者血清胃抑制性多肽和胰多肽水平与食管酸暴露时间延长的关系
Association of serum gastric inhibitory polypeptide and pancreatic polypeptide levels with prolonged esophageal acid exposure time in refractory gastroesophageal reflux disease.
作者信息
Chen Jing, Guo Baona, Guo Zihao, Li Li, Jiang Jiali, Zhan Yutao, Wu Jixiang, Zhang Chuan
机构信息
Department of Gastroenterology.
Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
出版信息
Medicine (Baltimore). 2019 Jun;98(23):e15965. doi: 10.1097/MD.0000000000015965.
BACKGROUND
Acid exposure time (AET) prolongation plays an important role in the pathogenesis of gastroesophageal reflux disease (GERD). Gastric inhibitory polypeptide (GIP) and pancreatic polypeptide (PP) participate in the regulation of gastric acid secretion, blood glucose and lipid levels, and food intake. In this study, we evaluated the serum GIP and PP levels in refractory GERD patients and analyzed their metabolic and motility characteristics.
METHODS
Seventy-three refractory GERD patients were enrolled in this study from September 2015 to September 2017. We investigated the clinical characteristics, severity, and duration of GERD symptoms. High-resolution manometry and 24 hours impedance-pH monitoring were performed to assess esophageal motility and reflux parameters. The patients were divided into the AET- group (AET <4.2%) and AET+ group (AET >4.2%). GIP and PP levels were determined in all subjects and their associations with other parameters evaluated.
RESULTS
Age and GERDQ score were significantly higher (P < .05) and acid reflux and heartburn more frequent in the AET+ group than in the AET- group. The contraction front velocity was increased in the AET- group, while there was no significant difference in the distal contraction integral, peristalsis interruption, distal latency, or resting pressures of the lower and upper esophageal sphincters between the 2 groups (P > .05). The serum levels of GIP (P = .003) and PP (P = .012) were significantly increased in the AET+ group. Increased GIP and PP levels were associated with abnormal upright AET (correlation coefficients 0.307 and 0.233, P = .008 and P = .047). There was a positive correlation between GIP and triglyceride levels (correlation coefficient 0.279, P = .017).
CONCLUSION
The serum levels of GIP and PP in refractory GERD patients with prolongation of AET are significantly elevated, mainly in the upright position.
背景
酸暴露时间（AET）延长在胃食管反流病（GERD）的发病机制中起重要作用。胃抑制多肽（GIP）和胰多肽（PP）参与胃酸分泌、血糖和血脂水平以及食物摄入的调节。在本研究中，我们评估了难治性GERD患者的血清GIP和PP水平，并分析了它们的代谢和运动特征。
方法
2015年9月至2017年9月，73例难治性GERD患者纳入本研究。我们调查了GERD症状的临床特征、严重程度和持续时间。进行高分辨率测压和24小时阻抗-pH监测以评估食管运动和反流参数。患者分为AET-组（AET<4.2%）和AET+组（AET>4.2%）。测定所有受试者的GIP和PP水平，并评估它们与其他评估参数的相关性。
结果
AET+组的年龄和GERDQ评分显著更高（P<0.05），酸反流和烧心比AET-组更频繁。AET-组的收缩前沿速度增加，而两组之间的远端收缩积分、蠕动中断、远端潜伏期或食管下括约肌和上括约肌的静息压力无显著差异（P>0.05）。AET+组的血清GIP（P=0.003）和PP（P=0.012）水平显著升高。GIP和PP水平升高与直立位AET异常相关（相关系数分别为0.307和0.233，P=0.008和P=0.047）。GIP与甘油三酯水平呈正相关（相关系数0.279，P=0.017）。
结论
AET延长的难治性GERD患者的血清GIP和PP水平显著升高，主要在直立位。
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