夜间基础阻抗均值：胃食管反流病的影响因素及其诊断价值。

Mean nocturnal baseline impedance: Influencing factors and diagnostic value in gastroesophageal reflux disease.

机构信息

Department of Digestive Diseases, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China.

Department of Digestive Disease, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.

出版信息

Technol Health Care. 2023;31(5):1875-1886. doi: 10.3233/THC-220814.

DOI:10.3233/THC-220814

PMID:36970927

Abstract

BACKGROUND

At present, there are few studies related to mean nocturnal baseline impedance (MNBI), esophageal dynamic reflux monitoring, high-resolution esophageal manometry (HRM) parameter indexes, and its diagnostic value in gastroesophageal reflux disease (GERD).

OBJECTIVE

To analyze the factors influencing MNBI and examine the diagnostic value of MNBI in GERD.

METHODS

A retrospective analysis on 434 patients with typical reflux symptoms who underwent gastroscopy, 24-hour multichannel intraluminal impedance and pH monitoring (MII/pH) and HRM. They were divided into the conclusive evidence group (103 cases), borderline evidence group (229 cases), and exclusion evidence group (102 cases) according to the level of diagnostic evidence of GERD based on the Lyon Consensus. We analyzed the differences in MNBI, esophagitis grade, MII/pH and HRM index among the groups; the correlation between MNBI and the above indexes and its influence on MNBI; and to evaluate the diagnostic value of MNBI in GERD.

RESULTS

There were significant differences in MNBI, Acid Exposure Time (AET) 4%, DeMeester score, and total reflux episodes among the three groups (P< 0.001). EGJ contractile integral (EGJ-CI) of the conclusive evidence group and the borderline evidence group was significantly lower than that in the exclusion evidence group (P< 0.001). MNBI was significantly and negatively correlated with age, BMI, AET 4%, DeMeester score, total reflux episodes, EGJ classification, esophageal motility abnormalities, and esophagitis grade (all P< 0.05), and significantly and positively correlated with EGJ-CI (P< 0.001). Age, BMI, AET 4%, EGJ classification, EGJ-CI, and esophagitis grade had significant effects on MNBI (P< 0.05); MNBI was used to diagnose GERD with a diagnostic cutoff of 2061 Ω, and AUC was 0.792 (sensitivity 74.9%, specificity 67.4%); MNBI was used to diagnose exclusion evidence group with a diagnostic cutoff of 2432 Ω, AUC was 0.774 (sensitivity 67.6%, specificity 72%).

CONCLUSION

AET, EGJ-CI, and esophagitis grade are the most important influence factors of MNBI. MNBI has good diagnostic value in identifying conclusive GERD.

摘要

背景

目前，与夜间基础阻抗（MNBI）、食管动力反流监测、高分辨率食管测压（HRM）参数指标相关，以及其在胃食管反流病（GERD）中的诊断价值的研究较少。

目的

分析影响 MNBI 的因素，并检验 MNBI 在 GERD 中的诊断价值。

方法

对 434 例具有典型反流症状的患者进行胃镜检查、24 小时多通道腔内阻抗和 pH 监测（MII/pH）和 HRM。根据 Lyon 共识，根据 GERD 的诊断证据水平，将这些患者分为确诊证据组（103 例）、边界证据组（229 例）和排除证据组（102 例）。我们分析了各组间 MNBI、食管炎分级、MII/pH 和 HRM 指标的差异；MNBI 与上述指标的相关性及其对 MNBI 的影响；并评估 MNBI 在 GERD 中的诊断价值。

结果

三组间 MNBI、酸暴露时间（AET）4%、DeMeester 评分和总反流次数差异均有统计学意义（P<0.001）。确诊证据组和边界证据组的食管下括约肌收缩积分（EGJ-CI）明显低于排除证据组（P<0.001）。MNBI 与年龄、BMI、AET 4%、DeMeester 评分、总反流次数、EGJ 分类、食管动力异常和食管炎分级呈显著负相关（均 P<0.05），与 EGJ-CI 呈显著正相关（P<0.001）。年龄、BMI、AET 4%、EGJ 分类、EGJ-CI 和食管炎分级对 MNBI 有显著影响（P<0.05）；以 2061 Ω 为截断值诊断 GERD，AUC 为 0.792（敏感度 74.9%，特异度 67.4%）；以 2432 Ω 为截断值诊断排除证据组，AUC 为 0.774（敏感度 67.6%，特异度 72%）。