24 小时食管多通道腔内阻抗和 pH 监测在儿童慢性咳嗽中的应用。
24 h combined esophageal multichannel intraluminal impedance and pH monitoring in children with chronic cough.
机构信息
Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P.R. China.
出版信息
BMC Pediatr. 2024 Aug 22;24(1):538. doi: 10.1186/s12887-024-04975-w.
BACKGROUND
Chronic cough in children is closely related to gastroesophageal reflux (GER). However, this association has not been adequately studied due to a lack of diagnostic tools. Combined esophageal multichannel intraluminal impedance and pH (MII-pH) monitoring is considered the most accurate method for evaluating the association between symptoms and reflux, but data on its use in children with chronic cough are still lacking. We aimed to assess the association between chronic cough and GER in children through MII-pH monitoring.
METHODS
Children with chronic cough (> 4 weeks) who were suspected gastroesophageal reflux disease(GERD) were selected to undergo 24 h MII-pH monitoring at our hospital. Patients were divided into groups according to their age, body position, reflux index (RI) or total reflux events, and the differences between the groups were analyzed. Then the significance and value of 24 h pH and impedance monitoring in chronic cough and the relationship between chronic cough and reflux were discussed.
RESULTS
Overall, 426 patients were included. The median age was 12 months (interquartile range: 6-39.5 months), 129 (30.3%) patients had RI > 7% detected by pH-metry, and 290 (68.1%) patients had positive diagnosis based on the impedance data. GER predominantly occurred in the upright position and mostly involved weakly acidic reflux and mixed gas-liquid reflux. There were 14.1% of children in non-acid GER group were SAP positive showing no difference in acid GER group 13.2% (P = 0.88), whereas patients with SAP > 95% in MII positive group (47[16.2%]) is higher than in MII negative group (P < 0.05).
CONCLUSION
Twenty four hour MII-pH monitoring is safe, well tolerated in children, but also has a higher detection rate of gastroesophageal reflux. It can find identify weakly acidic reflux, weakly alkaline reflux and reflux events with different physical properties, which can explain the relationship between GER and chronic cough more comprehensively. It provides new approach for exploring the etiology, diagnosis and treatment of children with chronic cough.
背景
儿童慢性咳嗽与胃食管反流（GER）密切相关。然而，由于缺乏诊断工具，这一关联尚未得到充分研究。食管多通道腔内阻抗和 pH 联合监测（MII-pH 监测）被认为是评估症状与反流之间关联的最准确方法，但有关其在慢性咳嗽儿童中应用的数据仍然缺乏。我们旨在通过 MII-pH 监测评估儿童慢性咳嗽与 GER 之间的关系。
方法
选择我院疑似胃食管反流病（GERD）的慢性咳嗽（>4 周）患儿进行 24 h MII-pH 监测。根据患儿年龄、体位、反流指数（RI）或总反流事件将患儿分组，分析组间差异。然后讨论 24 h pH 和阻抗监测在慢性咳嗽中的意义和价值，以及慢性咳嗽与反流的关系。
结果
共纳入 426 例患儿。中位年龄为 12 个月（四分位间距：6-39.5 个月），129 例（30.3%）患儿 pH 监测 RI>7%，290 例（68.1%）患儿根据阻抗数据诊断为阳性。GER 主要发生在直立位，主要为弱酸性反流和混合气液反流。非酸性 GER 组中 14.1%的患儿 SAP 阳性，与酸性 GER 组的 13.2%（P=0.88）无差异，而 MII 阳性组中 SAP>95%的患儿（47[16.2%]）高于 MII 阴性组（P<0.05）。
结论
24 h MII-pH 监测在儿童中安全、耐受良好，且胃食管反流的检出率较高。它可以发现并识别弱酸性反流、弱碱性反流和不同物理性质的反流事件，从而更全面地解释 GER 与慢性咳嗽之间的关系。为探索儿童慢性咳嗽的病因、诊断和治疗提供了新的方法。
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