Rao S S, Gregersen H, Hayek B, Summers R W, Christensen J
University of Iowa College of Medicine, Iowa City, USA.
Ann Intern Med. 1996 Jun 1;124(11):950-8. doi: 10.7326/0003-4819-124-11-199606010-00002.
To determine whether neuromuscular dysfunction of the esophagus causes chest pain in patients in whom no disease is found on cardiac work-up, upper gastrointestinal endoscopy, esophageal manometry, and 24-hour pH studies.
Prospective study.
Tertiary referral center.
24 consecutive patients and 12 healthy controls.
A new technique, impedance planimetry, was used to measure the sensory, motor, and biomechanical properties of the human esophagus. The impendance planimeter, which consists of a probe with four ring electrodes, three pressure sensors, and a balloon, simultaneously measures intraluminal pressure and cross-sectional areas. This allows calculation of the biomechanical variables of the esophageal wall.
Stepwise balloon distentions from 5 to 50 cm H2O induced a first sensation at a mean pressure (+/- SD) of 15 +/- 9 cm H2O in patients and 30 +/- 11 cm H2O in controls (P < 0.001). Moderate discomfort and pain were reported by 20 of 24 patients (83%) at 26 +/- 9 cm H2O and at 36 +/- 9 cm H2O, respectively, but by none of the controls (P < 0.001). Typical chest pain was reproduced in 20 of 24 patients (83%). In patients, the reactivity of the esophagus to balloon distention was greater (P = 0.01), the pressure elastic modulus was higher (P = 0.02), and the tension-strain association showed that the esophageal wall was less distensible (P = 0.02). Distention excited tertiary contractions and secondary peristalsis at a lower threshold of pressure (P = 0.05) and with a higher motility index in patients than in controls (P = 0.04).
In patients with chest pain and normal cardiac and esophageal evaluations, impedance planimetry of the esophagus reproduces pain and is associated with a 50% lower sensory threshold for pain, a 50% lower threshold for reactive contractions, and reduced esophageal compliance.
确定在心脏检查、上消化道内镜检查、食管测压及24小时pH监测均未发现疾病的患者中，食管神经肌肉功能障碍是否会导致胸痛。
前瞻性研究。
三级转诊中心。
24例连续患者及12名健康对照者。
采用一种新技术——阻抗平面测量法，测量人体食管的感觉、运动和生物力学特性。阻抗平面测量仪由带有四个环形电极的探头、三个压力传感器和一个气囊组成，可同时测量腔内压力和横截面积。这使得能够计算食管壁的生物力学变量。
从5至50 cmH₂O逐步进行气囊扩张时，患者产生首次感觉的平均压力（±标准差）为15±9 cmH₂O，对照组为30±11 cmH₂O（P<0.001）。24例患者中有20例（83%）分别在26±9 cmH₂O和36±9 cmH₂O时报告有中度不适和疼痛，但对照组均无（P<0.001）。24例患者中有20例（83%）再现了典型胸痛。患者食管对气囊扩张的反应性更强（P = 0.01），压力弹性模量更高（P = 0.02），张力-应变关系显示食管壁的可扩张性更低（P = 0.02）。与对照组相比，扩张在更低的压力阈值下激发了第三收缩波和继发性蠕动（P = 0.05），且患者的运动指数更高（P = 0.04）。
在胸痛且心脏和食管评估正常的患者中，食管阻抗平面测量法可再现疼痛，并与疼痛感觉阈值降低50%、反应性收缩阈值降低50%以及食管顺应性降低有关。
