内镜阴性烧心患者反流特征及其在探头式共聚焦激光显微内镜下的表现分析

Characteristics of reflux and manifestation under probe‑based confocal laser endoscopy in patients with endoscopic negative heartburn

摘要:

目的 基于罗马Ⅳ标准，评估内镜阴性烧心患者的反流特征及其在探头式共聚焦激光显微内镜（probe‑based confocal laser endoscopy， pCLE）下的表现。方法 纳入2020年9月—2021年3月于包头医学院第二附属医院消化内科门诊就诊且伴有典型烧心症状的内镜阴性患者36例，行24 h食管多通道腔内阻抗-pH监测及pCLE检查，遵循罗马Ⅳ诊断流程，筛选出非糜烂性反流病（16例）、反流高敏感（8例）及功能性烧心（12例）患者，并分为3组，比较3组间Gerd Q量表评分、24 h pH监测结果及pCLE下微结构改变。结果 3组患者间Gerd Q量表总分、阳性症状、阴性症状和阳性影响评分差异均无统计学意义（P>0.05）。非糜烂性反流病组DeMeester评分［28.45（20.08，34.53）分］和酸反流次数［（24.88±9.05）次］均显著高于反流高敏感组［7.30（3.90，11.38）分，P<0.001；（13.63±5.76）次，P=0.003］和功能性烧心组［6.90（4.80，9.73）分，P<0.001；（7.42±8.32）次，P<0.001］，反流高敏感组和功能性烧心组差异无统计学意义（P>0.05）。非糜烂性反流病组上皮乳头内毛细血管袢直径［（18.68±2.12）μm］和鳞状上皮细胞间隙［（3.95±0.97）μm］均高于反流高敏感组［（13.91±1.99）μm，P<0.001；（2.97±0.55）μm，P=0.006］和功能性烧心组［（13.83±2.00）μm，P<0.001；（2.31±0.54）μm，P<0.001］，反流高敏感组和功能性烧心组差异无统计学意义（P>0.05）。非糜烂性反流病组、反流高敏感组和功能性烧心组上皮乳头内毛细血管袢数目分别为2.0（1.00，2.75）个，2.0（1.00，2.75）个和1.5（1.00，2.00）个，3组患者比较差异无统计学意义（P=0.697）。结论 Gerd Q量表不适用于内镜阴性烧心患者的鉴别诊断。与功能性食管疾病（反流高敏感和功能性烧心）相比，非糜烂性反流病中酸反流和黏膜微结构改变有更重要的致病意义。

Abstract:

Objective To study reflux characteristics of patients with endoscopic negative heartburn and their manifestation under probe-based confocal laser endoscopy (pCLE) based on the Rome Ⅳ standard. Methods Thirty-six endoscopic negative outpatients with typical heartburn at the Department of Gastroenterology of the Second Affiliated Hospital of Baotou Medical College from September 2020 to March 2021 were included, and underwent 24-hour multichannel intraluminal impedance-pH monitor and pCLE. According to Rome Ⅳ diagnostic process, patients were divided into non-erosive reflux disease (NERD) group (n=16), reflux hypersensitivity (RH) group (n=8) and functional heartburn (FH) group (n=12). The Gerd-Q scale score, 24-hour pH monitoring results and microstructure changes under pCLE were compared among the three groups. Results There was no significant difference in the total score, positive symptom score, negative symptom score or positive influence score of Gerd-Q scale among the three groups (P>0.05). DeMeester score [28.45 (20.08, 34.53)] and acid reflux times (24.88±9.05) in the NERD group were significantly higher than those in the RH group [7.30 (3.90, 11.38), P<0.001; 13.63±5.76, P=0.003] and FH group [6.90 (4.80, 9.73), P<0.001; 7.42±8.32, P<0.001]. But there was no significant difference between the RH group and the FH group (P>0.05). The diameter of intra-papillary capillary loop (IPCL) (18.68±2.12 μm) and dilation of intercellular space (3.95±0.97 μm) in the NERD group were significantly higher than those in the RH group (13.91±1.99 μm, P<0.001; 2.97±0.55 μm, P=0.006) and FH group (13.83±2.00 μm, P<0.001; 2.31±0.54 μm, P<0.001), but there was no significant difference between the RH group and the FH group (P>0.05). The number of IPCL in the NERD group, RH group and FH group were 2.0 (1.00, 2.75), 2.0 (1.00, 2.75) and 1.5 (1.00, 2.00), respectively with no significant difference (P=0.697). Conclusion Gerd-Q scale is not suitable for differential diagnosis of patients with endoscopic negative heartburn. Compared with functional esophageal diseases (RH and FH), acid reflux and mucosal microstructure changes are of more important pathogenic significance in NERD.