摘要目的:评估胃食管连接部收缩指数(EGJ-CI)在区分功能性烧心(FH)与难治性胃食管反流病(RGERD)患者中的作用。方法:纳入2014年3月至2018年1月在南京医科大学第一附属医院消化内科门诊就诊的PPI难治性烧心和(或)反流患者82例，其中RGERD患者50例(RGERD组)，FH患者32例(FH组)。比较RGERD组和FH组患者的EGJ-CI，计算EGJ-CI区分RGERD与FH患者的灵敏度和特异度，并分析EGJ-CI与高分辨率食管测压参数、基线阻抗水平和24 h阻抗-pH监测参数的相关性。统计学方法采用Mann-Whitney U检验、ROC曲线分析和Spearman相关分析。 结果:RGERD组患者的EGJ-CI低于FH组[25.8 mmHg·cm (14.1 mmHg·cm, 35.9 mmHg· cm)(1 mmHg＝0.133 kPa)比39.2 mmHg·cm(23.0 mmHg·cm, 60.8 mmHg·cm)]，差异有统计学意义( Z＝-2.833， P＝0.005)。当EGJ-CI的临界值为35.8 mmHg·cm时，其区分RGERD与FH的灵敏度为76.0%，特异度为62.5%，AUC为0.69(95% CI 0.57～0.81)。EGJ-CI与下食管括约肌静息压、综合松弛压、远端收缩积分、远端食管压力、平均夜间基线阻抗水平(食管远端通道z6)均呈正相关( r＝0.812、0.631、0.451、0.490、0.401， P均<0.01)，而与DeMeester评分、酸暴露时间、总体反流事件数、酸反流事件数、长反流事件数、最长反流时间均呈负相关( r＝-0.363、-0.372、-0.346、-0.318、-0.300、-0.291， P均<0.01)。 结论:EGJ-CI有助于区分FH与RGERD患者。

abstractsObjective:To evaluate the role of esophagogastric junction contractile index (EGJ-CI) in distinguishing patients with refractory gastroesophageal reflux disease (RGERD) from functional heartburn (FH).Methods:From March 2014 to January 2018, 82 patients with proton pump inhibitor (PPI) refractory heartburn and/or regurgitation, who visited the Outpatient Department of Gastroenterology at The First Affiliated Hospital with Nanjing Medical University were enrolled, among them 50 patients with RGERD (RGERD group) and 32 patients with FH (FH group). EGJ-CI of RGERD group and FH group were compared. The sensitivity and specificity of EGJ-CI to distinguish RGERD from FH patients. The correlation between EGJ-CI and high resolution esophageal manometry parameters, baseline impedance level and 24 h impedance-pH monitoring parameters were analyzed. Mann-Whitney U test, receiver operator characteristic curve analysis and Spearman correlation analysis were used for statistical analysis. Results:The EGJ-CI of RGERD group was lower than that of FH group (25.8 mmHg·cm (14.1 mmHg·cm, 35.9 mmHg·cm)(1 mmHg=0.133 kPa) vs. 39.2 mmHg·cm (23.0 mmHg·cm, 60.8 mmHg·cm)), and the difference was statistically significant ( Z=-2.833, P=0.005). When the cut-off value of EGJ-CI was 35.8 mmHg·cm, the sensitivity and specificity to distinguish RGERD from FH were 76.0% and 62.5%, respectively; area under the curve was 0.69 (95% CI 0.57 to 0.81). EGJ-CI was positively correlated with lower sphincter resting pressure, integrated relaxation pressure, distal contractile integral, distal esophageal pressure, and mean nocturnal baseline impedance ( r=0.812, 0.631, 0.451, 0.490 and 0.401, all P<0.01). EGJ-CI was negatively correlated with DeMeester score, acid exposure time, total reflux episodes, acid reflux episodes, long reflux episodes and longest reflux time ( r=-0.363, -0.372, -0.346, -0.318, -0.300 and -0.291, all P<0.01). Conclusions:EGJ-CI can help to distinguish patients with FH from RGERD.