摘要目的 探讨难治性非糜烂性胃食管反流病(NERD)患者不同表型的发病特点.方法 回顾性分析2015年9月至2017年8月就诊于首都医科大学附属北京同仁医院消化内科门诊的难治性NERD患者,均行电子胃镜、食管测压和24h食管动态pH值阻抗监测,并按反流程度与症状相关性分为4个表型组.结果 共231例患者纳入研究.表型1组患者弱酸反流次数[(86±55)次比(37±8)次、(70±52)次、(31±9)次]以及气体反流次数[(86±76)次比(38±13)次、(58±57)次、(26±10)次]较多(均P＜0.05).难治性NERD患者各表型组间动力障碍类型差异无统计学意义.多因素非条件Logistic回归分析结果表明,女性构成比、芝加哥动力分类、气体反流、弱酸反流次数为是否出现反流相关症状的危险因素(OR=3.731、2.452、1.036和1.037,均P＜0.05).结论 难治性NERD患者不同表型组临床特征不同;女性构成比、芝加哥动力分类、气体反流、弱酸反流次数为是否出现反流相关症状的危险因素.

abstractsObjective To investigate the characteristics of different phenotypes of refractory non-erosive gastroesophageal reflux disease (NERD),the types of esophageal motility and the related factors of symptoms.Methods A retrospective analysis was made of the patients with refractory NERD of Beijing Tongren Hospital affiliated to Capital Medical University from September 2015 to August 2017.All patients underwent electronic gastroscopy,esophageal manometry and 24-hour dynamic esophageal pH impedance monitoring.They were divided into four phenotype groups according to the results.Results A total of 231 patients were enrolled in the study.There were 11 l(48.1％)cases in phenotype 1 group,9 (3.9％)cases in phenotype 2 group,100 (43.3％)cases in phenotype 3 group and 11 (4.8％) cases in phenotype 4 group.Compared with the other three groups,the number of weak acid reflux [(86±55) vs (37±8),(70±52),(31±9) times] and the number of gas reflux [(86±76) vs (38± 13),(58±57),(26±10)] in phenotype 1 group increased significantly (allP＜0.005).Dynamics disorders were common in refractory NERD patients (139/231,60.2％).Mild esophageal dynamics disorder was the main type of dynamics disorder (118/139,84.9％).There was no significant difference among the phenotype groups.Multivariate unconditional Logistic regression analysis showed that the risk factors for reflux-related symptoms were female ratio,Chicago power classification,gas reflux and weak acid reflux (OR=3.731,2.452,1.036 and 1.037,P＜0.05).Conclusions The characteristics of gastroesophageal reflux and the types of motility disorders are different in different phenotype groups of refractory NERD patients.The risk factors of reflux-related symptoms are female ratio,Chicago motility classification,gas reflux and the frequency of weak acid reflux.