功能性消化不良及十二指肠胃反流关系探究.doc

功能性消化不良及十二指肠胃反流关系探究 　 作者：戴菲，龚均，罗金燕，朱有玲，王学勤 【摘要】 目的 研究功能性消化不良(FD)与十二指肠胃反流(DGR)的关系。方法 对20例健康对照者和22例FD患者进行胃内pH和Bilitec 2000同步监测，并对FD患者DGR症状进行评分，研究DGR症状与胃内pH≥4及胆红素吸光值(Abs)≥0.14总时间百分比的关系。结果 FD组餐后期pH≥4时间(%)和Abs≥0.14时间(%)明显高于正常组，分别为45.78±22.54和23.69±17.26，45.12±25.31和23.97±18.54，有显著性差异，P均lt;0.05。两组夜间胃内pH≥4和Abs≥0.14出现例数(%)、总持续时间(min)、反流次数、反流gt;5min次数及最长反流时间无显著性差异。上腹痛症状评分(SS)与胃内pH≥4总时间%存在相关关系，r=0.678，Plt;0.01；呕吐胆汁SS与胃内Abs≥0.14总时间%存在相关关系，r=0.495，Plt;0.05。结论 DGR在FD发生中起一定作用。 【关键词】 功能性消化不良；十二指肠胃反流；胃内pH；胆汁 　　Relationship between functional dyspepsia and duodenogastric reflux 　　ABSTRACT: Objective To study the relationship between functional dyspepsia (FD) and duodenogastric reflux (DGR). Methods Simultaneous 24hour ambulatory intragastric pH and bilirubin concentration monitoring (Bilitec 2000) were performed in 20 healthy controls and 22 FD patients. For each patient, symptoms associated with alkaline and bile reflux score (SS) were calculated. The correlation between SS and and the percentage of the time pH≥4 of total time, SS and the percentage of the time Abs≥0.14 of total time were analyzed. Results The percentage of the time pH≥4 and Abs≥0.14 of postprandial periods was higher in FD patients than in normal controls, 45.78±22.54 vs. 23.69±17.26, 45.12±25.31 vs. 23.97±18.54, respectively (Plt;0.05). Rank correlation analysis showed a correlation between epigastric pain SS and the percentage of the time pH≥4 of total time (r=0.678, Plt;0.01), vomiting bile SS and the percentage of the time Abs≥0.14 of total time (r=0.495, Plt;0.05). Conclusion DGR may play a role in FD. 　　KEY WORDS: functional dyspepsia; duodenogastric reflux; gastric pH; bilirubin concentration 　　功能性消化不良(functional dyspepsia, FD)是消化系统最常见的功能性胃肠疾病，患病率高达20%-40%。FD的病因及发病机制还不十分清楚，可能是多种因素参与、经不同机制所致的疾病。目前，认为上胃肠道动力障碍是FD发病的一个主要因素。胃肠动力异常包括：胃排空延迟、胃窦动力低下、胃电节律紊乱、胃十二指肠非协调运动增加等。关于十二指肠胃反流(duodenogastric reflux, DGR)是否参与FD发病尚不明确，由于检测方法的不同，可能影响DGR在FD发生作用中的判断结果。目前，国内尚未见同步监测胃内pH和胆汁以研究DGR与FD症状之间的关系。 　　1 对象与方法 　　1.1 研究对象 健康对照组2