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Article(id=1208862461550269364, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862455166538583, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.08.11, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1616083200000, receivedDateStr=2021-03-19, revisedDate=1621785600000, revisedDateStr=2021-05-24, acceptedDate=null, acceptedDateStr=null, onlineDate=1766144870412, onlineDateStr=2025-12-19, pubDate=1630080000000, pubDateStr=2021-08-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766144870412, onlineIssueDateStr=2025-12-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766144870412, creator=13701087609, updateTime=1766144870412, updator=13701087609, issue=Issue{id=1208862455166538583, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='8', pageStart='743', pageEnd='848', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766144868890, creator=13701087609, updateTime=1766144939527, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1208862751481524455, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862455166538583, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1208862751481524456, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862455166538583, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=808, endPage=811, ext={EN=ArticleExt(id=1208862462351381480, articleId=1208862461550269364, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Clinical study of risk factors associated with extraesophageal symptoms in patients with reflux esophagitis, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To study the risk factors for extraesophageal symptoms in the patients with reflux esophagitis. Method One hundred and thirty-nine reflux esophagitis cases diagnosed by endoscophy and pH monitoring of the esophagus and hospitalized in Characteristic Medical Center of Strategic Support Army from March 2018 to November 2019. These cases were divided into positive or negative groups according to reflux symptom index (RSI) > or <13. Differences in gender, age, body mass index (BMI), smoking, drinking, emotional factors (anxiety and depression evaluation), reflux esophagitis microscopic classification,24-hour esophageal pH monitoring related index (Demeester index) were taking into account in logistical regression to identify the potential cause of reflux esophagitis. Results The positive group had higher age [(58.8±15.4) years], higher BMI (63%),higher anxiety (36%) and higher DeMeester (54%) than negative group [(52.8±11.7) years, 39%, 14%, 27% respectively], and the differences were statistically significant (P<0.05). There were no significant differences in gender, smoking, drinking, depression rate and endoscopic grade of reflux esophagitis between the two groups (P>0.05). Logistic multiple regression results showed that high BMI and positive DeMeester score were independent risk factors for patients with extrasoesophageal symptoms (OR=1.896, 95%CI 1.363-3.942, P<0.05; OR=6.868, 95%CI 1.648-18.087, P<0.01). Conclusions Higher BMI (overweight) and positive DeMeester score have predictive value for extraesophageal symptoms of the patients with reflux esophagitis, and they would increase the incidence of extraesophageal symptoms.

, correspAuthors=Wei Wu, Lian-Yong Li, authorNote=null, correspAuthorsNote=
*Wu Wei, E-mail: ;
Li Lian-Yong, E-mail:
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目的 分析反流性食管炎患者发生食管外症状的相关危险因素。方法 选取2018年3月—2019年11月战略支援部队特色医学中心消化内科收治的经内镜诊断为反流性食管炎的患者139例，均行24 h食管pH值监测。以食管反流症状评分表(RSI)评分为标准，RSI>13分者为阳性组(n=55)，RSI≤13分者为阴性组(n=84)。比较两组性别，年龄，超重、吸烟、饮酒、焦虑及抑郁的比例，反流性食管炎镜下分级，24 h食管pH值监测相关指数(DeMeester指数)等指标的差异，采用logistic回归分析反流性食管炎患者发生食管外症状的危险因素。结果 阳性组年龄[(58.8±15.4)岁]、超重比例(63%)、焦虑比例(36%)及DeMeester阳性比例(54%)高于阴性组[分别为(52.8±11.7)岁、39%、14%、27%]，差异有统计学意义(P<0.05)；两组性别，吸烟、饮酒、抑郁的比例及反流性食管炎内镜下分级程度差异无统计学意义(P>0.05)。Logistic回归分析结果显示，超重、DeMeester阳性是反流性食管炎出现食管外症状的独立危险因素(OR=1.896，95%CI 1.363~3.942，P<0.05；OR=6.868，95%CI 1.648~18.087，P<0.01)。结论 超重、DeMeester阳性对反流性食管炎出现食管外症状有预测价值，可能参与了食管外症状的发生。

, correspAuthors=吴玮, 李连勇, authorNote=null, correspAuthorsNote=
吴玮，E-mail：;
李连勇，E-mail：
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陈琰，医学硕士，主治医师，主要从事胃肠道动力及消化系统肿瘤方面的研究

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陈琰，医学硕士，主治医师，主要从事胃肠道动力及消化系统肿瘤方面的研究

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陈琰，医学硕士，主治医师，主要从事胃肠道动力及消化系统肿瘤方面的研究

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BMC Gastroenterol, 2021, 21(1): 127., articleTitle=Study on the relationship of depression, anxiety, lifestyle and eating habits with the severity of reflux esophagitis, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1209197623639142520, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, xref=1, ext=[AuthorCompanyExt(id=1209197623647531129, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, companyId=1209197623639142520, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Gastroenterology, Characteristic Medical Center of Strategic Support Army, Beijing 100101, China), AuthorCompanyExt(id=1209197623660114042, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, companyId=1209197623639142520, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1战略支援部队特色医学中心消化内科，北京 100101)]), AuthorCompany(id=1209197623718834299, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, xref=2, ext=[AuthorCompanyExt(id=1209197623727222908, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, companyId=1209197623718834299, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Gastroenterology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China), AuthorCompanyExt(id=1209197623735611517, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, companyId=1209197623718834299, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2解放军总医院第五医学中心消化科，北京 100039)]), AuthorCompany(id=1209197623802720382, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, xref=3, ext=[AuthorCompanyExt(id=1209197623811108991, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, companyId=1209197623802720382, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3Department of Otolaryngology-Head and Neck Surgery, Characteristic Medical Center of Strategic Support Army, Beijing 100101, China), AuthorCompanyExt(id=1209197623819497600, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, companyId=1209197623802720382, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3战略支援部队特色医学中心耳鼻咽喉头颈外科，北京 100101)])], figs=[ArticleFig(id=1209197627934109958, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, language=EN, label=Tab.1, caption=

Comparison of general data between two groups of patients with reflux esophagitis

, figureFileSmall=null, figureFileBig=null, tableContent=
指标阴性组(n=84)阳性组(n=55)t/χ2P
年龄(岁，$\bar{x}±s$)52.8±11.758.8±15.43.4750.010
男性[例(%)]57(67.9)32(58.2)1.3500.230
超重[例(%)]33(39.3)35(63.6)7.8800.040
吸烟[例(%)]21(25.0)17(30.9)0.5840.450
饮酒[例(%)]31(36.9)20(36.3)0.0400.984
焦虑[例(%)]12(14.3)20(36.3)9.1420.002
抑郁[例(%)]25(29.7)20(36.3)0.6620.416
DeMeester阳性[例(%)]23(27.3)30(54.5)10.3960.010
反流性食管炎分级[例(%)]
 A级41(48.8)21(38.2)1.5190.218
 B级34(40.5)20(36.4)0.2370.627
 C级7(8.3)10(18.2)3.0030.083
 D级2(2.4)4(7.2)1.9260.165
), ArticleFig(id=1209197628022190343, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, language=CN, label=表1, caption=

两组反流性食管炎患者一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标阴性组(n=84)阳性组(n=55)t/χ2P
年龄(岁，$\bar{x}±s$)52.8±11.758.8±15.43.4750.010
男性[例(%)]57(67.9)32(58.2)1.3500.230
超重[例(%)]33(39.3)35(63.6)7.8800.040
吸烟[例(%)]21(25.0)17(30.9)0.5840.450
饮酒[例(%)]31(36.9)20(36.3)0.0400.984
焦虑[例(%)]12(14.3)20(36.3)9.1420.002
抑郁[例(%)]25(29.7)20(36.3)0.6620.416
DeMeester阳性[例(%)]23(27.3)30(54.5)10.3960.010
反流性食管炎分级[例(%)]
 A级41(48.8)21(38.2)1.5190.218
 B级34(40.5)20(36.4)0.2370.627
 C级7(8.3)10(18.2)3.0030.083
 D级2(2.4)4(7.2)1.9260.165
), ArticleFig(id=1209197628106076426, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, language=EN, label=Tab.2, caption=

Multivariate logistic regression analysis of reflux esophagitis combined with extraesophageal symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
因素βWald χ2POR95%CI
年龄0.1120.0770.7821.1190.506~2.472
超重0.5625.7060.0171.8961.363~3.942
焦虑–0.1080.6260.4051.0630.032~1.892
DeMeester阳性1.9758.6570.0026.8681.648~18.087
常量–3.2729.5600.0310.068 
), ArticleFig(id=1209197628202545421, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862461550269364, language=CN, label=表2, caption=

反流性食管炎合并食管外症状的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素βWald χ2POR95%CI
年龄0.1120.0770.7821.1190.506~2.472
超重0.5625.7060.0171.8961.363~3.942
焦虑–0.1080.6260.4051.0630.032~1.892
DeMeester阳性1.9758.6570.0026.8681.648~18.087
常量–3.2729.5600.0310.068 
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反流性食管炎患者食管外症状的危险因素分析
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陈琰 1 , 隋昕珂 1 , 黄鑫 1 , 汤紫荣 2 , 王刚 3 , 王磊 3 , 钟长青 1 , 王晓英 1 , 吴玮 3, * , 李连勇 1, *
解放军医学杂志 | 临床研究 2021,46(8): 808-811
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解放军医学杂志 | 临床研究 2021, 46(8): 808-811
反流性食管炎患者食管外症状的危险因素分析
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陈琰1, 隋昕珂1, 黄鑫1, 汤紫荣2, 王刚3, 王磊3, 钟长青1, 王晓英1, 吴玮3, * , 李连勇1, *
作者信息
  • 1战略支援部队特色医学中心消化内科，北京 100101
  • 2解放军总医院第五医学中心消化科，北京 100039
  • 3战略支援部队特色医学中心耳鼻咽喉头颈外科，北京 100101

    • 陈琰，医学硕士，主治医师，主要从事胃肠道动力及消化系统肿瘤方面的研究

通讯作者:

吴玮，E-mail：;
李连勇，E-mail：
Clinical study of risk factors associated with extraesophageal symptoms in patients with reflux esophagitis
Yan Chen1, Xin-Ke Sui1, Xin Huang1, Zi-Rong Tang2, Gang Wang3, Lei Wang3, Chang-Qing Zhong1, Xiao-Ying Wang1, Wei Wu3, * , Lian-Yong Li1, *
Affiliations
  • 1Department of Gastroenterology, Characteristic Medical Center of Strategic Support Army, Beijing 100101, China
  • 2Department of Gastroenterology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
  • 3Department of Otolaryngology-Head and Neck Surgery, Characteristic Medical Center of Strategic Support Army, Beijing 100101, China
出版时间: 2021-08-28 doi: 10.11855/j.issn.0577-7402.2021.08.11
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摘要
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目的 分析反流性食管炎患者发生食管外症状的相关危险因素。方法 选取2018年3月—2019年11月战略支援部队特色医学中心消化内科收治的经内镜诊断为反流性食管炎的患者139例，均行24 h食管pH值监测。以食管反流症状评分表(RSI)评分为标准，RSI>13分者为阳性组(n=55)，RSI≤13分者为阴性组(n=84)。比较两组性别，年龄，超重、吸烟、饮酒、焦虑及抑郁的比例，反流性食管炎镜下分级，24 h食管pH值监测相关指数(DeMeester指数)等指标的差异，采用logistic回归分析反流性食管炎患者发生食管外症状的危险因素。结果 阳性组年龄[(58.8±15.4)岁]、超重比例(63%)、焦虑比例(36%)及DeMeester阳性比例(54%)高于阴性组[分别为(52.8±11.7)岁、39%、14%、27%]，差异有统计学意义(P<0.05)；两组性别，吸烟、饮酒、抑郁的比例及反流性食管炎内镜下分级程度差异无统计学意义(P>0.05)。Logistic回归分析结果显示，超重、DeMeester阳性是反流性食管炎出现食管外症状的独立危险因素(OR=1.896，95%CI 1.363~3.942，P<0.05；OR=6.868，95%CI 1.648~18.087，P<0.01)。结论 超重、DeMeester阳性对反流性食管炎出现食管外症状有预测价值，可能参与了食管外症状的发生。

反流性食管炎  /  胃食管反流病  /  食管外症状  /  危险因素

Objective To study the risk factors for extraesophageal symptoms in the patients with reflux esophagitis. Method One hundred and thirty-nine reflux esophagitis cases diagnosed by endoscophy and pH monitoring of the esophagus and hospitalized in Characteristic Medical Center of Strategic Support Army from March 2018 to November 2019. These cases were divided into positive or negative groups according to reflux symptom index (RSI) > or <13. Differences in gender, age, body mass index (BMI), smoking, drinking, emotional factors (anxiety and depression evaluation), reflux esophagitis microscopic classification,24-hour esophageal pH monitoring related index (Demeester index) were taking into account in logistical regression to identify the potential cause of reflux esophagitis. Results The positive group had higher age [(58.8±15.4) years], higher BMI (63%),higher anxiety (36%) and higher DeMeester (54%) than negative group [(52.8±11.7) years, 39%, 14%, 27% respectively], and the differences were statistically significant (P<0.05). There were no significant differences in gender, smoking, drinking, depression rate and endoscopic grade of reflux esophagitis between the two groups (P>0.05). Logistic multiple regression results showed that high BMI and positive DeMeester score were independent risk factors for patients with extrasoesophageal symptoms (OR=1.896, 95%CI 1.363-3.942, P<0.05; OR=6.868, 95%CI 1.648-18.087, P<0.01). Conclusions Higher BMI (overweight) and positive DeMeester score have predictive value for extraesophageal symptoms of the patients with reflux esophagitis, and they would increase the incidence of extraesophageal symptoms.

reflux esophagitis  /  gastroesophageal reflux  /  extraesophageal symptoms  /  risk factors
陈琰, 隋昕珂, 黄鑫, 汤紫荣, 王刚, 王磊, 钟长青, 王晓英, 吴玮, 李连勇. 反流性食管炎患者食管外症状的危险因素分析. 解放军医学杂志, 2021 , 46 (8) : 808 -811 . DOI: 10.11855/j.issn.0577-7402.2021.08.11
Yan Chen, Xin-Ke Sui, Xin Huang, Zi-Rong Tang, Gang Wang, Lei Wang, Chang-Qing Zhong, Xiao-Ying Wang, Wei Wu, Lian-Yong Li. Clinical study of risk factors associated with extraesophageal symptoms in patients with reflux esophagitis[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (8) : 808 -811 . DOI: 10.11855/j.issn.0577-7402.2021.08.11
正文
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胃食管反流病(gastroesophageal reflux disease，GERD)是指胃十二指肠内容物反流入食管或者口腔(包括喉)、肺，引起不适症状和(或)并发症的一种疾病[1]，其症状包括食管症状及食管外症候群，主要诊断依据包括以食管症状为主的反流性食管炎及以食管外症状为主的反流性喉炎综合征、反流性哮喘综合征、反流性咳嗽综合征、反流性牙侵蚀症等[2-3]。随着对GERD研究的深入，有学者发现在诊断为反流性食管炎的患者中，部分仅表现为食管症状，而另一部分则出现食管外症状，甚至后者成为就诊并造成临床困惑的主要原因[4]。目前对反流性食管炎患者出现食管外症状的原因及其影响因素尚无专家共识，与之相关的研究及文献报道也较少[5]。本研究旨在探索反流性食管炎患者出现食管外症状的危险因素。
1 资料与方法
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1.1 一般资料
选取2018年3月—2019年11月战略支援部队特色医学中心消化内科收治的反流性食管炎患者139例，均行电子胃镜检查明确诊断，并同意接受24 h食管pH值监测。排除标准：(1)有肿瘤病史；(2)有食管、胃部分及全切术史；(3)存在严重血液、内分泌及免疫系统疾病；(4)严重心、肺、肝、肾功能不全；(5)孕产妇及18岁以下者；(6)长期口服激素、免疫抑制剂者。
1.2 临床资料收集
(1)记录患者年龄、性别、体重指数(BMI)、吸烟史、饮酒史。(2)采用洛杉矶分级标准对胃镜下反流性食管炎进行分级[6]。正常：食管黏膜无破损；A级：1个及以上食管黏膜破损，长径<5 mm；B级：1个及以上食管黏膜破损，长径≥5 mm，但无融合性病变；C级：黏膜破损有融合，但<75%食管周径；D级：黏膜破损融合，≥75%食管周径。(3)食管反流症状评分表(reflux symptom index，RSI)评分：让患者回忆是否伴有咽部异物感、频繁清嗓、慢性咳嗽、声音嘶哑、吞咽不适、哮喘等食管外症状，每个症状按严重程度从无症状(0分)到症状最严重(5分)6个等级进行评分，RSI>13分定义为阳性[7]。(4)焦虑评分：采用焦虑自评量表(SAS)进行评估，≥50分诊断为焦虑状态。(5)抑郁评分：采用抑郁自评量表(SDS)进行评估，≥50分诊断为抑郁状态[8]。(6)进行24 h食管pH值监测，计算DeMeester指数(将仪器测量的酸反流时间百分比、立位酸反流时间百分比、卧位酸反流时间百分比、酸反流总次数、最长酸反流时间及>5 min酸反流次数等6项指标进行综合计算获得的统计指数，总体反映食管酸暴露情况)，DeMeester指数>14.72为阳性，提示异常酸反流。(7)评估患者是否超重：BMI 18~25 kg/m2为正常体重，BMI>25 kg/m2为超重。
1.3 临床资料分析
比较两组性别，年龄，超重、吸烟、饮酒、焦虑及抑郁的比例，反流性食管炎镜下分级，24 h食管pH值监测相关指数(DeMeester指数)等指标的差异，分析反流性食管炎患者发生食管外症状的危险因素。
1.4 统计学处理
采用SPSS 19.0软件进行统计分析。正态分布的计量资料以$\bar{x}±s$表示，组间比较采用t检验；计数资料以例(%)表示，组间比较采用χ2检验。采用logistic回归分析患者出现食管外症状的影响因素。P<0.05为差异有统计学意义。
2 结果
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2.1 两组一般资料比较
139例患者中，RSI>13分者55例，为食管外症状阳性组；RSI≤13分者84例，为食管外症状阴性组。阳性组年龄、超重比例、焦虑比例及DeMeester阳性比例高于阴性组，差异有统计学意义(P<0.05)；两组性别，吸烟、饮酒、抑郁比例及反流性食管炎内镜下分级程度差异无统计学意义(P>0.05，表1)。
2.2 反流性食管炎合并食管外症状的多因素logistic回归分析
以有无反流性食管炎合并食管外症状为因变量(有=1，无=0)，以年龄、超重(有=1，无=0)、焦虑(有=1，无=0)及DeMeester阳性(有=1，无=0)为自变量进行多因素logistic回归分析，结果显示，超重、DeMeester阳性是反流性食管炎患者出现食管外症状的独立危险因素(表2)。
3 讨论
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目前，反流性食管炎在我国慢性疾病中的比例逐渐增高[9-10]，一部分患者临床表现仅有反流、烧心等消化道症状，而另一部分患者合并食管外症状(咽痛、咳嗽、喘息等)，食管外症状越来越受到医师及患者的重视。据报道，在诊断为反流性食管炎的患者中，10%~15%的患者因咽喉不适、50%的患者因嗓音问题而就诊于耳鼻喉科，接受常规治疗后临床效果欠佳，而最终被诊断为合并食管外症状的反流性食管炎[3,11]。这些症状反复发作或持续存在，一定程度上影响了患者的情绪，干扰了患者正常的生活。目前，形成这样差异化临床表现的原因逐渐受到关注，除了反流性食管炎发病机制中抗反流屏障功能减弱、食管清除能力下降等因素外[9-10]，年龄、性别差异、超重、不良生活习惯(吸烟/饮酒)及情绪(焦虑/抑郁)因素等也与其有关[12]。有研究发现，酸性物质的反流及反流微粒刺激局部产生生理及病理性反应，可诱发支气管、咽喉部及肺部等相关症状的出现[13]。综合相关研究发现，酸反流程度、年龄大、超重、不良生活习惯(吸烟/饮酒)及情绪(焦虑/抑郁)等可能导致反流性食管炎合并食管外症状的发生及进展[14-15]，其中酸反流是最主要的影响因素。综合以往研究结果，本研究将评估酸反流程度的反流性食道炎胃镜下分级及能反映食管酸暴露程度的DeMeester指数纳入研究因素中，初步探讨引起反流性食管炎患者出现食管外症状的危险因素。
本研究139例反流性食管炎患者中，合并食管外症状者占39.6%(55/139)，与其他临床研究相似[16-17]。两组的性别，吸烟、饮酒、抑郁比例及反流性食管炎内镜下分级程度差异无统计学意义，阳性组的年龄高于阴性组，差异有统计学意义，提示高龄可能是影响因素之一。既往研究发现，40%~60%的反流性食管炎患者合并焦虑症状[18-19]，本研究发现阳性组焦虑患者的比例高于阴性组，与即往研究结果一致，提示焦虑情绪可能诱发或加重食管外症状。Logistic回归分析未发现年龄、焦虑是患者出现食管外症状的独立危险因素，考虑其原因除这两种因素的影响力较小外，还可能与本研究纳入的样本量较小有关，今后应扩大样本量或对年龄及焦虑程度进行分级进一步深入分析。
本研究结果显示，阳性组中超重患者比例高于阴性组，logistic回归分析结果也显示超重是反流性食道炎患者出现食管外症状的危险因素，主要原因是超重患者大多伴有腹压增高、膈肌上移等，增加了反流的风险及反流物的反流距离，直接或间接造成食管外症状。本研究还发现，阳性组的DeMeester阳性比例高于阴性组，logistic回归分析提示DeMeester阳性(酸暴露情况)是造成反流性食管炎患者出现食管外症状的独立危险因素，可能原因有以下两个方面：第一，酸反流及反流微粒反复刺激近端食管，导致其黏膜屏障功能下降或局部破坏，同时增加了近端食管的敏感性，造成近端食管及周围相邻组织、器官出现炎症反应及应激性变化。Cronin等[20]的体外研究发现，酸反流可增强核因子-κB(NF-κB)介导的基因表达，通过NF-κB介导的炎症反应引起食管局部病变。第二，在部分酸反流的同时合并有气液混合反流，反流物中的气体可增加反流物体积，进而增强食管的蠕动扩张作用，食管的廓清功能下降，使反流物易于到达更敏感的近端食管及其周围组织器官。所以酸反流程度越重、反流暴露时间越长、反流物达到近段食管的距离越远，产生食管外症状的可能性就越大。
综上所述，超重及DeMeester阳性是反流性食管炎患者出现食管外症状的独立危险因素，今后的工作中要加强对该类患者的认识及临床管理，在给予充分抑酸等治疗的同时，应针对不同病因的患者制定个体化治疗方案，如对超重患者应指导其加强饮食及运动管理，通过临床督导使其BMI控制在最佳状态，减少反流的发生；针对高龄及情绪异常的患者要关注其心理诉求，及时给予心理疏导，必要时加用抗焦虑抑郁药物，缓解患者的躯体及心理症状，从而缓解临床症状[21-23]。
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2021年第46卷第8期
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doi: 10.11855/j.issn.0577-7402.2021.08.11
  • 接收时间：2021-03-19
  • 首发时间：2025-12-19
  • 出版时间：2021-08-28
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  • 收稿日期：2021-03-19
  • 修回日期：2021-05-24
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    1战略支援部队特色医学中心消化内科，北京 100101
    2解放军总医院第五医学中心消化科，北京 100039
    3战略支援部队特色医学中心耳鼻咽喉头颈外科，北京 100101

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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