伴特发性肺纤维化的胃食管反流病患者夜间酸暴露特点

背景:胃食管反流是特发性肺纤维化(IPF)发生的危险因素之一,夜间反流在胃食管反流病(GERD)食管外表现中起重要作用。目的:研究伴IPF的GERD患者夜间食管酸暴露的特点。方法:选取2006年12月～2008年1月北京朝阳医院收治的16例IPF-GERD患者、32例GERD患者和16例健康志愿者(非GERD)。各组患者行24 h食管pH监测,对夜间8 h内(10pm-6am)的酸暴露程度,包括pH4的时间百分比、酸清除时间、反流次数、长反流(5 min)次数、最长反流时间等指标进行分析。结果:14例(87.5%)IPF-GERD患者存在夜间酸暴露,其程度高于非GERD组(P0.05),而与GERD患者无明显差异(P0.05)。IPF-GERD组患者前半夜pH4的时间百分比显著高于后半夜(12.2%±3.9%对1.1%±0.5%,P0.05),GERD组两者无明显差异(10.8%±2.7%对5.1%±1.8%,P0.05)。结论:大部分IPF-GERD患者存在夜间酸暴露,其主要发生于前半夜。

Characteristics of Nocturnal Acid Exposure in Gastroesophageal Reflux Disease Patients Associated with Idiopathic Pulmonary Fibrosis

Background： Gastroesophageal reflux is one of the risk factors in the pathogenesis of idiopathic pulmonary fibrosis （IPF）, and nocturnal reflux plays an important role in the extraesophageal manifestation of gastroesophageal reflux disease （GERD）. Aims： To study the characteristics of nocturnal esophageal acid exposure in GERD patients associated with IPF. Methods： Sixteen IPF-GERD patients, 32 GERD patients and 16 healthy volunteers （non-GERD） admitted in Beijing Chaoyang Hospital from December 2006 to January 2008 were enrolled. All the patients underwent 24-hour esophageal pH monitoring. Nocturnal acid exposure parameters during the 8-hour nighttime period （10pm-6am） including percentage of time pH〈4, time of acid clearance, number of reflux episodes, number of long reflux episodes （〉5 minutes）, and the longest time of reflux were assessed. Results： Fourteen （87.5%） IPF-GERD patients had nocturnal acid exposure episodes. The nocturnal acid exposure parameters in IPF-GERD patients were significantly higher than those in non-GERD （P〈0.05）, and were not significantly different from those in GERD patients （P〉0.05）. Percentage of time pH〈4 in the first half of nighttime period was significantly higher than that in the second half of nighttime period in IPF-GERD group （12.2%±3.9% vs. 1.1%±0.5%, P〈0.05）, however, no significant difference was found in GERD group （10.8%±2.7% vs. 5.1%±1.8%, P〉0.05）. Conclusions： Most IPF-GERD patients have nocturnal acid exposure episodes, nocturnal acid exposure mainly occurs in the first haft of nighttime period.