胃食管反流会增加慢性阻塞性肺疾病急性加重吗？
2016/08/31
摘要
背景：慢性阻塞性肺疾病（COPD）急性加重和胃食管反流（GER）的关系研究比哮喘和胃食管反流的关系研究要少。我们旨在评估COPD患者中出现胃食管反流的情况，以及它对急性加重的影响。
方法：我们招募了24例轻中度慢性阻塞性肺疾病稳定期患者，19例自愿者作为对照。我们进行了胃食管反流病（GERD）症状问卷、胃镜、测压和24小时便携式的pH阻抗研究。
结果: 根据GERD问卷，只有5例（20.8%）COPD患者有典型的GER症状。根据24小时pH-阻抗研究，COPD组平均DeMeester评分（DMS）为38.1±34.6对照组为13.3±16.8（P = 0.01）。酸反流（DMS > 14.7）率COPD患者组比对照组（73.9% VS 26.3%，P = 0.01）的高。症状相关的概率阳性率在COPD组为17.4%（n = 4），与对照组类似（P = 0.11）。COPD组的平均近端扩张回流率（Z 17 CM）为26.4 ± 12.9%。回流的近端程度与每年的COPD加重人数（P = 0.03，R = 0.448）呈正相关。在活动力结果方面，对照组只有2例（20%）有小的运动障碍。COPD组有17例（70.8%）有小的运动障碍，4例（16.7%）有主要的运动障碍（P＜0.001）。
结论：在我们的研究中，COPD患者的胃食管反流是常见的，但只有四分之一有典型的反流症状。近端回流程度可能会引起慢性阻塞性肺病的频繁发作。
（杨冬 审校）
Respir Med. 2016 Jun;115:20-5. doi: 10.1016/j.rmed.2016.04.005. Epub 2016 Apr 20.
Does gastroesophageal reflux increase chronic obstructive pulmonary disease exacerbations?
Iliaz S1, Iliaz R2, Onur ST3, Arici S4, Akyuz U5, Karaca C6, Demir K7, Besisik F8, Kaymakoglu S9, Akyuz F10.
Author information
Abstract
BACKGROUND:The relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations.
METHODS:We included 24 patients with stable mild-moderate stage COPD and 19 volunteers as the control group. We conducted a gastroesophageal reflux disease (GERD) symptom questionnaire, gastroscopy, manometry, and an ambulatory 24-h pH-impedance study.
RESULTS:According to the GERD questionnaire, only 5 (20.8%) patients with COPD had typical GER symptoms. According to the 24-h pH-impedance study, the mean DeMeester score (DMS) was 38.1 ± 34.6 in the COPD group and 13.3 ± 16.8 in the control group (p = 0.01). The acid reflux (DMS > 14.7) rate was higher in patients with COPD than in controls (73.9% vs 26.3%, p = 0.01). The symptom association probability positivity rate was 17.4% (n = 4) in the COPD group, which was similar to the controls (p = 0.11). The mean proximal extension rate of reflux (Z 17 cm) was 26.4 ± 12.9% in the COPD group. The proximal extent of reflux was positively correlated with the number of COPD exacerbations per year (p = 0.03, r = 0.448). In the motility results, only 2 (20%) patients in the control group had a minor motility disorder. Seventeen (70.8%) patients in the COPD group had a minor motility disorder, and 4 (16.7%) had major motility disorders (p < 0.001).
CONCLUSION:In our study, gastroesophageal reflux was frequent in patients with COPD, but only a quarter had typical reflux symptoms. The proximal extent of reflux may trigger frequent exacerbations of COPD.
Copyright © 2016 Elsevier Ltd. All rights reserved.
KEYWORDS:COPD; Exacerbation; Gastroesophageal reflux; HRM; Impedance; pH monitoring
Respir Med. 2016 Jun;115:20-5. doi: 10.1016/j.rmed.2016.04.005. Epub 2016 Apr 20.
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