无效食管动力患者的临床症状和食管动力特征分析
| 作 者：罗燕菊, 黄茸, 安瑛, 陈冬梅, 段鹏, 李岩 |
| 单 位：昆明理工大学医学部，云南省第一人民医院 |
| 基金项目：云南省“兴滇英才支持计划”青年人才专项 |
| 摘 要： |
| 背景：无效食管动力（IEM）的发病机制未明，其与临床症状之间的相关性仍未确定。既往研究多聚焦于IEM与病理性酸反流之间的关联，而对不伴病理性酸反流的IEM患者关注较少。目的：在排除病理性酸反流的基础上，分析IEM患者的临床症状和食管动力学特点。方法：选取2013年7月—2023年6月在云南省第一人民医院消化内科经胃镜检查排除食管黏膜和结构异常并接受高分辨率食管测压的受检者，经24 h食管pH监测排除病理性酸反流，纳入符合芝加哥分类4.0版IEM诊断标准的患者，以及年龄匹配、符合正常食管动力标准的对照者，每组各46例。对两组临床症状和食管动力学参数进行回顾性分析，并采用二元单因素和多因素Logistic回归分析筛选IEM的相关因素。结果：IEM组男性占比73.9%，中位年龄45.5岁。主要临床症状包括吞咽困难（37.0%）、反酸/烧心（32.6%）以及胸痛、咽部异物感等，吞咽困难症状发生率显著高于对照组的2.2%（P<0.05）。两组上食管括约肌静息压和残余压差异无统计学意义（P均>0.05），IEM组食管远端收缩积分（DCI）、下食管括约肌静息压（LESP）和综合松弛压（IRP）均显著低于对照组（P均<0.05）。二元多因素Logistic回归分析显示，吞咽困难、DCI和LESP与IEM显著相关（P均<0.05）。结论：IEM患者最常见的临床症状为吞咽困难，且存在食管体部动力不足，食管廓清能力下降；LESP降低可能与弱酸和非酸反流相关。 |
| 关键词：高分辨率食管测压； 无效食管动力； 食管蠕动障碍 |
Clinical Symptoms and Esophageal Motility Characteristics of Patients With Ineffective Esophageal Motility
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| Abstract: |
| Background: The pathogenic mechanism of ineffective esophageal motility (IEM) is not yet well understood, and its correlation with clinical symptoms remains unclear. Previous studies primarily focused on the association between IEM and pathological acid reflux, while less attention has been paid to IEM patients without pathological acid reflux. Aims: To analyze the clinical symptoms and esophageal motility characteristics of patients with IEM based on the premise of excluding pathological acid reflux. Methods: Subjects who underwent high-resolution esophageal manometry at the Department of Gastroenterology, the First People's Hospital of Yunnan Province from July 2013 to June 2023 were preliminarily included. After ruling out esophageal mucosal and structural abnormalities and pathological acid reflux based on gastroscopy and 24 h esophageal pH monitoring, respectively, those who met the diagnostic criteria of IEM in Chicago Classification version 4.0 were selected as the IEM group, and the age-matched subjects with normal esophageal motility were selected as the control group (46 cases in each group). The clinical symptoms and esophageal motility parameters were analyzed retrospectively. Binary univariate and multivariate Logistic regression analyses were performed to identify relevant factors for IEM. Results: There were 34 males in the IEM group, accounting for 73.9% of the patients, and the median age was 45.5 years. The main clinical symptoms included dysphagia (37.0%), reflux/heartburn (32.6%), chest pain, throat discomfort, etc. Dysphagia was more common in the IEM patients than in the control group (37.0% vs. 2.2%, P<0.05). There were no significant differences in upper esophageal sphincter pressure and residual pressure between the two groups (all P>0.05). The distal contractile integral (DCI), lower esophageal sphincter pressure (LESP), and integrated relaxation pressure (IRP) in the IEM group were significantly lower than those in the control group (all P<0.05). Binary multivariate Logistic regression analysis revealed that IEM was associated with dysphagia, DCI, and LESP (all P<0.05). Conclusions: Dysphagia is the most common clinical symptom in patients with IEM. IEM patients present with impaired esophageal body motility and decreased clearance function, and their lower LESP might be correlated with the weak acid and non-acid reflux. |
| Keywords: High-Resolution Esophageal Manometry; Ineffective Esophageal Motility; Esophageal Peristalsis Dysfunction |
| 投稿时间：2025-09-29 |
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