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小儿胃食管反流的食管pH值监测及胃贲门角的超声观察

Esophageal pH value monitoring of gastroesophageal reflux in children and ultrasound observation of gastric cardia angle

    摘要
  • 摘要:
      目的  探讨24 h食管动态pH值监测及超声观察胃贲门（His）角对小儿胃食管反流（GER）的诊断价值。
      方法  选取收治的疑似小儿胃食管反流患儿188例为研究对象，患儿均行超声检查测量His角，同时动态监测24 h食管pH值，分析GER的危险因素，并以受试者工作特征（ROC）曲线评估His角及24 h食管pH值对GER的诊断价值。
      结果  188例疑似GER患儿采用Boix-Ochoa标准进行评估，包括病理性GER 142例（GER组），非GER 46例（非GER组）。GER组患儿的His角、pH值< 4反流总时间比、站立位pH值< 4反流时间百分比、卧位pH值< 4反流时间百分比、平均反流周期数、反流持续时间≥5 min次数及最长反流持续时间均大于或长于非GER组，差异有统计学意义（P < 0.05）。Logistic回归分析显示，病程为GER发生的保护因素（OR=0.075，P < 0.05），呕吐、His角、pH值< 4反流总时间比、平均反流周期数、反流持续时间≥5 min次数、最长反流持续时间长为GER发生的危险因素（OR=3.609、1.221、8.600、1.124、46.136、1.574，P < 0.05）。ROC曲线结果显示，His角、pH值< 4反流总时间比、平均反流周期数、反流持续时间≥5 min次数、最长反流持续时间预测GER的曲线下面积（AUC）分别为0.912、0.998、0.963、0.988、0.986。
      结论  超声检查下测量食管His角及24 h食管动态监测pH值对GER的诊断价值高，可作为GER筛查的有效方法。

     

    Abstract:
      Objective  To explore the diagnostic value of 24 h esophageal dynamic pH value monitoring and ultrasound observation of gastric cardia (His) angle in children with gastroesophageal reflux (GER).
      Methods  A total of 188 children with suspected gastroesophageal reflux in children were selected as research objects. All children underwent ultrasonic examination to measure His Angle, and 24 h esophageal pH value was dynamically monitored to analyze the risk factors of GER, and the diagnostic value of His Angle and 24 h esophageal pH value for GER was evaluated by receiver operating characteristic (ROC) curve.
      Results  Of 188 children with suspected GER, there were 142 cases (GER group) with GER and 46 cases (non-GER group) without GER according to Boix-Ochoa standard assessment. His angle, pH value < 4 total reflux time ratio, pH value < 4 reflux time percentage in standing position, pH value < 4 reflux time percentage in lying position, average number of reflux cycles, times of reflux duration ≥ 5 min, and the longest reflux duration were significantly more or longer than those of the non-GER group, and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that course of disease was protective factors for GER (OR=0.075, P < 0.05), while vomiting, His angle, pH value < 4 total reflux time ratio, the total reflux time ratio, the average number of reflux cycles, and the duration of reflux ≥ 5 min times and the longest reflux duration were high risk factors for GER (OR=3.609, 1.221, 8.600, 1.124, 46.136, 1.574, P < 0.05). ROC curve results showed that the area under the curve (AUC) of His angle, pH value < 4 total reflux time ratio, average number of reflux cycles, reflux duration ≥ 5 min times, and longest reflux duration in predicting GER were 0.912, 0.998, 0.963, 0.988, 0.986, respectively.
      Conclusion  Ultrasound measurement of esophageal His and 24 h esophageal dynamic pH monitoring are of high diagnostic value for GER, and can be used as an effective method for GER screening.

     

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