CAJ | 학술논문

目的探讨质子泵抑制剂( PPIs)治疗对胃食管反流病(GERD)患者食管酸暴露的影响及焦虑抑郁情绪与GERD患者PPI停药后酸相关症状再发的相关性.方法 2010年2月至2011年6月北京积水潭医院经24h食管pH动态监测确诊的GERD患者28例(男16例,女12例),给予口服埃索美拉唑20 mg 2次/d,治疗8周.监测停药后症状,对停药后8周内有症状复发者,复查24h食管pH动态监测.同时测定患者的BMI、焦虑自评量表(SAS)积分、抑郁自评量表(SDS)积分.结果 28例GERD患者中,停药后症状复发者15例(53.6％).PPI停药后症状复发者较无症状复发者治疗前的pH ＜4时间百分比(卧位)、24h酸反流总时间、24h酸反流＞5 min时间段数、最长酸反流时间、24h总反流次数均明显更高(分别为11.7％比4.5％,138.8 min比62.1 min,6.0比2.0,27.0 min比12.4 min,74.0次比43.0次,P值均＜0.05).各组GERD患者BMI、SAS积分、SDS积分比较,差异无统计学意义.结论 GERD患者接受PPI治疗前基础食管酸暴露水平可能对PPI治疗后食管酸暴露产生影响,从而影响症状的再发.虽然焦虑抑郁在GERD患者中普遍存在,但未发现焦虑抑郁情绪与GERD患者PPI治疗停药后酸相关症状的再发相关.
목적 탐토질자빙억제제( PPIs)치료대위식관반류병(GERD)환자식관산폭로적영향급초필억욱정서여GERD환자PPI정약후산상관증상재발적상관성.방법 2010년2월지2011년6월북경적수담의원경24h식관pH동태감측학진적GERD환자28례(남16례,녀12례),급여구복애색미랍서20 mg 2차/d,치료8주.감측정약후증상,대정약후8주내유증상복발자,복사24h식관pH동태감측.동시측정환자적BMI、초필자평량표(SAS)적분、억욱자평량표(SDS)적분.결과 28례GERD환자중,정약후증상복발자15례(53.6％).PPI정약후증상복발자교무증상복발자치료전적pH ＜4시간백분비(와위)、24h산반류총시간、24h산반류＞5 min시간단수、최장산반류시간、24h총반류차수균명현경고(분별위11.7％비4.5％,138.8 min비62.1 min,6.0비2.0,27.0 min비12.4 min,74.0차비43.0차,P치균＜0.05).각조GERD환자BMI、SAS적분、SDS적분비교,차이무통계학의의.결론 GERD환자접수PPI치료전기출식관산폭로수평가능대PPI치료후식관산폭로산생영향,종이영향증상적재발.수연초필억욱재GERD환자중보편존재,단미발현초필억욱정서여GERD환자PPI치료정약후산상관증상적재발상관.
Objective To explore the effects of proton pump inhibitors (PPIs) therapy on esophageal acid exposure of patients with gastroesophageal reflux disease(GERD),and the correlation of anxiety and depression with recurrence of acid-related symptoms after discontinuation of PPIs.Methods From February 2010 to June 2011,28 patients with GERD diagnosed by ambulatory 24 h esophageal pH monitoring admitted to Beijing Jishuitan Hospital were treated with esomeprazole 20 mg 2 times/d for 8 weeks (male 16,female 12).Symptoms after drug discontinuation were monitored.Ambulatory 24 h esophageal pH monitoring was performed on patients,whose symptom recurred within 8 weeks after treatment.BMI,Self-rating Anxiety Scale(SAS),and Self-rating Depression Scale (SDS) were detected.Results Among the 28 patients with GERD,15 (53.6％) recurred symptoms after withdraw of PPIs.Compared with the asymptomatic group after withdraw of PPIs,the pretreatment duration of pH 4 (supine),24 h total acid reflux time,number of time periods with acid reflux ＞5 minutes,the maximal acid reflux time and 24 h total number of acid reflux in the symptomatic recurrence group were statistically significantly increased ( 11.7％vs 4.5％,138.8 minutes vs 62.1 minutes,6.0 vs 2.0,27.0 minutes vs 12.4 minutes,74.0 times vs43.0times,respectively,all P values ＜ 0.05 ).There were no significant differences in BMI,SAS and SDS between the two groups.Conclusions The basic level of esophageal acid exposure of patients with GERD before PPIs therapy may influence the esophageal acid exposure after PPIs therapy and then may affect the recurrence of symptoms.Although anxiety and depression is common in patients with GERD,it is not found that the recurrence of acid-related symptoms after the discontinuation of PPIs therapy is related to the anxiety and depression.