CAJ | 학술논문

背景：最新的高分辨率食管测压（ HRM）芝加哥分类将贲门失弛缓症分为3种亚型，国内外研究发现不同亚型的贲门失弛缓症患者具有不同的临床特点和食管动力学特征。目的：应用芝加哥分类标准评价贲门失弛缓症患者的临床和食管动力学特征。方法：纳入2012年1月-2014年4月首都医科大学附属北京友谊医院收治的未经治疗的初诊贲门失弛缓症患者25例，回顾性分析患者临床症状、内镜和食管X线钡餐造影表现以及HRM数据。结果：25例患者中，5例（20.0%）为Ⅰ型，15例（60.0%）为Ⅱ型，5例（20.0%）为Ⅲ型。所有患者均有吞咽困难，4例（26.7%）Ⅱ型患者表现为胸痛。反流的发生率在Ⅰ型、Ⅱ型、Ⅲ型患者中分别为60.0%（3/5）、53.3%（8/15）、20.0%（1/5），3种亚型间差异无统计学意义（ P＞0.05）。食管扩张的发生率在Ⅰ型、Ⅱ型、Ⅲ型患者中分别为60.0%（3/5）、73.3%（11/15）、20.0%（1/5），3种亚型间差异无统计学意义（ P=0.11）。下食管括约肌（ LES）长度、LES腹内段长度、LES静息压、上食管括约肌（ UES）静息压、完整松弛压（ IRP）在3种亚型中差异无统计学意义（ P＞0.05）。多次吞咽和吞咽间歇“食管嗳气”的发生率分别为32.0%（8/25）和24.0%（6/25），3种亚型间差异无统计学意义（ P＞0.05）。结论：在贲门失弛缓症患者中，Ⅱ型最为常见。大样本的多中心资料尚有待进一步研究。
배경：최신적고분변솔식관측압（ HRM）지가가분류장분문실이완증분위3충아형，국내외연구발현불동아형적분문실이완증환자구유불동적림상특점화식관동역학특정。목적：응용지가가분류표준평개분문실이완증환자적림상화식관동역학특정。방법：납입2012년1월-2014년4월수도의과대학부속북경우의의원수치적미경치료적초진분문실이완증환자25례，회고성분석환자림상증상、내경화식관X선패찬조영표현이급HRM수거。결과：25례환자중，5례（20.0%）위Ⅰ형，15례（60.0%）위Ⅱ형，5례（20.0%）위Ⅲ형。소유환자균유탄인곤난，4례（26.7%）Ⅱ형환자표현위흉통。반류적발생솔재Ⅰ형、Ⅱ형、Ⅲ형환자중분별위60.0%（3/5）、53.3%（8/15）、20.0%（1/5），3충아형간차이무통계학의의（ P＞0.05）。식관확장적발생솔재Ⅰ형、Ⅱ형、Ⅲ형환자중분별위60.0%（3/5）、73.3%（11/15）、20.0%（1/5），3충아형간차이무통계학의의（ P=0.11）。하식관괄약기（ LES）장도、LES복내단장도、LES정식압、상식관괄약기（ UES）정식압、완정송이압（ IRP）재3충아형중차이무통계학의의（ P＞0.05）。다차탄인화탄인간헐“식관애기”적발생솔분별위32.0%（8/25）화24.0%（6/25），3충아형간차이무통계학의의（ P＞0.05）。결론：재분문실이완증환자중，Ⅱ형최위상견。대양본적다중심자료상유대진일보연구。
BacKground:AchaIasia of cardia is categorized into 3 subtypes by Chicago cIassification criteria defined by high-resoIution manometry( HRM). These different subtypes present different cIinicaI and esophageaI dynamic characteristics. Aims:To study the cIinicaI and esophageaI dynamic characteristics of patients with achaIasia of cardia categorized by Chicago cIassification criteria. Methods:Twenty-five untreated achaIasia of cardia patients from January 2012 to ApriI 2014 at Beijing Friendship HospitaI,CapitaI MedicaI University were enroIIed. CIinicaI data incIuding cIinicaI symptoms, manifestations of endoscopy and barium meaI radiography and data of HRM were anaIyzed retrospectiveIy. Results:Of the 25 patients,5 patients(20. 0%)were cIassified as type Ⅰ,15(60. 0%)as type Ⅱ and 5(20. 0%)as type Ⅲ. AII patients compIained as having dysphagia,and 26. 7%( 4/15 ) of type Ⅱ patients had chest pain. Incidences of regurgitation in typeⅠ,ⅡandⅢwere 60. 0%(3/5),53. 3%(8/15)and 20. 0%(1/5),respectiveIy,no significant difference was found among the three types(P>0. 05). Incidences of diIatation of esophagus in type Ⅰ,ⅡandⅢwere 60. 0%(3/5),73. 3%(11/15)and 20. 0%(1/5),respectiveIy,no significant difference was found among the three types (P=0. 11). No differences in Iength of Iower esophageaI sphincter(LES),abdominaI LES Iength,LES resting pressure, upper esophageaI sphincter( UES)resting pressure and integrated reIaxation pressure( IRP)among the three types were found(P>0. 05). Incidences of muItipIe swaIIowing and spontaneous UES reIaxation were 32. 0%(8/25)and 24. 0%(6/25),respectiveIy,no significant difference was found among the three types(P>0. 05). Conclusions:Of the patients with achaIasia of cardia ,typeⅡis more common. Large-sampIe muIticenter studies are needed for further research.