切换至 "中华医学电子期刊资源库"
高级检索
中华诊断学电子杂志

中华诊断学电子杂志 ›› 2016, Vol. 04 ›› Issue (03) : 153 -156. doi: 10.3877/cma.j.issn.2095-655X.2016.03.003

所属专题： 文献；

消化系统疾病与心身医学观

癔球症患者食管上括约肌压力分型及其严重程度的影响因素
陈冬云1, 贾林2,†()   
  1. 1. 511400　广州医科大学附属广州市第一人民医院消化内科
    2. 511400　广州医科大学附属广州市第一人民医院消化内科；511457　广州市南沙中心医院消化内科
  • 收稿日期:2016-07-30 出版日期:2016-08-26
  • 通信作者: 贾林

The types of upper esophageal sphincter pressure and influencing factors in patients with globus pharyngeus

Dongyun Chen1, Lin Jia2,†()   

  1. 1. Department of Gastroenterology, Guangzhou First People′s Hospital, the Affiliated Hospital of Guangzhou Medical University, Guangzhou 511400, China
    2. Department of Gastroenterology, Guangzhou First People′s Hospital, the Affiliated Hospital of Guangzhou Medical University, Guangzhou 511400, China; Department of Gastroenterology, Guangzhou Nansha Central Hospital Affiliated to Guangzhou First People’s Hospital, Guangzhou 511457, China
  • Received:2016-07-30 Published:2016-08-26
  • Corresponding author: Lin Jia
  • About author:
    Corresponding author: Jia Lin, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈冬云, 贾林. 癔球症患者食管上括约肌压力分型及其严重程度的影响因素[J]. 中华诊断学电子杂志, 2016, 04(03): 153-156.

Dongyun Chen, Lin Jia. The types of upper esophageal sphincter pressure and influencing factors in patients with globus pharyngeus[J]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(03): 153-156.

目的

探讨癔球症患者食管上括约肌(UES)压力分型及其严重程度的影响因素。

方法

120例癔球症患者采用高分辨率食管测压技术(HRM)检测食管上括约肌静息压，将其分为高压组和非高压组；并进行癔球症症状评分(GETS)，匹兹堡睡眠质量指数(PSQI)及汉密顿焦虑/抑郁量表(HAMA/HAMD)评估。

结果

24.2%(29/120)的癔球症患者存在UES高压，而33.3%(40/120)的癔球症患者存在UES残余压过高。高压组与非高压组相比，在病程持续时间[(42.17±50.11)月，(20.67±17.07)月]、GETS评分[(11.79±3.49)分，(7.81±2.12)分]、UES静息压[(131.38±22.38)mmHg，(66.83±16.98)mmHg，1 mmHg＝0.133 kPa]、HAMA评分[(13.59±2.84)分，(8.08±1.46)分]等指标差异有统计学意义(t＝4.175，3.957，4.126，3.382；P<0.05)。癔球症患者的GETS评分与UES静息压(r＝0.617)、UES残余压(r＝0.265)、HAMA评分(r＝0.531)呈显著正相关(P<0.05)，而与LES静息压(r＝0.012)、PSQI评分(r＝0.082)、HAMD评分(r＝0.105)等指标无明显相关性(P>0.05)。多重线性回归分析显示，UES静息压、UES残余压、HAMA评分是癔球症症状严重程度的影响因素，最终拟合癔球症症状影响因素的方程：癔球症症状严重程度(GETS评分)＝2.813＋0.040(UES静息压)＋0.059(UES残余压)＋0.206(HAMA评分)。

结论

UES静息压过高在癔球症患者中并不少见，与非高压型患者相比，高压性患者癔球症症状持续时间长、症状严重程度高、焦虑状态更严重；癔球症症状严重程度与UES静息压、UES残余压、HAMA评分等因素有关。

关键词: 癔球症, 食管括约肌，上段, 高分辨率食管测压
Objective

To explore the types of upper esophageal sphincter (UES) pressure and influencing factors in patients with globus pharyngeus.

Methods

UES resting pressure of 120 patients with globus pharyngeus were taken by high resolution manometry (HRM), and all patients were evaluated by Glasgow Edinburgh Throat Scale (GETS), Pittsburgh Sleep Quality Index (PSQI) and hamilton Rating Scale Anxiety/Depression(HAMA/HAMD). According to the UES resting pressure, the 120 patients were divided into hypertensive UES group and non-hypertensive UES group.

Results

24.2% (29/120) of globus pharyngeus patients had high UES resting pressure, while 33.3% (40/120) of globus phyaryngeus patients had high UES residual pressure. Hypertensive UES patients had longer symptom duration [(42.17±50.11)months, (20.67±17.07)months], more severe symptom [(11.79±3.49)points, (7.81±2.12)points], higher UES resting pressure [(131.38±22.38)mmHg, (66.83±16.98)mmHg], higher HAMA scores [(13.59±2.84)points, (8.08±1.46)points], compared with non-hypertensive UES group (t=4.175, 3.957, 4.126, 3.382; P<0.05). The severity of globus pharyngeus symptoms was associated with UES residual pressure, UES resting pressure, HAMA scores. Multiple linear regression analysis showed that UES residual pressure, UES resting pressure, HAMA scores were influencing factors of globus symptoms.

Conclusions

Hypertensive UES is not rare among globus patients. Hypertensive UES patients have longer symptom duration, more severe symptom, higher UES resting pressure, higher HAMA scores. The severity of globus pharyngeus symptoms is associated with symptom duration, UES residual pressure, UES resting pressure, HAMA scores.

Key words: Globus pharyngeus, Esophageal sphincter, upper, High resolution manometry
表1 高压组及非高压组癔球症患者一般资料分析
项目 非高压组(n＝91) 高压组(n＝29) 统计量 P值
性别(例，男/女) 35/56 10/19 χ2＝0.061 0.827
年龄(岁，±s) 45.43±13.10 45.50±12.80 t＝0.382 0.970
病程(月，±s) 20.67±17.07 42.17±50.11 t＝4.175 0.000
GETS(分，±s) 7.81±2.12 11.79±3.49 t＝3.957 0.003
UES静息压(mmHg，±s) 66.83±16.98 131.38±22.38 t＝4.126 0.000
UES残余压(mmHg，±s) 12.41±8.54 13.70±10.72 t＝0.629 0.507
LES静息压(mmHg，±s) 19.16±8.75 20.22±8.72 t＝0.821 0.569
PSQI(分，±s) 7.59±4.36 9.03±4.70 t＝0.709 0.538
HAMA(分，±s) 8.08±1.46 13.59±2.84 t＝3.382 0.001
HAMD(分，±s) 7.36±3.93 7.52±4.74 t＝1.754 0.088
表2 癔球症GETS评分与各变量的相关性分析结果
变量 r值 P值
UES静息压 0.617 0.000
UES残余压 0.265 0.003
LES静息压 0.012 0.899
PSQI评分 0.082 0.372
HAMA评分 0.531 0.000
HAMD评分 0.105 0.253
表3 癔球症症状严重程度的影响因素的多重线性回归分析
因变量 预测变量 非标准化回归数 标准化偏回归数 t值 P值 R 2值 F值 P值
β 标准误 Beta
癔球症症状评分 常量 2.813 0.747 ? 3.765 0.000 0.424 28.506 0.000
? 食管上括约肌静息压 0.040 0.010 0.436 4.166 0.000 ? ? ?
? 食管上括约肌残余压 0.059 0.024 0.176 2.443 0.016 ? ? ?
? 抑郁量表评分 0.206 0.104 0.205 1.985 0.049 ? ? ?
[1]
Lee BE,Kim GH.Globus pharyngeus：a review of its etiology, diagnosis and treatment[J]. World J Gastroenterol, 2012, 18(20): 2462-2471.
[2]
Watson WC,Sullivan SN. Hypertonicity of the cricopharyngeal sphincter：A cause of globus sensation[J]. Lancet, 1974, 2(7894): 1417-1419.
[3]
Corso MJ,Pursnani KG,Mohiuddin MA, et al.Globus sensation is associated with hypertensive upper esophageal sphincterbut not with gastroesophageal reflux[J]. Dig Dis Sci, 1998, 43(7): 1513-1517.
[4]
Halum SL,Butler SG,Koufman JA, et al.Treatment of globus by upper esophageal sphincter injection with botulinum A toxin[J]. Ear Nose Throat J, 2005, 84(2): 74.
[5]
Kwiatek MA,Mirza F,Kahrilas PJ, et al.Hyperdynamic upper esophageal sphincter pressure：a manometric observation in patients reporting globus sensation[J]. Am J Gastroenterol, 2009, 104(2): 289-298.
[6]
Peng L,Patel A,Kushnir V, et al.Assessment of upper esophageal sphincter function on high-resolutionmanometry：identification of predictors of globus symptoms[J]. J Clin Gastroenterol, 2015, 49(2): 95-100.
[7]
Deary IJ,Wilson JA,Harris MB, et al.Globus pharyngis：development of a symptom assessment scale[J]. J Psychosom Res, 1995, 39(2): 203-213.
[8]
Buysse DJ,Reynolds CF 3rd,Monk TH, et al.The pittsburgh sleep quality index：a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28(2): 193-213.
[9]
Matza LS,Morlock R,Sexton C, et al.Identifying HAM-A cutoffs for mild, moderate, and severe generalized anxiety disorder[J]. Int J Methods Psychiatr Res, 2010, 19(4): 223-232.
[10]
Calotǎ DR,Nitescu C,Marinescu S, et al.Correlations between morphological appearance and psychosocial difficulties in patients with extensive burns who received allotransplant[J]. Rom J Morphol Embryol, 2012, 53(3 Suppl): 703-711.
[11]
杨志寅. 现代医学科学发展中的缺憾与思考[J/CD]. 中华诊断学电子杂志, 2013, 1(1): 1-7.
[12]
唐贝,贾林,蔡厚达, 等. 广州地区人群癔球症的发病学特征及城乡差异[J]. 中华行为医学与脑科学杂志, 2016, 25(6): 537-541.
[13]
曹建新. 整体医学模式下心身医学评估的临床实践[J/CD]. 中华诊断学电子杂志, 2015, 3(2): 128-132.
[14]
Burns P,O′Neill JP.The diagnosis and management of globus：a perspective from Ireland[J]. Curr Opin Otolaryngol Head Neck Surg, 2008, 16(6): 503-506.
[15]
Tang B,Jia L,Liu J, et al.Clinical-psychological characteristics of refractory globus patients in China[J]. Dig Liver Dis, 2016, 48(4): 381-384.
[16]
Gale CR,Wilson JA,Deary IJ.Globus sensation and psychopathology in men：the vietnam experience study[J]. Psychosom Med, 2009, 71(9): 1026-1031.
[17]
Sun J,Xu B,Yuan YZ, et al.Study on the function of pharynx upper esophageal sphincter in globus hystericus[J]. World J Gastroenterol, 2002, 8(5): 952-955.
[18]
Cook IJ,Dent J,Collins SM.Upper esophageal sphincter tone and reactivity to stress in patients with a history of globus sensation[J]. Dig Dis Sci, 1989, 34(5): 672-676.
[19]
Choi WS,Kim TW,Kim JH, et al.High-resolution manometry and globus：comparison of globus, gastroesophageal reflux disease and normal controls using high-resolution manometry[J]. J Neurogastro-enterol Motil, 2013, 19(4): 473-478.
[20]
汪涛,侯鹏. 埃索美拉唑和帕罗西汀治疗癔球症的临床分析[J/CD]. 中华临床医师杂志(电子版), 2010, 4(6): 772-775.
[21]
顾韵,钱炜. 咽异感症的高分辨率食管测压特点分析[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(17): 1553-1555.
[1] 杜亚君, 尚占民, 秦昌富. 高分辨率食管测压技术在腹腔镜治疗食管裂孔疝中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(06): 522-524.
[2] 王健, 史以超, 赵会君, 王潇潇, 彭丽华, 杨云生. 胃食管反流病患者伴有或不伴有食管黏膜损伤与食管上、下括约肌压力相关性研究[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(01): 32-35.
[3] 中华医学会行为医学分会消化病学组. 癔球症多学科诊治中国专家共识[J]. 中华诊断学电子杂志, 2020, 08(04): 217-222.
[4] 何梓健, 贾林, 邓祺, 赵寒冰, 孟默, 郭婉薇. 癔球症患者临床精神心理学特征及少商穴经皮电刺激治疗的疗效评价[J]. 中华诊断学电子杂志, 2020, 08(02): 130-134.
[5] 刘尧, 贾林. 难治性癔球症患者食管压力特征及血清脑肠肽水平的变化[J]. 中华诊断学电子杂志, 2016, 04(03): 149-152.
[6] 张含花, 孙露, 刘欢宇, 侯崇智, 方莹. 高分辨率食管测压辅助诊断婴儿食管裂孔疝一例[J]. 中华胃食管反流病电子杂志, 2023, 10(01): 56-58.
[7] 高红雷, 徐慧民, 徐冬梅, 肖相明, 张文星, 孙作成. 高分辨率食管测压联合24小时pH阻抗技术在胃食管反流病合并食管裂孔疝中的应用[J]. 中华胃食管反流病电子杂志, 2021, 08(01): 16-19.
[8] 阿不来克木·马合木提, 买买提·依斯热依力, 赵新胜, 努尔艾力·艾尼, 闫晶, 李义亮, 张雷, 克力木·阿不都热依木. 食管混合性酸反流和低动力在非心源性胸痛发作的作用研究[J]. 中华胃食管反流病电子杂志, 2019, 06(03): 121-125.
[9] 潘红艳, 冯艳艳, 穆雪峰, 康文全. 食管动力评估对胃食管反流病诊治的意义[J]. 中华胃食管反流病电子杂志, 2017, 04(04): 172-174.
[10] 热衣拉·克尤木, 布马力亚·克衣木, 克力木·阿不都热依木. 高分辨率食管测压技术在诊断胃食管反流病合并哮喘中的意义[J]. 中华胃食管反流病电子杂志, 2017, 04(01): 31-34.
[11] 刘洪琴, 徐磊, 蔡明军, 王忠安, 胡霞, 罗丽娅. 水灌注高分辨率食管测压及24 h pH-阻抗监测在GERD诊断中的应用价值研究[J]. 中华胃食管反流病电子杂志, 2016, 03(02): 58-61.
[12] 杜智, 张成, 克力木, 王志, 热依拉, 李义亮, 苏福增, 李慧灵. 高分辨率食管测压与食管24 h pH监测在胃食管反流病中的应用价值[J]. 中华胃食管反流病电子杂志, 2015, 02(03): 147-151.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号