食管胃结合部功能的高分辨率测压参数是胃食管反流病的等效预测指标：一项头对头比较
Manometric Parameters of Esophagogastric Junction Competence Are Equivalent Predictors of Gastroesophageal Reflux Disease: A Head-To-Head Comparison.
文献信息
| PMID | 42928510 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Carlo Galdino Riva |
| 作者单位 | Division of General and Emergency Surgery, Esophageal and Reflux Center (CER), IRCCS Policlinico San Donato, Milano, University of Milan, Milan, Italy. |
| 期刊 | Neurogastroenterology and motility |
| SCI 分区 | Q2 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 存在多种评估食管胃结合部（EGJ）功能的高分辨率测压（HRM）指标，但从未在同一队列中、采用统一的胃食管反流病（GERD）定义进行头对头比较。我们旨在评估是否存在某种解剖学或压力指标优于其他指标。
方法： 纳入2022年12月至2025年12月期间因疑似GERD而接受内镜、HRM及动态反流监测的连续患者。GERD依据Lyon 2.0标准定义。所有EGJ指标均由一名设盲的阅片者重新计算。配对AUC差异采用DeLong方法检验，并以预设的等效界值ΔAUC 0.05进行解读。
结果： 在429例患者中（男性48.3%；中位年龄52岁），212例（49.4%）患有GERD。各指标在组间均有差异（均p < 0.001），并与酸暴露时间和平均夜间基线阻抗呈弱至中度相关。在解剖学指标中，EGJ形态（2017共识）的AUC最高（0.714）；LES腹内长度、食管裂孔疝和Akimoto形态等效（ΔAUC的95% CI在±0.05以内），而LES总长度表现较差（ΔAUC 0.095，95% CI 0.034-0.155）。在压力指标中，IGP + 2 mmHg时的EGJ-CI的AUC最高（0.692），7个比较指标中有6个等效。食管裂孔疝测量方法之间的比较以及LESPI的比较结果不确定。
结论： EGJ功能的解剖学和压力HRM指标在0.05 AUC界值内等效，且均仅对GERD提供中等程度的区分能力。基于诊断理由无法偏好其中任何一项，因此可合理选择计算最简单、最快捷的指标。
英文摘要
BACKGROUND: Several high-resolution manometry (HRM) metrics of esophagogastric junction (EGJ) competence exist, but they have never been compared head-to-head in one cohort against a uniform gastroesophageal reflux disease (GERD) definition. We aimed to assess whether any anatomical or pressure metric outperforms the others.
METHODS: Consecutive patients undergoing endoscopy, HRM, and ambulatory reflux monitoring for suspected GERD between December 2022 and December 2025 were studied. GERD was defined by the Lyon 2.0 criteria. All EGJ metrics were recalculated de novo by a single blinded reader. Paired AUC differences were tested with the DeLong method and interpreted against a pre-specified equivalence margin of ΔAUC 0.05.
RESULTS: Of 429 patients (48.3% male; median age 52 years), 212 (49.4%) had GERD. Every metric differed between groups (all p < 0.001) and correlated weakly to moderately with acid exposure time and mean nocturnal baseline impedance. Among anatomical metrics, EGJ morphology (2017 Consensus) had the highest AUC (0.714); LES intra-abdominal length, hiatal hernia, and Akimoto morphology were equivalent (95% CI of ΔAUC within ±0.05), whereas LES total length performed worse (ΔAUC 0.095, 95% CI 0.034-0.155). Among pressure metrics, EGJ-CI at IGP + 2 mmHg had the highest AUC (0.692), and six of seven comparators were equivalent. Comparisons between hiatal hernia sizing methods and for LESPI were inconclusive.
CONCLUSIONS: Anatomical and pressure HRM metrics of EGJ competence are equivalent within a 0.05 AUC margin and all provide only moderate discrimination for GERD. None can be preferred on diagnostic grounds, so the simplest and fastest to calculate may reasonably be chosen.