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Clin Trans Gastroenterology:胆汁吸入的危险因素及其对临床结果的影响

2021-12-18 MedSci原创 MedSci原创

食管反流一般指反流性食管炎。 反流性食管炎(RE)是由胃、十二指肠内容物反流入食管引起的食管炎症性病变,内镜下表现为食管黏膜的破损,即食管糜烂和(或)食管溃疡。

      食管外反流病的症状有咽喉炎、胸痛、咳嗽、哮喘、吸入性肺炎等,其诊断很困难,因为诊断胃食管反流的金标准测试仅测量食管反流负荷,而不是反流事件对肺的影响。目前的试图将食管反流暴露与呼吸道症状相关联的研究显示出相互矛盾的结果,因此,需要新的反流相关肺部疾病的生物标志物来满足临床需求。

 

      对生物标志物的研究集中在鉴定在肺中发现的胃特异性底物,作为胃吸入的证据。最早提出的生物标志物之一是胃蛋白酶,它在胃中产生,如果存在于支气管镜检查期间获得的支气管肺泡灌洗 (BAL) 液中,则可能表明误吸了反流的胃内容物。对成人和儿童的研究表明,44%–100% 的患者肺部存在胃蛋白酶,与 pH 阻抗(pH-MII)测得的食管反流负荷相比,胃蛋白酶的敏感性仅为 45%–71%,因此需要新的生物标志物。

 

 

      另一种潜在的替代生物标志物是胆汁,在成人肺移植人群中,38%的移植肺患者的肺中发现了胆汁。然而,尚不清楚胆汁是否是儿童或非移植患者的有效生物标志物。

此外,在成人和儿童中缺乏以下数据:

(i) 胃胆汁的存在与随后肺胆汁的存在之间的关系,

(ii) 抑酸对胃或肺样本中胆汁成分的影响,

(iii)胃动力障碍和胃食管反流对肺胆汁存在的影响,

(iv) 肺胆汁对非移植患者临床预后的影响。

本研究的目标是克服当前文献的局限性,以促进人们对胆汁作为潜在生物标志物的理解,以及对呼吸道症状患者和儿童肺移植 (LTX) 患者预后的相关影响。

 

      本项研究前瞻性地招募了有呼吸道症状 (RP) 的肺移植 (LTX) 患者和非移植患者,并收集了作为健康对照患者的胃和肺样本。然后使用液相色谱-质谱法评估样品的胆汁浓度和组成。将胆汁结果与临床参数进行比较,包括存在食管炎、胃动力障碍和/或病理性胃食管反流进行了相关性分析。

 

 

      研究人员总共招募了70名患者(48名RP和22名LTX)。总体而言,100% 的胃和 98% 的支气管肺泡灌洗液样本含有胆汁。RP和LTX患者的平均胃胆汁浓度分别为280±703 nmol/L和1,004±1721 nmol/L ( P=0.02)。RP和 LTX之间的肺胆汁浓度没有差异 (9±30 nmol/L VS 11±15 nmol/L, P = 0.7)。胃排空延迟患者的肺胆汁浓度 (15.5±18.8 nmol/L) 高于胃排空正常患者 (4.8±5.7 nmol/L, P= 0.05) 与回流负荷无关。质子泵抑制剂的使用增加了未结合的胃胆汁酸的比例。高肺胆汁浓度与 RP 患者住院风险增加和住院时间延长有关(P< 0.05)。

 

      本项研究证实在肺移植人群中,胆汁被认为是误吸的标志物和更严重肺部疾病的先兆。尽管本项研究还表明胆汁(尤其是结合胆汁酸)与慢性肺同种异体移植功能障碍(CLAD)相关,但现在表明胆汁也是非移植患者更严重疾病的预测因子。

 

 

原始出处:

Rosen, Rachel. Et al. Risk Factors for Bile Aspiration and its Impact on Clinical Outcomes. Clinical and Translational Gastroenterology.2021.

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    2022-09-17 许安
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    2022-06-16 bsmagic9140
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    2021-12-21 ms5000001976519034

    受教了

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    2021-12-18 146f2224m16暂无昵称

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