血清胃泌素与胃蛋白酶原Ⅰ、Ⅱ联合24 h食管pH-阻抗监测诊断胃食管反流相关性胸痛的价值

doi:10.3877/cma.j.issn.2095-2015.2026.05.008

目的

探究24 h食管pH-阻抗监测联合血清胃泌素、胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）对胃食管反流相关性胸痛的诊断价值。

方法

选取2023年12月至2025年10月通辽市人民医院收治的158例疑似胃食管反流相关性胸痛患者进行回顾性分析，以是否胃食管反流分为胃食管反流组与无反流组（有相关性胸痛但非胃食管反流患者）。比较胃食管反流组与无反流组患者的一般资料、24 h食管pH-阻抗监测结果及血清胃泌素、PGⅠ、PGⅡ水平。多因素Logistic回归分析胃食管反流相关性胸痛发生的影响因素。ROC曲线分析24 h食管pH-阻抗监测单独诊断及联合血清胃泌素、PGⅠ、PGⅡ诊断胃食管反流相关性胸痛的价值。Bootstrap法重复100次抽样交叉验证进行内部验证。Hosmer-Lemeshow检验评估24 h食管pH-阻抗监测联合血清胃泌素、PGⅠ、PGⅡ水平诊断胃食管反流相关性胸痛的价值的拟合优度。

结果

158例疑似胃食管反流相关性胸痛患者中有80例患者确诊为胃食管反流相关性胸痛。胃食管反流组患者的酸反流次数、平均酸清除时间、气体反流次数均高于无反流组患者（P<0.05）。胃食管反流组胃泌素及PGⅡ水平低于无反流组，PGⅠ水平高于无反流组（P<0.05）。酸反流次数、平均酸清除时间、气体反流次数及血清胃泌素、PGⅠ、PGⅡ水平是胃食管反流相关性胸痛发生的影响因素（P<0.05）。24 h食管pH-阻抗监测联合血清胃泌素、PGⅠ、PGⅡ水平诊断胃食管反流相关性胸痛的价值高于上述指标单独诊断（P<0.05）。Bootstrap重抽样内部验证结果显示，校准曲线与理想曲线基本一致。Hosmer-Lemeshow检验发现诊断模型具有较好的拟合优度。

结论

胃食管反流相关性胸痛患者血清胃泌素及PGⅡ水平降低，PGⅠ水平升高，24 h食管pH-阻抗监测联合血清胃泌素、PGⅠ、PGⅡ诊断胃食管反流相关性胸痛的价值较高。

关键词: 胃食管反流相关性胸痛, 24 h食管pH-阻抗监测, 胃泌素, 胃蛋白酶原Ⅰ, 胃蛋白酶原Ⅱ, 诊断

Objective

To investigate the diagnostic value of 24-hour esophageal pH-impedance monitoring combined with serum gastrin, pepsinogenⅠ(PGⅠ), and pepsinogenⅡ(PGⅡ) for gastroesophageal reflux-related chest pain.

Methods

A retrospective analysis was conducted on 158 patients with suspected gastroesophageal reflux-related chest pain who were admitted to Tongliao People's Hospital from December 2023 to October 2025. They were divided into two groups based on the presence of gastroesophageal reflux: the gastroesophageal reflux group and the non-reflux group (patients with related chest pain but without gastroesophageal reflux). The general data, 24-hour esophageal pH-impedance monitoring results, and serum gastrin, PGⅠ, and PGⅡ levels between patients with gastroesophageal reflux and those without reflux were compared. Multivariate logistic regression analysis was conducted to identify the influencing factors for the occurrence of gastroesophageal reflux-related chest pain. ROC curve analysis was conducted to evaluate the value of 24-hour esophageal pH-impedance monitoring alone, as well as its combination with serum gastrin, PGⅠ, and PGⅡ in diagnosing gastroesophageal reflux-related chest pain. Internal validation was performed using Bootstrap sampling with 100 iterations of cross-validation. The Hosmer-Lemeshow test was used to evaluate the goodness-of-fit of the diagnostic model combining 24-hour esophageal pH-impedance monitoring with serum gastrin, PGⅠ, and PGⅡ levels for diagnosing gastroesophageal reflux-related chest pain.

Results

Among 158 patients with suspected gastroesophageal reflux-related chest pain, 80 were diagnosed with the condition. Patients in the gastroesophageal reflux group exhibited higher rates of acid reflux episodes, longer mean acid clearance times, and more frequent gas reflux episodes compared to patients in the non-reflux group (P<0.05). The levels of gastrin and PGⅡ in the gastroesophageal reflux group were lower than those in the non-reflux group, while the level of PGⅠ was higher than that in the non-reflux group (P<0.05). The number of acid reflux episodes, mean acid clearance time, number of gas reflux episodes, and serum gastrin, PGⅠ, and PGⅡ levels were factors influencing the occurrence of gastroesophageal reflux-related chest pain (P<0.05). The value of 24-hour esophageal pH-impedance monitoring combined with serum gastrin, PGⅠ, and PGⅡ levels demonstrated superior diagnostic value for gastroesophageal reflux-related chest pain compared to standalone diagnosis (P<0.05). Internal validation results from Bootstrap resampling indicated that the calibration curve was essentially consistent with the ideal curve. The Hosmer-Lemeshow test indicated that the diagnostic model exhibited good goodness-of-fit.

Conclusion

The levels of serum gastrin and PGⅡ in patients with gastroesophageal reflux-related chest pain decrease, while the level of PGⅠ increases. The 24-hour esophageal pH-impedance monitoring combined with serum gastrin, PGⅠ, and PGⅡ levels has a relatively high value in the diagnosis of gastroesophageal reflux-related chest pain.

Key words: Gastroesophageal reflux-related chest pain, 24-hour esophageal pH-impedance monitoring, Gastrin, PepsinogenⅠ, PepsinogenⅡ, Diagnosis

表1 两组疑似胃食管反流相关性胸痛患者的一般资料

组别	例数	年龄(岁,±s)	性别[例(%)]		吸烟史[例(%)]		饮酒史[例(%)]		糖尿病[例(%)]		食管胃静脉曲张类型[例(%)]
组别	例数	年龄(岁,±s)	男	女	有	无	有	无	有	无	Ι型	Ⅱ型
胃食管反流组	80	56.13±8.24	60(75.00)	20(25.00)	43(53.75)	37(46.25)	46(57.50)	34(42.50)	10(12.50)	70(87.50)	28(35.00)	36(45.00)
无反流组	78	54.27±7.38	56(71.79)	22(28.21)	39(50.00)	39(50.00)	42(53.85)	36(46.15)	8(10.26)	70(89.74)	24(30.77)	34(43.59)
t/χ²值		1.493	0.208		0.222		0.214		0.197		0.784
P值		0.137	0.648		0.637		0.644		0.657		0.676

表1 两组疑似胃食管反流相关性胸痛患者的一般资料

组别	例数	年龄(岁,±s)	性别[例(%)]		吸烟史[例(%)]		饮酒史[例(%)]		糖尿病[例(%)]		食管胃静脉曲张类型[例(%)]
组别	例数	年龄(岁,±s)	男	女	有	无	有	无	有	无	Ι型	Ⅱ型
胃食管反流组	80	56.13±8.24	60(75.00)	20(25.00)	43(53.75)	37(46.25)	46(57.50)	34(42.50)	10(12.50)	70(87.50)	28(35.00)	36(45.00)
无反流组	78	54.27±7.38	56(71.79)	22(28.21)	39(50.00)	39(50.00)	42(53.85)	36(46.15)	8(10.26)	70(89.74)	24(30.77)	34(43.59)
t/χ²值		1.493	0.208		0.222		0.214		0.197		0.784
P值		0.137	0.648		0.637		0.644		0.657		0.676

表2 两组疑似胃食管反流相关性胸痛患者的24 h食管pH-阻抗监测结果（

±s）

组别	例数	酸反流次数(次)	平均酸清除时间(s)	非酸反流次数(次)	气体反流次数(次)	食团清除时间(s)
胃食管反流组	80	25.88±3.02	76.58±4.65	15.18±1.87	15.44±2.22	12.05±1.33
无反流组	78	22.41±2.37	71.07±4.01	14.91±0.86	13.58±1.02	11.74±1.25
t值		8.021	7.968	1.161	6.738	1.509
P值		<0.001	<0.001	0.247	<0.001	0.133

表2 两组疑似胃食管反流相关性胸痛患者的24 h食管pH-阻抗监测结果（

±s）

组别	例数	酸反流次数(次)	平均酸清除时间(s)	非酸反流次数(次)	气体反流次数(次)	食团清除时间(s)
胃食管反流组	80	25.88±3.02	76.58±4.65	15.18±1.87	15.44±2.22	12.05±1.33
无反流组	78	22.41±2.37	71.07±4.01	14.91±0.86	13.58±1.02	11.74±1.25
t值		8.021	7.968	1.161	6.738	1.509
P值		<0.001	<0.001	0.247	<0.001	0.133

表3 两组疑似胃食管反流相关性胸痛患者的血清胃泌素、胃蛋白酶原水平（

±s）

组别	例数	胃泌素(pg/mL)	胃蛋白酶原Ⅰ(ng/mL)	胃蛋白酶原Ⅱ(ng/mL)
胃食管反流组	80	49.29±9.51	38.66±5.84	10.48±1.05
无反流组	78	60.92±10.35	31.78±5.28	12.95±2.84
t值		7.358	7.762	7.286
P值		<0.001	<0.001	<0.001

表3 两组疑似胃食管反流相关性胸痛患者的血清胃泌素、胃蛋白酶原水平（

±s）

组别	例数	胃泌素(pg/mL)	胃蛋白酶原Ⅰ(ng/mL)	胃蛋白酶原Ⅱ(ng/mL)
胃食管反流组	80	49.29±9.51	38.66±5.84	10.48±1.05
无反流组	78	60.92±10.35	31.78±5.28	12.95±2.84
t值		7.358	7.762	7.286
P值		<0.001	<0.001	<0.001

表4 影响胃食管反流相关性胸痛发生的多因素Logistic回归分析

自变量	赋值	β	S.E.	OR	Wald χ²	P	95% CI
酸反流次数	原值代入	1.103	0.332	3.012	11.030	0.001	1.571~5.774
平均酸清除时间	原值代入	0.777	0.273	2.176	8.111	0.004	1.274~3.716
气体反流次数	原值代入	1.520	0.531	4.573	8.196	0.004	1.615~12.948
胃泌素	原值代入	-0.662	0.195	0.516	11.513	0.001	0.352~0.756
胃蛋白酶原Ⅰ	原值代入	1.788	0.627	5.979	8.134	0.004	1.750~20.433
胃蛋白酶原Ⅱ	原值代入	-1.259	0.437	0.284	8.297	0.004	0.121~0.669

表4 影响胃食管反流相关性胸痛发生的多因素Logistic回归分析

自变量	赋值	β	S.E.	OR	Wald χ²	P	95% CI
酸反流次数	原值代入	1.103	0.332	3.012	11.030	0.001	1.571~5.774
平均酸清除时间	原值代入	0.777	0.273	2.176	8.111	0.004	1.274~3.716
气体反流次数	原值代入	1.520	0.531	4.573	8.196	0.004	1.615~12.948
胃泌素	原值代入	-0.662	0.195	0.516	11.513	0.001	0.352~0.756
胃蛋白酶原Ⅰ	原值代入	1.788	0.627	5.979	8.134	0.004	1.750~20.433
胃蛋白酶原Ⅱ	原值代入	-1.259	0.437	0.284	8.297	0.004	0.121~0.669

图1 24 h食管pH-阻抗监测诊断胃食管反流相关性胸痛的ROC曲线

表5 24 h食管pH-阻抗监测诊断胃食管反流相关性胸痛的价值分析

指标	AUC	截断值	敏感度(%)	特异度(%)	95% CI	约登指数
酸反流次数	0.806	24.87次	66.25	82.05	0.736~0.865	0.483
平均酸清除时间	0.807	72.84 s	80.00	70.51	0.737~0.866	0.505
气体反流次数	0.796	14.13次	75.00	73.08	0.725~0.856	0.481
24 h食管pH-阻抗监测	0.878	-	70.00	89.74	0.817~0.925	0.597

表5 24 h食管pH-阻抗监测诊断胃食管反流相关性胸痛的价值分析

指标	AUC	截断值	敏感度(%)	特异度(%)	95% CI	约登指数
酸反流次数	0.806	24.87次	66.25	82.05	0.736~0.865	0.483
平均酸清除时间	0.807	72.84 s	80.00	70.51	0.737~0.866	0.505
气体反流次数	0.796	14.13次	75.00	73.08	0.725~0.856	0.481
24 h食管pH-阻抗监测	0.878	-	70.00	89.74	0.817~0.925	0.597

图2 24 h食管pH-阻抗监测联合血清GAS、PGⅠ、PGⅡ水平诊断胃食管反流相关性胸痛的ROC曲线注：GAS胃泌素；PG胃蛋白酶原

表6 24 h食管pH-阻抗监测联合血清胃泌素、胃蛋白酶原水平诊断胃食管反流相关性胸痛的价值分析

指标	AUC	截断值	敏感度(%)	特异度(%)	95% CI	约登指数
24 h食管pH-阻抗监测	0.878	-	70.00^a	89.74^a	0.817~0.925	0.597
胃泌素	0.813	54.02 pg/mL	76.25^a	79.49	0.743~0.870	0.557
胃蛋白酶原Ⅰ	0.811	36.87 ng/mL	65.00^a	83.33	0.742~0.872	0.483
胃蛋白酶原Ⅱ	0.815	11.49 ng/mL	72.50^a	78.21	0.745~0.872	0.507
联合诊断	0.931	-	98.75	76.92	0.880-0.965	0.757

表6 24 h食管pH-阻抗监测联合血清胃泌素、胃蛋白酶原水平诊断胃食管反流相关性胸痛的价值分析

指标	AUC	截断值	敏感度(%)	特异度(%)	95% CI	约登指数
24 h食管pH-阻抗监测	0.878	-	70.00^a	89.74^a	0.817~0.925	0.597
胃泌素	0.813	54.02 pg/mL	76.25^a	79.49	0.743~0.870	0.557
胃蛋白酶原Ⅰ	0.811	36.87 ng/mL	65.00^a	83.33	0.742~0.872	0.483
胃蛋白酶原Ⅱ	0.815	11.49 ng/mL	72.50^a	78.21	0.745~0.872	0.507
联合诊断	0.931	-	98.75	76.92	0.880-0.965	0.757

图3 24 h食管pH-阻抗监测联合血清GAS、PGⅠ、PGⅡ水平诊断胃食管反流相关性胸痛的校准曲线

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Value of serum gastrin and pepsinogenⅠ/Ⅱ combined with 24-hour esophageal pH-impedance monitoring in diagnosing gastroesophageal reflux-related chest pain

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Value of serum gastrin and pepsinogenⅠ/Ⅱ combined with 24-hour esophageal pH-impedance monitoring in diagnosing gastroesophageal reflux-related chest pain