慢性胃炎脾气虚证临床研究

Clinical Research on Spleen Qi Deficiency Syndrome of Chronic Gastritis

目的 :研究慢性胃炎脾气虚证的临床症状、体征和胃镜下胃黏膜象 ,以探求慢性胃炎脾气虚证宏观及微观的诊断要点。方法 :根据临床辨证和胃镜确诊慢性胃炎患者 90例 ,按中医辨证分为脾气虚证、胃阴虚证、脾胃湿热证三组 ,各 30例。观察各组脘腹疼痛、面色、口渴、饮食、出汗、寒热、二便、舌象、脉象等临床症状和体征。在胃镜下观察不同中医证型患者胃镜下不同的胃黏膜象 ,并作病理活检。结果 :慢性胃炎脾气虚证的主要临床症状及体征为胃脘隐痛、食后胀闷、痞塞、纳呆少食、便溏或腹泻 ,乏力、四肢酸软 ,舌淡白或淡胖嫩、有齿痕、苔薄白润 ,脉沉细 ;胃黏膜象为 :胃黏膜白相或红白相间 ,以白为主 ,黏液稀薄而多 ,色多清白 ,胃壁蠕动减弱 ,或有黏膜水肿 ;病理检查结果 :脾气虚证组浅表性胃炎 ( CAG)、中重度萎缩性胃炎 ( CAG)分别占 46.67%、33.33% ,明显高于胃阴虚证组的 2 0 .0 0 %和 1 0 .0 0 %、脾胃湿热证组的 1 3.3%和 3.33% ( P<0 .0 5 )。结论 :脾气虚证是慢性胃炎的主要证型。

Objective: To study the mucosa under gastroscope, physical signs and clinical symptoms of the spleen Qi deficiency of chronic gastritis and explore the macroscopic and microcosmic diagnostic indexes of the spleen Qi deficiency of chronic gastritis.Methods:90 patients suffering from chronic gastritis were divided into 3 groups according to clinical differentiation of signs and correct diagnosis by gasroscope, including spleen Qi deficiency syndrome group(30 cases), gastric Yin deficiency syndromegroup(30 cases) and spleenogastric hygropyrexia syndrome group(30 cases). The clinical symptoms and signs including abdominall distensian, epigastralgia, appetite, thirsty, complexion, weight, enuresis,lingual and pulse picture were observed. Results: The main symptoms of spleen Qi deficiency of chronic gastritis were vague epigastralgea, fullness in the stomach after eating, less appetite, loose stool,lassitude and myasthenia of limbs, light white or light and fat and soft and indented tongue, thin and white and moist tongue fur, deep and thin pulse. The gastric mucosa was white or red alternating with white and most in white, thin and much secretion, light and white color, the moving of the stomach getting weaker. The results show that the proportion of CAG and serious CAG in the group of syndrome of spleen Qi deficiency (46.67%, 33.33%) was markedly higher than that in the group of stomach Yin deficiency syndrome (20.00%, 10.00%, p<0.05) and group of splenogastric hygropyrexia syndrome (13.33%, 3.33%,p<0.05).Conclusion: It provides the macroscopic and microcosmic diagnostic standards and differentiating points for the syndrome of spleen Qi deficiency syndrome of chronic gastritis.