寒区军人消化性溃疡中医证候的流行病学调查

EPIDEMIOLOGICAL INVESTIGATION ON TRADITIONAL CHINESE MEDICINE SYNDROME OF PEPTIC ULCER IN MILITARY PERSONNEL IN COLD REGION

目的调查寒区军人消化性溃疡(peptic ulcer,PU)中医证候分布规律及发病相关因素,为进一步采取中医理论和方法防治该病提供依据。方法依据中医学三因制宜理论,采用多阶段分层整群随机抽取的方法,对东北寒区7345名军人进行PU发病中医证候分布规律及危险因素的流行病学调查。在此基础上,进行中医证候辨证,并进行胃镜与幽门螺旋杆菌(Hp)检测。结果 PU相关症状总发生率(总积分≥5分者)为20.1%,标化后的PU发生率为13.6%。其中医辨证以寒凝气滞(48.5%)与寒凝血瘀(19.6%)为主,其次为脾胃虚寒(13.3%),均高于其他各型,差异有显著性(P<0.01)。冬秋季发病占总发病的53.6%。Hp感染率为63.7%,肝胃不和、胃热炽盛型Hp感染率与感染程度均高于其他各型,差异有显著性(P<0.01)。装甲兵PU发生率最高,步兵PU发生率最底。精神紧张(OR 3.1)、吸烟(OR 2.8)、高强度训练(OR 3.5)、饮食不洁(OR 4.6)、饮酒(OR 2.1)、胃病家族史(OR 3.4)与PU相关症状关系密切。结论寒区军人PU发生率较高,以冬季发病多,中医证候分布以寒凝气滞与寒凝血瘀为主,其次为脾胃虚寒。温阳散寒为主的中医药是防治寒区军人消化性溃疡的重要方法之一。

Objective To investigate the incidence and distribution of traditional Chinese medicine syndrome and risk factors of peptic ulcer（PU） in military personnel in cold region and to provide an evidence for the prevention and cure of PU by the theory of traditional Chinese medicine. Methods A stratified multi-stage cluster random sampling method was used. A total of 7345 soldiers from northeast China was investigated with traditional Chinese dialectics medicine, questionnaires, gastroscopy and Hp detection. Results The total incidence of PU related symptoms （ Sc ≥ 5） was 20.1%, after standardization it was 13.6%. According to Chinese dialectics,48.5% of the syndrome was stagnation of vital energy caused by cold-evil, 19.57% blood stasis due to cold, and 13.3% deficiency-cold of the spleen, all were higher than those other types（ P 〈 0.01 ）. The incidence in autumn and winter acounted for 53.64% of total incidence. The incidence of Hp infection was 63.71% （ out of 350 PU patients）. Hp infection in ineoordination between the liver and stomach, and intense stomach-heat type were higher than in other types （ P 〈 0.01 ）. Higher incidence of PU was found among the soldiers in the armored troops and lower in infantry. Mental strain（OR 3.1）, smoking（OR 2.8）, sustained intense training（OR 3.5）, drinking（OR 2.1 ）, family history of gastropathy（OR 3.4）, insanitary diet（OR 4.6） were the main risk factors of PU. Conclusion Higher incidence of PU existed in military personnel in cold region in winter and autumn, most of them were stagnation of vital energy caused by cold-evil, and blood stasis due to cold. Warming Yang and expelling cold may be one of the important ways of prevention and cure of PU in cold region.