慢性胃炎中医证候与胃窦十二指肠运动及胃炎程度的相关性

Relationship of TCM Syndrome Types with the Degree of Gastritis and Antroduodenal Motility

研究慢性胃炎中医辨证分型与幽门螺杆菌 (Hp)感染、胃粘膜炎症程度以及胃窦十二指肠消化间期移行性运动复合波之间的关系。将慢性胃炎 117例 ,按中医辨证分为实证和虚证 ,实证包括脾胃湿热型 37例和肝胃不和型 34例 ,虚证包括脾胃虚弱型 2 6例和胃阴不足型 2 0例。均进行内镜、Hp及病理检查 ,分型统计并进行显著性检验。其中 38例用腔内测压法分别测定其消化间期移行性运动复合波 (MMC)。实证组Hp阳性率高于虚证组 ,依次为 :脾胃湿热型 86 .5% ,肝胃不和型 79.4 % ,脾胃虚弱型 50 .0 % ,胃阴不足4 0 .0 %。各型的重度胃炎所占比率依次为脾胃湿热型 54.0 % ,肝胃不和型 38.2 % ,脾胃虚弱型 19.2 % ,胃阴不足型 15.0 %。胃粘膜炎症程度与Hp感染呈平行关系 ,与慢性胃炎虚实证密切相关。MMC测定实证组主要表现为胃窦十二指肠收缩增强 ,甚至亢进紊乱 ;虚证组主要表现为胃窦和十二指肠Ⅱ相运动指数、收缩频率和波幅降低 ,Ⅲ相不出现或时间缩短、波幅降低。显示Hp感染。

To study the relationship of TCM syndrome types with Helicobacter pylori (Hp) infection, the degree of gastritis and antroduodenal interdigestive migrating motor complex (MMC), 117 patients with chronic gastritis were classified to excess syndrome and deficiency syndrome. The excess syndrome included damp_heat in the spleen and the stomach (DHSS, 37?cases) and incoordination between the liver and the spleen (ILS, 34). The deficiency syndrome included deficiency of the spleen and the stomach (DSS, 26) and deficiency of stomach_yin (DSY,20). All subjects received endoscopic and pathological examination, and urease test for Hp was conducted simultaneously. Among them, 37 cases received MMC measurement as well. The results showed that the Hp_positive rate was 86.5% , 79.4% , 50.0% and 40.0% in cases with DHSS,ILS,DSS and DSY respectively. The percentage of severe gastritis was 54.0% , 38.2% , 19.2% and 15.0% in cases with DHSS,ILS,DSS and DSY respectively. The results of MMC measurement showed that the patients with excess syndrome mainly manifested as strong contraction or even accentuation and derangement at the antrum of stomach and duodenum; the patients with deficiency syndrome mainly manifested as the decrease in motility index, contraction frequency and amplitude at phage Ⅱ, duration shortening, amplitude reduction or even disappearance of phage Ⅲ. It is suggested that TCM syndrome types in chronic gastritis are closely correlated with Hp infection, the degree of inflammation in gastric mucosa and the features of antroduodenal interdigestive MMC.