反流性食管炎不同中医证型患者胃肠激素水平的研究

The correlation between traditional Chinese medicine differentiation syndrome and gastrointestinal hormone in reflux esophagitis

目的研究反流性食管炎(reflux esophagitis, RE)不同中医证型患者血清胃泌素(gastrin, GAS)、胃动素(motilin, MTL)、胆囊收缩素(cholecystokinin, CCK)、血管活性肠肽(vasoactive intestinal peptide, VIP)水平,为中医辨证治疗RE提供参考。方法选择2014年2月-2015年11月北京中医药大学东直门医院脾胃病科RE患者120例,中医辨证后留取血液标本,分析不同证型RE患者血清GAS、MTL、CCK、VIP水平。结果不同性别的中医证型分布比例中,男性患者以肝胃郁热证为主,女性患者以肝胃不和证为主(χ^2=27.994,P值均<0.001);不同胃镜下分级的中医证型分布比例中,A级以痰湿内阻证为主,B级以肝胃不和证为主,C级以肝胃郁热证为主(χ^2=9.951,P=0.007)。与肝胃不和、痰湿内阻、中虚气逆、气虚血瘀、寒热错杂型比较,肝胃郁热型患者血清中GAS含量降低(t值分别为3.874、4.025、3.694、2.150、2.968,P<0.01或P<0.05);与肝胃郁热、肝胃不和、痰湿内阻、中虚气逆证患者比较,寒热错杂证(t值分别为4.123、5.230、8.103、3.793)、气虚血瘀证(t值分别为3.899、4.873、7.936、3.546)患者血清中CCK含量升高(P<0.01);与肝胃郁热证患者比较,痰湿内阻、寒热错杂证患者血清中MTL升高(t值分别为2.549、3.733,P<0.01或P<0.05),与肝胃不和、中虚气逆证比较,寒热错杂证患者血清中MTL升高(t值分别为2.107、2.422,P<0.05)。各证型患者血清中VIP水平差异无统计学意义(P>0.05)。结论寒热错杂、气虚血瘀、中虚气逆证RE患者其发病可能与CCK水平升高有关,肝胃郁热证RE的发病可能由GAS和MTL水平下降引起。

ObjectiveTo provide evidence for TCM treatment according to syndrome differentiation by studying the correlation between TCM syndromes and serum gastrin (GAS), motilin (MTL), cholecystokinin (CCK) and vasoactive intestinal peptide (VIP) levels of reflux esophagitis (RE) patients. MethodsA total of 120 eligible RE patients from Dongzhimen Hospital were differentiated with TCM syndromes, and blood samples were taken to test for GAS, MTL, CCK and VIP levels. Differences between the different TCM syndromes in terms of serum gastrointestinal hormones levels were analysed. ResultsThe male patients had the most distribution of stagnation of heat in the liver and stomach syndrome, but the female patients had the most distribution of disharmony of the liver and stomach syndrome (χ2=27.994, Ps<0.001). The Grades A, B and C were mainly associated with the obstruction of phlegm syndrome, disharmony of the liver and stomach syndrome, and stagnation of heat in the liver and stomach syndrome respectively (χ2=9.951, P=0.007). For patients with the syndrome of stagnation of heat in the liver and stomach, the serum GAS level was significantly lower than the syndrome of disharmony of the liver and stomach, the syndrome of obstruction of phlegm, the syndrome of deficiency of the center and upward flow of qi, and mixture of cold and heat syndrome (P<0.01 or P<0.05). For patients with mixture of cold and heat and patients with deficiency of qi and stagnation of blood, there was a significant raise in serum CCK level, compared to the patients with stagnation of heat in the liver and stomach, patients with disharmony of the liver and stomach, or patients with deficiency of the center and upward flow of qi (P<0.01). Compared with the patients with disharmony of the liver and stomach and patients with the syndrome of obstruction of phlegm, the serum CCK level of patients with the syndrome of deficiency of the center and upward flow of qi rose significantly (P<0.01). Compared with the patients with the syndrome of stagnation of heat in the liver and stomach, the serum MTL levels of patients with obstruction of phlegm and patients with mixture of cold and heat rose significantly (P<0.01). There was a significant raise in serum MTL level of patients with the syndrome of mixture of cold and heat compared to patients with disharmony of the liver and stomach and patients with deficiency of the center and upward flow of qi (P<0.05). ConclusionsThe RE patients with mixture of cold and heat, and patients with deficiency of qi and stagnation of blood, and patients with deficiency of the center and upward flow of qi may be related to the rise in CCK levels. The patients with the syndrome of stagnation of heat in the liver and stomach are related to the decrease in GAS and MTL levels.