慢性萎缩性胃炎中医证型与幽门螺杆菌感染、病理分级的相关性研究

Study on correlation of syndrome types of TCM with H. pylori infection and pathological grade in chronic atrophic gastritis

目的探讨慢性萎缩性胃炎中医证型与幽门螺杆菌(H.pylori)感染、病理分级的相关性。方法将胃镜及病理诊断为慢性萎缩性胃炎患者106例中医辨证分为脾胃虚弱证、脾胃湿热证、胃阴不足证、肝胃不和证、胃络瘀血证,观察比较各证型的中医证候分布与H.pylori感染、萎缩程度、肠化、异型增生程度的关系。结果慢性萎缩性胃炎中医证型按所占比例由高到低分别是脾胃虚弱证>脾胃湿热证>肝胃不和证>胃阴不足证>胃络瘀血证。H.pylori的阳性感染率从高到低依次为脾胃湿热证、肝胃不和证、胃络瘀血证、脾胃虚弱证、胃阴不足证,总感染率为58.49%。肝胃不和证中轻度萎缩所占比例偏高。脾胃湿热证、胃络瘀血证、胃阴不足证中重度萎缩所占比例较脾胃虚弱证、肝胃不和证高。5组证型中度萎缩、轻中度肠化所占比例比较差异无统计学意义。胃络瘀血证、脾胃湿热证中轻度异型增生所占比例较脾胃虚弱证、肝胃不和证、胃阴不足证比例高。胃络瘀血证胃癌前病变程度最高,其次为脾胃湿热证,脾胃虚弱证胃癌前病变程度最低。结论慢性萎缩性胃炎中医证型与H.pylori感染、胃黏膜的病理改变及病理分级存在一定的相关性。

Objective It is to study the relationship between H. pylori infection and pathological grade in chronic atrophic gastritis with syndrome types of TCM. Methods 106 cases of patients with chronic atrophic gastritis diagnosed by gastroscopy and pathology were divided into five groups according to TCM syndrome differentiation： spleen-stomach deficiency group,spleen-stomach dampness-heat group,stomach Yin deficiency group,liver and stomach disharmony group and blood stagnation of stomach collaterals group. The relationship of distribution of syndrome types of TCM with H. pylori infection,atrophy,intestinal metaplasia,dysplasia degree was observed and compared. Results Chronic atrophic gastritis in proportion from high to low were spleen and stomach deficiency type,dampness-heat of spleen and stomachtype,liver and stomach disharmony type,stomach Yin deficiency type and blood stagnation of stomach collaterals type. The total infection rates in proportion from high to low were dampness-heat of spleen and stomach type,liver and stomach disharmony type,blood stagnation of stomach collaterals type,spleen and stomach deficiency type,stomach Yin deficiency type,and the total infection rate was 58. 49%. Mild atrophy of liver stomach disharmony of the ratio was higher. The proportion of spleen stomach damp heat syndrome,blood stasis syndrome of stomach meridian,stomach Yin deficiency syndrome in severe atrophy degree were higher than that of spleen and stomach weakness,liver and stomach disharmony type. No significant difference in proportion of mild to moderate atrophy,intestinal metaplasia among the five groups was found. The proportion of mild dysplasia was higher in spleen stomach damp heat syndrome,blood stasis syndrome than that in spleen and stomach deficiency syndrome,syndrome of incoordination between liver and stomach,deficiency of stomach Yin syndrome. The degree of gastric precancerous lesions of stomach meridian in the blood stasis was the highest,followed by spleen stomach damp heat syndrome,the degree of deficiency of spleen and stomach precancerous lesions was the lowest. Conclusion TCM syndrome type of chronic atrophic gastritis has correlation with pathological changes and pathological grading in gastric mucosa and H. pylori infection.