慢性胃炎中医证候演变规律研究

Evolvement characteristics of TCM syndrome types of chronic gastritis: a clinical study of 592 patients

目的探索慢性胃炎在慢性非萎缩性胃炎(CNAG)、慢性萎缩性胃炎(CAG)、慢性萎缩性胃炎伴肠上皮化生和(或)不典型增生(PLGC)转化过程中的证候演变规律。方法收集2013年9月—2014年2月就诊于北京中医药大学东直门医院、东方医院、第三附属医院、中国中医科学院望京医院,接受胃镜检查并通过病理组织活检确诊为慢性胃炎患者共592例。其中,CNAG338例、CAG134例、PLGC120例。应用Epi Data 3.1建立数据库,使用SPSS 17.0软件进行主成分分析、因子分析及卡方检验。结果经主成分分析及因子分析,CNAG得到证候类型9个,前3位依次为脾胃不和证、肝胃郁热证、肝胃不和证;CAG得到证候类型10个,前3位依次为肝胃不和证、瘀阻胃络证、脾胃虚寒证;PLGC得到证候类型10个,前3位依次为胃阴不足证、胃阳亏虚证、瘀阻胃络证。根据因子构成提取证候要素,结合描述性统计结果,CNAG病位证素:胃>肝>脾,病性证素:气滞>热>气虚>湿>阳虚;CAG病位证素:胃>肝>脾,病性证素:气滞>热>阳虚>湿>瘀>阴虚>气虚;PLGC病位证素:胃>脾>肝,病性证素:热>阳虚>阴虚>气滞>瘀>湿>气虚,χ2检验结果显示3个阶段病位证素及病性证素分布均有统计学意义。结论慢性胃炎在由非萎缩性胃炎向萎缩、肠化及不典型增生转化过程中存在由实至虚、渐见阴虚、血瘀的证候演变规律。

Objective To explore the evolvement rule of TCM syndrome types of the transformation of chronic gastritis（ CG） ： from chronic non-atrophic gastritis（ CNAG）,chronic atrophic gastritis（ CAG）to precancerous lesions of gastric carcinoma（ PLGC）. Methods Based on gastroscopy and gastrobiopsy,altogether 592 patients included from three hospitals affiliated to Beijing University of Chinese Medicine Dongzhimen Hospital,（ Dongfang Hospital and Third affiliated Hospital） and Wangjing hospital of China Academy of Chinese Medical Sciences from September 2013 to February 2014,were diagnosed with CNAG（ 338 cases）,CAG（ 134 cases） and PLGC（ 120 cases）. By using Epidata 3. 1 the database was established,then principal component analysis,factor analysis and Chi-square test were conducted by using software SPSS 17. 0. Results There were nine common syndrome types in CNAG,and the three leading ones were syndrome of incoordination between spleen and stomach,syndrome of heat-stagnation in liver and stomach,syndrome of incoordination between liver and stomach. There were ten syndrome types in CAG,and the highest frequency was syndrome of incoordination between liver and stomach,then syndrome of static blood in stomach collaterals and syndrome of deficient cold of spleen and stomach. The highest frequency of three syndrome of ten in PLGC were syndrome of yin deficiency in stomach,syndrome of yang deficiency in stomach and syndrome of static blood in stomach collaterals.The frequencies of location factors of CNAG from high to low were stomach,liver and spleen,the same as those of CAG; the frequencies of nature factors from high to low were qi stagnation,heat,qi deficiency,dampness and yang deficiency,which were some different from those of CAG being qi stagnation,heat,yang deficiency,dampness,blood stasis,yin deficiency and qi deficiency. With the disease progression,the frequencies of location factors of PLGC from high to low were stomach,spleen and liver,while those of nature factors were heat,yang deficiency,yin deficiency,qi stagnation,blood stasis,dampness,and qi deficiency. The distributions of location factors as well as nature factors were significantly different during the whole procedure of CG progression,CNAG,CAG and finally PLGC. Conclusion During the procedure of： CNAG turned into CAG and into PLGC in the end,the evolvement characteristic of ＂sthenia transforming into asthenia and appearing yin deficiency and blood stasis gradually＂was found.