慢性胃炎胃黏膜胃镜像1167例的中医证候学分析

TCM syndrome properties of gastroscopic findings by an analysis of 1167 cases of chronic gastritis

目的研究慢性胃炎的胃黏膜胃镜像的中医证候属性。方法通过调查表收集1167例慢性胃炎的胃镜下胃黏膜像表现,同时行中医辨证分型,经统计分析进行评价。结果脾胃湿热证在胆汁反流、黏液池状态方面有统计学差异(P<0.05),提示脾胃湿热型较其他型易出现胆汁反流、黏液池呈黄绿色;脾胃虚弱(含虚寒)证与病变部位有统计学差异(P<0.05),提示全胃炎多发生于脾胃虚弱(含虚寒)证中;脾虚气滞型与贲门状态有统计学差异(P<0.05),提示脾虚气滞型较其他证型易出现贲门松弛或疝囊形成;胃络瘀阻型在黏膜以白相为主、呈颗粒样改变、黏膜糜烂、黏膜血管网改变及胃镜下诊断为萎缩性胃炎等方面有统计学差异(P<0.05),提示胃络瘀阻证在上述五方面较其他型多见;进一步行Logistic统计分析,黏膜血管网改变、黏膜糜烂与胃络瘀阻证关系有统计学差异(P<0.05),提示胃络瘀阻证胃镜下黏膜出现血管网改变及糜烂的可能性明显大于其他证型。结论部分胃黏膜胃镜像与慢性胃炎的中医证候之间存在一定程度的关联,可为中医微观辨证提供参考。

Objective To investigate the TCM syndrome properties of gastroscopic findings of gastric mucosa in chronic gastritis （CG）. Methods Gastroscopic signs of gastric mucosa of 1167 cases of CG were collected by questionnaire, and they were typed by TCM syndrome differentiation and evaluated by statistical analysis. Results There were statistically significant differences between the syndrome of dampness-heat of spleen and stomach and the bile reflux and mucus pool （P〈0.05）, suggesting that the syndrome was more prone to bile reflux and yellowish green mucus pool compared to other types of syndromes. There were statistically significant differences between syndromes of deficiency of spleen and stomach （including syndrome of deficient cold） and lesion sites （ P 〈 0. 05 ）, suggesting that complete gastritis is mostly common in those with syndromes of deficiency of spleen and stomach （ including syndrome of deficient cold）. There was statistically significant difference between the syndrome of spleen deficiency and qi stagnation and the cardiac status compared to other types of syndromes （ P〈0.05 ）, suggesting that the syndrome is more prone to cardiochalasia or hernial sac formation. There were statistically significant differences in the domination of the syndrome of static blood in stomach collaterals by white lesions in the gastric mucosa, mucosal granular changes, mucosal erosion, changes of mucosal vascular network, and gastroscopic diagnosis with chronic atrophic gastritis （CAG） （P〈0.05）, suggesting that the syndrome is more prone to the above five aspects compared to other types of syndromes. Further logistic analysis showed that both changes of mucesal vascular network and mucosal erosion were statistically related to the syndrome of static blood in stomach collaterals （P〈0.05）, suggesting that the possibility of gastroscopic occurrence of changes of vascular network and erosion was significantly greater in this syndrome than in other types of syndromes. Condusion Some gastrescopic findings of gastric mucosa are partly correlated with TCM syndromes of CG, and provide reference for microcosmic syndrome differentiation of TCM.