胆汁反流性胃炎中医证候分布规律分析

Analysis of Distribution of TCM Syndromes in Bile Reflux Gastritis

目的探讨胆汁反流性胃炎中医证候分布情况。方法通过统一的观察量表采集来自2014年1月~2016年1月就诊于北京朝阳医院、北京市通州区中西医结合医院、北京中医药大学第三附属医院的门诊102例胆汁反流性胃炎患者临床资料,并对一般资料、中医主要症状和症候分布、中医症候与内镜下胃粘膜表现的关系进行分析。结果 (1)胆汁反流性胃炎女性居多,发病年龄以51~60岁年龄段为主,病程分布以1~3年居多。(2)BRG的发病与饮食不节、情绪不畅有一定相关性。(3)临床症状以胃胀、口苦、心烦易怒、口干、反酸、呃逆、胃痛为主。(4)常见中医证候以胆热犯胃和肝胃不和。(5)中医证候与内镜下胃粘膜表现比较,差异具有统计学意义(P<0.05)。粘膜充血、水肿多见于肝胃不和证,其次为胆热犯胃证,粘膜水肿、糜烂多见于胆热犯胃证,其次为脾胃湿热证。粘膜出血多见于胃络瘀血证、肝胃不和证。结论胆汁反流性胃炎病位在胆胃,多以胆热犯胃、肝胃不和为主;中医证候与内镜下胃粘膜表现具有相关性。故在中医药治疗应注重清热化痰、利胆和胃、疏肝和胃;胆汁反流性胃炎患者的胃黏膜改变与中医证候之间存在密切联系,在临床治疗中运用中医分型有助于辨证施治。

Objective To investigate the distribution of TCM syndromes in bile reflux gastritis.Methods A total of 102 cases of bile reflux gastritis were collected from January 2014 to January 2016 in the outpatient department of Beijing Chaoyang hospital,Tongzhou district hospital of Integrated traditional Chinese and western medicine,and the third affiliated hospital of Beijing university of traditional Chinese medicine.The clinical data of the patients were analyzed,and the relationship between general data,distribution of major symptoms and symptoms of traditional Chinese medicine,and symptoms of TCM and gastric mucosa under endoscopy was analyzed.Results①Most bile reflux gastritis women,the age of onset is mainly 51 to 60 years of age,disease course distribution is mostly 1 to 3 years.②the onset of BRG is related to eating and drinking,and there is a certain correlation between emotional unobstruction.③The clinical symptoms were stomach distension,bitter mouth,upset and irritable,dry mouth,acid regurgitation,hiccup and stomach pain.④The main syndromes of TCM were gallbladder fever invading stomach and liver stomach disharmony.⑤There was a statistically significant difference between the TCM syndrome and endoscopic gastric mucosal performance(P<0.05).Mucosal hyperemia and edema were more common in liver-stomach disharmony syndrome,followed by gallbladder heat invasion of stomach syndrome,mucosal edema,erosion more seen in gallbladder heat into stomach syndrome,followed by spleen and stomach damp-heat syndrome.Mucosal bleeding is more common in the gastric collaterals blood stasis syndrome,liver and stomach disharmony syndrome.Conclusion Bile reflux gastritis is located in gall stomach,most of which are gall fever invading the stomach and disharmony between liver and stomach,and there is a correlation between TCM syndromes and gastric mucosal manifestations under endoscope.Therefore,Chinese medicine treatment should pay attention to clearing heat and resolving phlegm,promoting gallbladder and stomach,soothing liver and stomach;there is close relation between gastric mucosal changes and TCM syndrome in patients with bile reflux gastritis,and the application of TCM classification in clinical treatment is helpful to syndrome differentiation and treatment.