慢性萎缩性胃炎藏医四诊表现与胃黏膜病理变化的相关性研究

Correlation between Tibetan Medical Four Diagnostic Information and Pathological Changes in Patient with CAG

目的探索慢性萎缩性胃炎藏医四诊临床表现与胃粘膜病理变化的相关性特征,为其临床证型分类提供客观量化的科学依据。方法收集166例慢性萎缩性胃炎患者体征与症状、脉象、舌诊、尿诊信息等四诊资料,采集胃粘膜病理变化信息,建立胃粘膜病理变化信息数据库,Logistic回归分析其宏观表象与微观表征之间的相关性。结果(P值均小于0.05):①症状:与Hp阳性程度相关的症状有心烦、食欲不振;与增生程度相关的症状有消瘦、抑郁、疼痛;与萎缩程度相关的症状有反酸;与肠化生程度相关的症状有上腹部不适、消瘦、乏力、嗳气、手脚心烧;与中性粒细胞浸润程度相关的症状有乏力、嘈杂。②脉诊:与Hp阳性程度相关的脉象有衰脉、左恰、右恰;与增生程度相关的脉诊有沉脉、右根;与单个核细胞浸润程度相关的脉诊有实脉、弱脉、右恰;与中性粒细胞浸润程度相关的脉诊有弱脉、右根。③尿诊:与Hp阳性程度相关的尿诊有酥油样、白色;与萎缩程度相关的尿诊有酥油样、嗅味大、嗅味小;与单个核细胞浸润程度相关的尿诊有色红、蒸汽大、蒸汽小、嗅味大、嗅味小。④舌诊:与Hp阳性程度相关的舌诊有舌色红;与增生程度相关的舌诊有舌色红、舌苔厚、舌苔薄;与中性粒细胞浸润程度相关的舌诊有褐色。结论依据胃黏膜病理变化与藏医四诊表现,可把CAG证型分为隆型、赤巴型、培根型、混合型、培根赤巴型、隆赤巴型、培根隆型等七种,该分型特征符合藏医学临床疾病分型规律,为其诊疗规范提供科学依据。

Objective To explore the correlation between the manifestations of Tibetan medical four diagnostic information and pathological changes in gastric mucosa,to provide objective and quantitative scientific basis for the classification of CAG patterns.Methods A total of 166 patients with CAG were enrolled in four diagnostic approaches of Tibetan medicine including signs and symptoms,pulse signs,tongue diagnosis and urinalysis information.Pathological changes were detected simultaneously by biopsy,and established the database of four diagnostic information and biological changes.By using the logistic regression to analyze the correlation between the macroscopic and microscopic features of the the gastric mucosa.Results(P<0.05):①Symptoms:Hp-positive level is associatedg with upset,loss of appetite;hyperplasia-related symptoms are weight loss,depression,pain;atrophy is associated acid reflux;intestinal metaplasia is associated with including upper abdominal discomfort,weight loss,fatigue,belching,hands and feet burn;neutrophil infiltration is associated with fatigue and stomach noisy.②Pulse beating:Hp is associated with weak pulse and right middle finger;hyperplasia is associated with sunk pulse and right middle finger;mononuclear cellular infiltration is associated with strong and weakness pulse,and right ring finger;neutrophil infiltration is associated with weak pulse and right middle finger.③Urinary diagnosis:Hp is associated with butter-like urine and white color,atrophy is associated with the diagnosis of butter-like,smell large,and smell small;mononuclear cell infiltration is associated with colored red,large steam,small steam,large smell,small smell.④tongue examination:Hp is associated with tongue red;hyperplasia is associated with tongue red,thick tongue coat,thin tongue coat,neutrophil infiltration is associated with brown tongue.Conclusion Correlation between four diagnostic information and pathological changes have shown that patterns of CAG in Tibetan medicine that can classified with wind,bile,phlegm,wind-phlegm,bile-wind,phlegm-bile and blended types.The classified patterns are followed the rule of Tibetan medical therory and have provided scientific basis for standization in diagnosis and treatment of CAG from Tibetan medical perspective.