不同分期消化性溃疡患者证型分布特点与舌苔脱落细胞凋亡及胃蛋白酶原关系

The Relationship between the Distribution Traits of Syndrome Types in Patients with Different Stages of Peptic Ulcer and Apoptosis of Exfoliated Cells and Pepsinogen

目的探讨不同期消化性溃疡中医证型分布特点以及各分期和证型与舌苔脱落细胞凋亡、胃蛋白酶原Ⅰ、Ⅱ(PGⅠ、PGⅡ)之间的关系。方法112例消化性溃疡患者中,年龄分组:青年组51例,中年组50例,老年组11例;溃疡分期:活动期55例和非活动期57例。对各年龄组及两溃疡分期患者进行中医辨证分型,并采用流式荧光法检测血清胃蛋白酶Ⅰ、Ⅱ水平,采用流式细胞仪检测舌苔脱落细胞凋亡指数。结果消化性溃疡中医证型分布在不同年龄组中差异具有统计学意义(P=0.033),其中青年组主要证型为脾胃虚寒,中年组主要证型为肝胃不和,老年组主要证型为脾胃湿热,同时瘀血阻络证型在老年组中比例明显提高;消化性溃疡活动期和非活动期中医证型分布差异有统计学意义(P<0.05),活动期以脾胃湿热为主,其次为肝胃不和;非活动期溃疡以脾胃虚弱(寒)为主,其次为肝胃不和。各中医证型同期溃疡胃蛋白酶原水平比较差异无统计学意义(P>0.05);PGⅠ、PGⅠ/PGⅡ同一证型活动期和非活动期比较差异无统计学意义(P>0.05);PGⅡ同一证型溃疡活动期较非活动期溃疡明显升高(P<0.05)。各中医证型同期溃疡舌苔细胞各期凋亡指数比较差异无统计学意义(P>0.05);舌苔细胞早期凋亡指数同一证型活动期和非活动期比较差异无统计学意义(P>0.05);舌苔脱落细胞晚期凋亡和总凋亡指数同一证型溃疡活动期较非活动期明显降低(P<0.05)。结论消化性溃疡发病年龄和分期与中医证型分布有关;舌苔脱落细胞晚期和总凋亡指数可作为中医舌诊客观理化指标;PGⅡ水平可作为预测溃疡复发的重要血清学指标。

Objective To observe the distribution characteristics of TCM syndromes in different stages of pep-tic ulcer and the relationship between each stage and syndrome type and apoptosis of exfoliated tongue coating cells,pepsinogenⅠ(PGⅠ),pepsinogenⅡ(PGⅡ).Methods Totally 112 patients with peptic ulcer were assigned to three groups by age,51 in the young group,50 in the middle age group,and 11 in the old group.Ulcer staging:55 in active stage and 57 in inactive stage.Moreover,TCM syndromes were typed in all patients,and the levels of serum PGⅠand PGⅡwere determined by flow fluorescent method.The apoptosis index of exfoliated tongue coating cells was measured by flow cytometry.Results The distribution of TCM syndromes of peptic ulcer was statistically significant in different age groups(P=0.033).Pi-Wei deficient cold syndrome(PWDCS)was a main syndrome in the young group.Gan-Wei disharmony syndrome(GWDS)was the main form in the middle age group.Pi-Wei damp-heat syn-drome(PWDHS)was the main syndrome in the old group.Meanwhile,static blood blocking collaterals syndrome(SB-BCS)significantly occupied a higher proportion in the old group.The distribution of TCM syndromes was statistically different between active and inactive peptic ulcer patients(P=0.022,P<0.05).PWDHS was dominated in the active stage,followed by GWDS.PWDCS was dominated in the inactive stage,followed by GWDS.There was no signifi-cant difference in pepsinogen levels among all TCM syndrome types groups(P>0.05).And there was no significant difference in PGⅠor PGⅠ/PGⅡbetween active and inactive stages of the same syndrome type(P>0.05).But PGⅡwas significantly higher in active stage patients than non-active stage patients of the same syndrome type(P<0.05).In addition,there was no significant difference in apoptosis index of exfoliated tongue coating cells(P>0.05).Early apoptosis index of exfoliated tongue coating cells had no statistical difference between active stage patients and non-active stage patients of the same syndrome type(P>0.05).The late apoptosis and total apoptosis index of ex-foliated tongue coating cells were more significantly reduced in active stage patients than non-active stage patients of the same syndrome type(P<0.05).Conclusions Age and staging of peptic ulcer are related to the distribution of TCM syndrome types.Late stage exfoliated tongue coating cells and the total apoptosis index could be taken as objective physi-ochemical makers of tongue inspection.Moreover,the level of PGⅡcould be taken as an important serological maker of ulcer recurrence prediction.