慢性胃炎中医辨证与胃镜像相关性研究

Study on the Correlation between Traditional Chinese Medicine Syndrome Differentiation and Gastroscopy in Chronic Gastritis

目的:探讨慢性胃炎中医辨证与胃镜像相关性,从微观角度证实中医宏观辨证论治科学性,完善中医辨证理论体系,为慢性胃炎临床诊治提供更多客观依据。方法:选取2016年1月至2019年1月北京市房山区中医医院收治的慢性胃炎患者385例作为研究对象,收集所有患者一般资料、中医四诊(望、闻、问、切)、胃镜像表现,观察常见中医证型(肝胃气滞、肝胃郁热、脾胃湿热、脾胃气虚、脾胃虚寒、胃阴不足、胃络瘀阻)和胃镜像表现萎缩、糜烂、胆汁反流、黏膜颜色、黏膜池颜色、黏膜充血水肿、黏膜血管显露、黏膜隆起、黏膜粗糙、黏膜颗粒增生等相关性,比较不同证型在胃镜像表现比率情况。结果:脾胃虚寒证、脾胃湿热证、肝胃郁热证最常见,分别为40.52%、30.91%、12.21%,显著高于其他证型(P<0.05);病变部位以胃窦最常见,占49.92%,显著高于其他部位(P<0.05);脾胃虚寒证以40~65岁多见,表现为萎缩性胃炎,黏膜以白为主,黏膜池颜色清澈为主;脾胃湿热证以18~40岁男性居多,以非萎缩性胃炎为主,黏膜糜烂多见;肝胃郁热证男性居多,胃镜像无显著变化,和脾胃湿热证有相似处。结论:慢性胃炎中医证型和胃镜像存在一定相关性,尤其是脾胃虚寒证和脾胃湿热证,胃镜像可作为中医证型客观依据,可指导临床科学研究。

Objective:To explore the correlation between traditional Chinese medicine(TCM)syndrome differentiation and gastroscopy image of chronic gastritis,to confirm the scientific nature of TCM macroscopic syndrome differentiation and treatment from a micro perspective and to improve the theoretical system of TCM syndrome differentiation,so as to provide more objective basis for clinical diagnosis and treatment of chronic gastritis.Methods:A total of 385 patients with chronic gastritis admitted to Fangshan District Hospital of Traditional Chinese Medicine from Jan.1st 2016 to Jan.1st 2019 were selected as the research objects.The general data of all patients were selected.The 4 diagnoses of TCM(sight,smell,question and cut),gastroscopic manifestations were collected.The common TCM syndromes(liver-stomach qi stagnation,liver-stomach stagnation heat,spleen-stomach dampness-heat,spleen-stomach qi deficiency,spleen-stomach deficiency-cold,stomach yin deficiency,stomach collateral stasis)and gastroscopic images,the correlations of atrophy,erosion,bile reflux,mucosal color,mucosal cistern color,mucosal congestion and edema,mucosal vessel exposure,mucosal eminence,mucosal roughness and mucosal granular hyperplasia were observed and different syndrome types in the gastric mirror image manifestation ratio were compared.Results:Spleen-stomach deficiency-cold syndrome,spleen-stomach damp-heat syndrome and liver-stomach stagnation-heat syndrome were the most common,accounting for 40.52%,30.91%,12.21%of the total,significantly higher than other syndromes(P<0.05);the most common lesions were gastric antrum,accounting for 49.92%,significantly higher than other parts(P<0.05);spleen-stomach deficiency-cold syndrome was more common in 40-65 years old patients,manifested as atrophic gastritis,with white mucosa predominantly and clear mucosal pools predominantly.The spleen-stomach damp-heat syndrome was mostly in males aged 18-40,mainly in non-atrophic gastritis and mucosal erosion;the liver-stomach stagnation-heat syndrome was mostly in males,with no significant changes in gastroscopy,which was similar to the spleen-stomach damp-heat syndrome.Conclusion:There is a certain correlation between TCM syndromes and gastroscopic images of chronic gastritis,especially spleen-stomach deficiency cold syndrome and spleen-stomach dampness-heat syndrome.The gastroscopic images can be used as objective basis of TCM syndromes,and can guide clinical scientific research.