舌苔脱落细胞理化指标与慢性胃炎患者中医证型相关性分析

Correlation between indexes of exfoliated cells of tongue coating and Traditional Chinese Medicine syndrome differentiation in patients with chronic gastritis

目的探讨舌苔脱落细胞理化指标与慢性胃炎患者中医辨证分型的相关性。方法选择2017年3月-2018年5月本院慢性胃炎患者148例,经辨证分为脾胃虚弱证36例、肝胃不和证39例、胃阴不足证32例、脾胃湿热证41例,分别入组相应的中医证型组;再选择无寒热虚实证候的50位健康志愿者作为健康对照组。于高倍镜下观察各组受试者舌苔脱落细胞,分别行表、中、底层细胞计数,并计算成熟指数(maturity index,MI)及成熟价值(mature value,MV),检测舌苔脱落细胞中酸性磷酸酶(acid phosphatases,ACP)、LDH、琥珀酸脱氢酶(succinate dehydrogenase,SDH)及巯基含量,采用流式细胞术检测舌苔脱落细胞的细胞周期;采用Spearman等级相关法分析舌苔脱落细胞理化指标与中医证型分布的相关性。结果与健康对照组比较,脾胃虚弱证组、肝胃不和证组、胃阴不足证组、脾胃湿热证组受试者中层细胞百分比[(26.47±3.94)%、(22.32±5.41)%、(31.47±3.28)%、(35.62±3.96)%比(14.85±4.03)%]升高(P<0.05),表层细胞百分比[(73.53±6.47)%、(77.68±5.38)%、(68.53±4.20)%、(64.38±4.39)%比(85.15±5.33)%]降低(P<0.05),MV值[(83.52±3.10)%、(87.64±2.95)%、(79.38±3.21)%、(75.63±2.83)%比(92.61±3.74)%]降低(P<0.05)。与健康对照组比较,脾胃虚弱证组、肝胃不和证组、胃阴不足证组受试者舌苔脱落细胞中ACP、LDH、SDH、巯基均降低(P<0.05),脾胃湿热证组受试者ACP、LDH、SDH、巯基均升高(P<0.05);胃阴不足证组、脾胃湿热证组受试者G1期细胞百分降低(P<0.05),S期细胞百分升高(P<0.05)。Spearman等级相关法分析,脾胃虚弱证组、肝胃不和证组、胃阴不足证组、脾胃湿热证组与ACP、LDH、SDH、巯基均有相关性(r值分别为0.608、0.712、0.704、0.631,P值均<0.05)。结论慢性胃炎不同中医证型患者可出现不同的舌苔脱落细胞形态学变化、细胞周期差异较大且细胞生化指标水平不同。

Objective To explore the correlation between the indexes of tongue coating exfoliated cells and the Traditional Chinese Medicine(TCM)syndromes of patients with chronic gastritis.Methods One hundred and forty-eight patients with chronic gastritis in our hospital from March 2017 to May 2018 were selected and divided into 4 groups,including 36 patients with spleen and stomach weakness syndrome,39 patients with liver-stomach discordance syndrome,32 patients with stomach yin deficiency syndrome,and spleen and 41patients with stomach damp-heat syndrome according to the TCM classification.In addition,another 50 healthy people without cold and heat deficiency syndrome were selected as healthy control group.The maturity index(MI)and mature value(MV)of tongue coating exfoliated cells,chemical indicators and cell cycle of tongue coating exfoliated cells were detected.The spearman rank correlation method was used to analyze the indicators of tongue coating exfoliated cells and TCM syndromes.Results Compared with the healthy control group,the subjects with spleen and stomach weakness syndrome,liver-stomach discord syndrome,stomach-yin deficiency syndrome,spleen-stomach damp-heat syndrome showed significantly higher percentage of intermediate cells[(14.85±4.03)%vs.(26.47±3.94)%,(22.32±5.41)%,(31.47±3.28)%,(35.62±3.96)%,P<0.05],significantly lower percentage of surface cells[(85.15±5.33)%vs.(73.53±6.47)%,(77.68±5.38)%,(68.53±4.20)%,(64.38±4.39)%,P<0.05],and significantly lower percentage of MV value[(92.61±3.74)%vs.(83.52±3.10)%,(87.64±2.95)%,(79.38±3.21)%,(75.63±2.83)%,P<0.05].Compared with the healthy control group,the ACP,LDH,SDH,and-SH in tongue coating exfoliated cells of subjects with spleen and stomach weakness syndrome,liver and stomach discordance syndrome,and stomach yin deficiency syndrome were all significantly decreased(P<0.05),while ACP,LDH,SDH,and-SH in subjects with spleen and stomach damp-heat syndrome were all significantly increased(P<0.05).the percentage of cells in G1 phase of subjects with gastric yin deficiency and spleen and stomach damp-heat syndrome were significantly decreased(P<0.05),while the percentage of S phase cells were significantly increased(P<0.05).Spearman rank correlation analysis showed that each syndrome type was correlated with ACP,LDH,SDH,-SH(r values were 0.608,0.712,0.704,0.631,respectively,all Ps<0.05).Conclusion Patients with different TCM syndromes of chronic gastritis may have different morphological changes of tongue coating exfoliated cells,large differences in cell cycle,and different levels of cell biochemical indicators.