慢性胃炎恶性转化不同阶段舌象分布规律研究

Changes in the tongue characteristics distribution in different stages of chronic gastritis shifting to gastric carcinoma

目的 分析慢性胃炎恶性转化不同阶段的舌象特征规律,为研究中医舌象辨证与慢性胃炎恶性转化病机的联系提供证据与支撑。方法 通过多中心临床流行病学调查,收集3 637例慢性胃炎及100例原发性胃癌患者的舌象资料,对慢性胃炎恶性转化不同阶段中慢性非萎缩性胃炎、慢性萎缩性胃炎、慢性胃炎伴异型增生、原发性胃癌患者的舌象数据进行描述性统计分析,并通过聚类分析探讨舌象分布规律。结果 聚类分析显示舌象特征可归结为肝胃气滞证、肝胃郁热证、脾胃湿热证、痰湿内阻证、脾虚湿困证、脾胃虚弱证、胃阴不足证和胃络瘀阻证8个舌象类型,并且舌象类型的分布在慢性胃炎恶性转化不同阶段有所不同,整体分布呈现出由实至虚、再由虚至实的变化规律。结论 舌象特征反映了慢性胃炎恶性转化不同阶段整体呈现出本虚标实的病机,并且能在一定程度上体现不同阶段的证候演变规律,对于慢性胃炎恶性转化不同阶段的中医辨证和病机研究具有重要意义。

Objective To analyze the characteristics of the tongue image in the process of chronic gastritis shifting to gastric carcinoma and provide evidence and support for the study of the relationship between TCM tongue characteristic differentiation and the pathogenesis of chronic gastritis shifting to gastric carcinoma.Methods The tongue image data of 3 637 patients with chronic gastritis and 100 patients with primary gastric cancer were collected using a multi-center clinical epidemiological investigation. The tongue image data of patients with chronic non-atrophic gastritis, chronic atrophic gastritis, chronic gastritis with dysplasia, and primary gastric cancer during the process of the malignant transformation of chronic gastritis were analyzed using descriptive statistics, and the tongue image distribution was discussed using cluster analysis.Results The cluster analysis showed that the characteristics of the tongue image could be divided into eight tongue image types that respectively represented the syndromes of qi stagnation of the liver and stomach, heat stagnation of the liver and stomach, internal obstruction of phlegm and dampness, spleen deficiency with dampness, weakness of the spleen and stomach, and deficiency of stomach Yin and obstruction of stomach collateral stasis. The distribution of tongue image types differed in different stages of the malignant transformation of chronic gastritis. The overall distribution showed a change rule from excess to deficiency and then from deficiency to excess.Conclusion The characteristics of the tongue image reflect the pathogenesis of chronic gastritis during the process of malignant transformation and can reflect the evolution law of the different stages of the syndrome to a certain extent. This is of great significance for TCM syndrome differentiation and the pathogenesis of chronic gastritis.