老年消化性溃疡的中医证素与危险因素的相关性分析

Analysis on Correlation of TCM Syndrome Elements with Risk Factors in Senile Peptic Ulcer

【目的】探讨老年消化性溃疡中医证素与危险因素的相关性。【方法】回顾性分析216例老年消化性溃疡患者的病历资料,统计中医证素分布,分析不同证素与吸烟、饮酒、睡眠、幽门螺旋杆菌(Hp)感染、非甾体抗炎药物(NSAIDs)的使用等的相关性。【结果】(1)证型分布方面:主要证型为脾胃湿热证、脾虚不摄证、脾虚湿热证,分别占32.9%(71/216)、19.4%(42/216)、12.0%(26/216),其他证型分布频率由高到低依次为脾虚湿蕴、肝郁脾虚、气虚血瘀、脾胃气虚、气血亏虚、脾虚湿瘀、肝胆湿热、肝胃郁热、脾虚气滞、气阴两虚、痰湿阻滞证。(2)证素方面:病位证素3个,包括脾、胃、肝,其中分布频率最高的证素为脾,占84.3%(182/216);病性证素8个,包括气虚、湿、热、动血、气郁、血瘀、血虚和痰,其中分布频率排前3位的证素为气虚、湿和热,分别占60.6%(131/216)、57.9%(125/216)、53.2%(115/216)。(3)性别、年龄与中医证素分布方面,男性148例(68.5%),女性68例(31.5%),男性多于女性;60~69岁102例,70~79岁76例,80~89岁33例,90岁及以上5例,即以60~79岁患者多见;不同性别和主要年龄段(60~79岁)患者常见的证素均主要集中在脾、气虚、湿、热等。(4)证素与危险因素Logistic回归显示,在老年消化性溃疡患者中,饮酒是湿(OR=8.487)、热(OR=18.689)的独立危险因素(P<0.05),Hp感染是湿(OR=8.693)、热(OR=11.033)的独立危险因素(P<0.05),吸烟是血瘀(OR=83.868)的独立危险因素(P<0.05),失眠是气虚(OR=7.068)的独立危险因素(P<0.05),服用NSAIDs是气虚(OR=2.938)的独立危险因素(P<0.05)。Hosmer-Lemeshow检验均P>0.05,说明模型有较好的校准能力。【结论】老年消化性溃疡的中医证素主要包括脾、气虚、湿、热等;不同中医证素的相关危险因素不同,饮酒与湿、热正相关,Hp感染与湿、热正相关,吸烟与血瘀正相关,失眠与气虚正相关,服用NSAIDs与气虚正相关。

Objective To explore the correlation between traditional Chinese medicine(TCM)syndrome elements and risk factors in senile peptic ulcer.Methods The medical records of 216 senile peptic ulcer patients were retrospectively analyzed,the distribution of TCM syndrome elements were counted,and the correlation of syndrome elements with smoking,alcohol intake,sleep,Helicobacter pylori(Hp)infection and the use of nonsteroidal anti-inflammatory drugs(NSAIDs)was analyzed.Results(1)The predominated syndrome types in the senile peptic ulcer patients were spleen and stomach damp-heat syndrome,failure of arresting due to spleen deficiency syndrome,and spleen deficiency with damp-heat syndrome,accounting for 32.9%(71/216),19.4%(42/216),12.0%(26/216),respectively.The other syndromes in descending order of frequency were spleen deficiency with dampness accumulation,liver depression and spleen deficiency,qi deficiency and blood stasis,qi deficiency in spleen and stomach,qi and blood insufficiency,spleen deficiency with damp-stasis,liver and gallbladder damp-heat,heat stagnation in liver and stomach,spleen deficiency and qi stagnation,deficiency of both qi and yin,and phlegm-damp obstruction.(2)The diseases-location syndrome elements involved spleen,stomach and liver,of which the spleen had the highest occurrence frequency,accounting for 84.3%(182/216).There were 8 diseases-nature syndrome elements,and they were qi deficiency,dampness,heat,blood stirring,qi stagnation,blood stasis,blood deficiency,and phlegm.The top 3 diseases-nature syndrome elements were qi deficiency,dampness,and heat,accounting for 60.6%(131/216),57.9%(125/216),and 53.2%(115/216),respectively.(3)The distribution of gender,age and TCM syndrome elements showed that 148 cases(68.5%)were male and 68 cases(31.5%)were female,indicating that the male was predominated;102 cases were aged60-69 years,76 cases were aged 70-79 years,33 cases were aged 80-89 years and 5 cases were aged 90 years or above,indicating that patients aged 60-79 years were predominated;the common syndrome elements in the patients with different genders and major age group of 60-79 years were spleen,qi deficiency,dampness,and heat.(4)Logistic regression of syndrome element and risk factors showed that for the senile peptic ulcer patients,alcohol intake was an independent risk factor for dampness(OR=8.487)and heat(OR=18.689)(P<0.05),Hp infection was an independent risk factor for dampness(OR=8.693)and heat(OR=11.033)(P<0.05),smoking was an independent risk factor for blood stasis(OR=83.868)(P<0.05),insomnia was an independent risk factor for qi deficiency(OR=7.068)(P<0.05),and medication of NSAIDs was an independent risk factor for qi deficiency(OR=2.938)(P<0.05).Hosmer-Lemeshow tests showed all P>0.05,indicating that the model had good calibration.Conclusion The primary TCM syndrome elements of senile peptic ulcer are spleen,qi deficiency,dampness,and heat.The risk factors associated with various TCM syndrome elements are different:alcohol intake is positively correlated with dampness and heat,Hp infection is positively correlated with dampness and heat,smoking is positively correlated with blood stasis,insomnia is positively correlated with qi deficiency,and medication of NSAIDs is positively correlated with qi deficiency.