基于文献的慢性萎缩性胃炎胃镜像与中医辨证的相关性研究

Study on the Correlation between Gastroscopic Images and TCM Syndrome Differentiation of Chronic Atrophic Gastritis Based on Literature

目的探索慢性萎缩性胃炎(CAG)胃镜像与中医辨证的相关性,提高临床对CAG辨证的准确性。方法对CAG现代文献进行研究整理,在中国知网(CNKI)、万方、维普、中国生物医学文献数据库(CBM)、PubMed、EMBase、Cochrane Library数据库中检索建库-2022年8月1日涉及CAG中医辨证分型及胃镜像描述的文献,筛选合格文献,提取CAG患者的中医证型、胃镜像等信息,整理数据后建立数据库,应用SPSS 20.0软件进行相关性分析。结果纳入合格文献10篇,纳入有效病例1562例,涉及中医证型5种。中医辨证分型按频次高低依次为肝胃不和证、脾胃虚弱证、脾胃湿热证、胃络瘀阻证、胃阴不足证。胃镜像检出率以黏膜白相最高,为47.38%。黏膜白相以脾胃虚弱证检出率最高,黏膜粗糙、充血、水肿、颗粒增生、血管显露、结节隆起均在胃络瘀阻证中检出率最高;黏膜出血、糜烂以脾胃湿热证检出率最高;皱襞变平、黏膜灰白色以胃阴不足证检出率最高;胆汁反流以肝胃不和证检出率最高。结论中医辨证与部分胃镜像具有相关性,基于胃镜像的CAG中医辨证规律总结如下:镜下出现黏膜白相、皱襞变平,考虑为脾胃虚弱证或胃阴不足证,胃阴不足证兼见黏膜灰白;镜下出现胆汁反流,考虑为肝胃不和证、脾胃湿热证,肝胃不和证多兼见黏膜充血、水肿,脾胃湿热证多兼见黏膜糜烂;镜下出现颗粒增生、结节隆起,考虑为胃络瘀阻证。

Objective Exploring the correlation between the chronic atrophic gastritis(CAG)gastroscopic images and TCM syndrome differentiation,to improve the accuracy of clinical diagnosis of CAG.Methods Articles concerning CAG TCM syndrome differentiation and gastroscopic description were retrieved in CNKI,Wanfang,VIP,CBM,PubMed,EMBase and Cochrane Library databases from their establishment to August 1,2022.Screening qualified literature,extracting TCM syndromes and gastroscopic images of CAG patients.Then build database after data sorting,use SPSS 20.0 software to analysis the correlation.Results Finally 10 qualified papers were intaked,including 1562 valid cases,which involve 5 TCM syndromes.According to the frequency of TCM syndrome differentiation,the order is liver-stomach disharmony syndrome,spleen-stomach weakness syndrome,spleen-stomach damp-heat syndrome,stomach collateral stasis syndrome,and stomach Yin deficiency syndrome.The highest detection rate of gastroscopic images is white mucosa,accounted for 47.38%of the total occurrence frequency.The detection rate of white mucosa is the highest in spleen-stomach weakness syndrome.The detection rate of rough mucosa,congested mucosa,edematous mucosa,granular hyperplasia,exposed blood vessels and nodulated apophysis is the highest in stomach collateral stasis syndrome.The detection rate of mucosal hemorrhage and mucosal erosion is the highest in spleen-stomach damp-heat syndrome.The detection rate of flattening folds and grey mucosa is the highest in stomach yin deficiency syndrome.The detection rate of bile regurgitation was the highest in liver-stomach disharmony syndrome.Conclusion There is a correlation between TCM syndrome differentiation and some gastroscopic images,and summarize the rules as follows.It will be considered to be spleen-stomach weakness syndrome or stomach yin deficiency syndrome,when gastroscopic shows white mucosa and flattening folds,but stomach yin deficiency syndrome also shows mucosal gray.It will be considered to be liver-stomach disharmony syndrome or spleen-stomach damp-heat syndrome,when gastroscopic shows bile regurgitation,but liver-stomach disharmony syndrome also shows congested mucosa and edematous mucosa,spleen-stomach damp-heat syndrome also shows mucosal erosion.It will be considered to be stomach collateral stasis syndrome,when gastroscopic shows granular hyperplasia and nodulated apophysis.