功能性消化不良中医证型分布及与十二指肠嗜酸性粒细胞相关性研究

Study on Traditional Chinese Medicine Syndrome Types and Correlation with Duodenal Eosinophils in Functional Dyspepsia

目的:探究功能性消化不良(FD)中医证型分布特点及与十二指肠嗜酸性粒细胞(EOS)的相关性。方法:245例FD患者按中医证型分为脾虚气滞证、肝胃不和证、脾胃湿热证、脾胃虚寒证和寒热错杂证5组,并以46名健康体检者为对照组。记录患者的临床资料,内镜下取十二指肠球部组织,经苏木精-伊红染色后通过光学显微镜观察十二指肠EOS数量,分析FD中医证型分布规律及证型与十二指肠EOS的相关性。结果:(1)在245例FD患者中,肝胃不和证、脾虚气滞证为最常见的证型,其次为脾胃湿热证、脾胃虚寒证和寒热错杂证。FD患者不同亚型的中医证型分布存在差异(P<0.05),上腹痛综合征(EPS)以肝胃不和证最多见,餐后不适综合征(PDS)及EPS+PDS以脾虚气滞证多见。(2)FD不同证型间的十二指肠EOS数量差异具有统计学意义(P<0.01),依次为脾胃湿热证(26.60±7.41)>肝胃不和证(24.71±6.17)>寒热错杂证(23.96±4.72)>脾胃虚寒证(21.94±6.40)>脾虚气滞证(21.92±5.85)。脾胃湿热证、肝胃不和证十二指肠EOS数量均高于脾虚气滞证和脾胃虚寒证(P<0.01或P<0.05)。(3)Pearson相关性分析结果表明,肝胃不和证、脾胃湿热证与十二指肠EOS数量均呈正相关(P<0.01)。结论:十二指肠EOS数量可作为FD的中医辨证分型参考指标。

Objective:To explore the distribution of functional dyspepsia(FD) traditional Chinese medicine (TCM) syndrome types and its correlation with eosinophils(EOS) in duodenum. Method:Total 245 patients with FD according to TCM syndrome types were divided into five types, syndrome of spleen-deficiency and qi stagnation,syndrome of incoordination between liver and stomach,syndrome of dampness-heat of spleen and stomach,syndrome of deficient cold of spleen and stomach,cold-heat complicated syndrome. Total 46 healthy volunteers was normal control group. Patients’ clinical data was recorded. Endoscopic duodenal bulb organization were collected for HE staining. Eosinophils were counted,and their associations with clinical syndromes were analyzed. Results:(1)In 245 FD patients,syndrome of incoordination between liver and stomach,syndrome of spleen-deficiency and qi stagnation were the most common syndromes,followed by syndrome of dampness-heat of spleen and stomach,syndrome of deficient cold of spleen and stomach,cold-heat complicated syndrome. There were significantly statistical differences in the distribution of different TCM syndromes from different subtypes of FD patients(P<0.05). Most of patients with epigastric pain syndrome(EPS) were syndrome of incoordination between liver and stomach. Most patients of postprandial distress syndrome(PDS) or patients both EPS and PDS were syndrome of spleen-deficiency and qi stagnation.(2) The number of EOS between different FD syndromes was statistically significant different(P<0.01). The EOS quantity of syndrome of dampness-heat of spleen and stomach(26.60±7.41) was more than that syndrome of incoordination between liver and stomach(24.71 ±6.17),more than cold-heat complicated syndrome(23.96 ±4.72),more than syndrome of deficient cold of spleen and stomach( 21.94 ± 6.40), more than syndrome of spleen-deficiency and qi stagnation(21.92±5.85). The number of EOS in syndrome of dampness-heat of spleen and stomach and syndrome of incoordination between liver and stomach was significantly higher than that in syndrome of spleen-deficiency and qi stagnation and syndrome of deficient cold of spleen and stomach(P<0.01 or P<0.05).(3)Data from Pearson correlation analysis showed that syndrome of incoordination between liver and stomach,syndrome of dampness-heat of spleen and stomach,were positively correlated with EOS quantity in duodenum(P<0.01).Conclusion:The number of EOS in duodenum can be used as a reference index for TCM syndrome differentiation and classification of functional dyspepsia.