慢性荨麻疹严重程度、中医证型与幽门螺杆菌感染的关系研究

Correlation of the severity and traditional Chinese medicine syndrome of chronic urticaria with Helicobacter pylori infection

目的 研究分析慢性荨麻疹严重程度、中医证型与幽门螺杆菌(H.pylori)感染的相关性,为慢性荨麻疹的临床诊疗提供参考。方法 采用横断面调查的研究方法,选取2021年3月—2022年2月于中国中医科学院广安门医院皮肤科门诊就诊的慢性荨麻疹患者85例,采集患者临床疾病信息和四诊资料,使用7日荨麻疹活动性评分(UAS7评分)进行严重程度评价,依据《瘾疹(荨麻疹)中医治疗专家共识》对患者中医证型进行判定,具体证型包括风热证、风寒证、肠胃湿热证、毒热炽盛证及气血亏虚证。采用免疫印迹法检测血清H.pylori抗体,任一抗体阳性则为H.pylori感染,抗体无阳性则为H.pylori未感染;H.pylori感染患者根据阳性抗体类型进一步分为Ⅰ型H.pylori感染和Ⅱ型H.pylori感染。分析慢性荨麻疹一般资料、严重程度、中医证型与H.pylori感染情况的关系。结果 辨证为风热证21例,风寒证4例,肠胃湿热证38例,毒热炽盛证9例,气血亏虚证13例。不同中医证型患者性别、年龄、病程及UAS7评分比较差异均无统计学意义(P均>0.05)。慢性荨麻疹不同证型中均存在H.pylori感染,不同证型患者的H.pylori感染率及感染类型之间差异均无统计学意义(P均>0.05)。H.pylori感染患者UAS7评分明显高于H.pylori未感染患者(Z=2.127,P=0.033),但不同H.pylori感染类型患者之间UAS7评分差异无统计学意义(Z=0.224,P=0.823)。结论 慢性荨麻疹各个中医证型中均存在H.pylori感染患者,不同证型之间H.pylori的感染情况差异不明显;H.pylori感染可以加重慢性荨麻疹疾病活动度,但H.pylori不同感染类型之间慢性荨麻疹的严重程度并没有明显差异。对于病情严重、常规治疗不佳的慢性荨麻疹患者,无论其属于何种中医证型,必要时均应及时行H.pylori检测,以便明确病因而进一步治疗。

Objective It is to study and analyze the correlation of the severity and traditional Chinese medicine syndrome of chronic urticaria with Helicobacter pylori(H.pylori)infection,and to provide some reference for the clinical diagnosis and treatment of chronic urticaria.Methods A total of 85 patients with chronic urticaria who attended the outpatient clinic of the Department of Dermatology,Guang’anmen Hospital,China Academy of Chinese Medicine Science from March 2021 to February 2022 were selected by A cross-sectional survey,and their clinical disease information and data of four diagnostic methods were collected,and the severity of the disease was evaluated by the 7-day Urticaria Activity Score(UAS7 Score),and the Chinese medicine syndrome types were diagnosed according to“Expert Consensus of Chinese Medicine Treatment of Obscure Rash(Urticaria)”,which included wind-heat syndrome,wind-cold syndrome,stomach and intestines wet-heat syndrome,toxin-heat intense syndrome,and qi-blood deficiency syndrome.The serum H.pylori antibodies were detected by immunoblotting,either antibody positive was H.pylori infected,and no antibody positive was H.pylori uninfected;the patients with H.pylori infection were further classified into type I H.pylori infection and type II H.pylori infection according to the type of positive antibody.The correlations of the general information,severity,and traditional Chinese medicine syndrome of chronic urticaria with H.pylori infection were analyzed.Results Twenty one cases of patients were diagnosed as wind-heat syndrome,4 cases as wind-cold syndrome,38 cases as stomach and intestines wet-heat syndrome,9 cases as toxin-heat intense syndrome,and 13 cases as qi-blood deficiency syndrome.There was no statistically significant difference in gender,age,duration of disease and UAS7 score of patients among different traditional Chinese medicine syndromes(all P>0.05).H.pylori infection was present in different syndrome types of chronic urticaria,and the differences in the H.pylori infection rates and infection types were not statistically significant among different traditional Chinese medicine syndromes(all P>0.05).The UAS7 scores of patients with H.pylori infection were significantly higher than those of patients without H.pylori infection(Z=2.127,P=0.033),but the difference in UAS7 scores was not statistically significant among different types of H.pylori infection(Z=0.224,P=0.823).Conclusion H.pylori infection was found in patients with chronic urticaria in all traditional Chinese medicine syndromes,and the difference in H.pylori infection between different syndromes was not significant;H.pylori infection could aggravate the disease activity of chronic urticaria,but there was no significant difference in the severity of chronic urticaria between different types of H.pylori infection.For patients with severe chronic urticaria unsatisfied and curative effect of conventional treatment,regardless of the type of Chinese medicine syndromes,H.pylori testing should be performed timely if necessary to identify the cause for further therapy.