儿童慢性胃炎中医证型分布及与临床因素的关系

Distribution of TCM syndrome type of chronic gastritis in children and its relationship with clinical factors

目的探讨儿童慢性胃炎中医证型分布特点与临床因素、幽门螺杆菌(HP)感染的关系。方法回顾性分析2018年1月至2020年12月就诊于天津市中西医结合医院(天津市南开医院)儿科的慢性胃炎患儿128例,收集其临床资料,判定中医证型,分析中医证型分布特点及其与临床因素(性别、年龄、发病季节、胃镜表现)、HP感染的关系。结果儿童慢性胃炎中医证型分布依次为脾胃湿热证(43.8%)、脾胃虚弱证(25.0%)、肝胃不和证(22.6%)、胃阴不足证(5.5%)、胃络瘀血证(3.1%)。脾胃湿热证各年龄段均可见,夏、秋季(分别为59.3%,52.4%)多见,多表现为糜烂性胃炎(69.6%);脾胃虚弱证多见于学龄期儿童(44.8%),冬季(44.4%),多表现为浅表性胃炎(40.8%);肝胃不和证多见于青春期儿童(35.1%),春季(43.5%),多表现为胆汁反流性胃炎(48.0%)。中医证型分布与年龄、发病季节、胃镜表现相关(P<0.05或P<0.01)。脾胃湿热证(46.0%)、肝胃不和证(25.5%)在HP阳性患儿中占比高于其他证型;脾胃湿热证(36.6%)、脾胃虚弱证(26.7%)、胃阴不足证(16.7%)在HP阴性患儿中占比高于其他证型,组间比较,差异有统计学意义(P<0.05)。结论不同年龄段、季节、胃镜表现及HP感染的儿童慢性胃炎中医证型分布不同,我们在临床辨证治疗过程中要结合多方因素综合辨证,以提高辨证的准确性,从而提高治疗效果。

Objective To explore the relationship between TCM syndromes distribution,clinical factors and Helicobacter pylori(HP)infection in children with chronic gastritis.Methods 128 cases of chronic gastritis admitted to the Department of Pediatrics of Tianjin Hospital of Integrated Traditional Chinese and Western Medicine(Tianjin Nankai Hospital)from January 2018 to December 2020 were retrospectively analyzed.Clinical data were collected,TCM syndrome types were determined,and the distribution characteristics of TCM syndrome types and their relationship with clinical factors(gender,age,season of onset,gastroscopy manifestations)and HP infection were analyzed.Results The traditional Chinese medicine syndromes of chronic gastritis in children were spleen and stomach dampness-heat syndrome(43.8%),spleen and stomach weakness syndrome(25.0%),liver and stomach disconcerting syndrome(22.6%),stomach yin deficiency syndrome(5.5%)and stomach stasis syndrome(3.1%).spleen and stomach dampness-heat syndrome can be seen in all age groups and is more common in summer and autumn(59.3%and 52.4%,respectively),manifesting more often as erosive gastritis(69.6%).The syndrome of spleen and stomach weakness was more common in school age children(44.8%),winter(44.4%),and superficial gastritis(40.8%).Liver and stomach disconcerting syndrome was more common in adolescent children(35.1%),spring(43.5%),and bile reflux gastritis(48.0%).The distribution of TCM syndromes was correlated with age,season of onset and gastroscopy(P<0.05 or P<0.01).Spleen and stomach dampness-heat syndrome(46.0%)and liver and stomach disconcerting syndrome(25.5%)were higher in HP-positive children than other syndrome types.Spleen and stomach dampness-heat syndrome(36.6%),spleen and stomach weakness syndrome(26.7%)and stomach yin deficiency syndrome(16.7%)accounted for a higher proportion of HP-negative children than other syndrome types,and the difference between groups was statistically significant(P<0.05).Conclusion The distribution of TCM syndromes of chronic gastritis in children with different age,season,gastroscopy and HP infection is different.In the process of clinical syndrome differentiation,we should combine multiple factors to improve the accuracy of syndrome differentiation and improve the therapeutic effect.