190例慢性萎缩性胃炎患者微观辨证研究

Microscopic Syndrome Differentiation of 190 Patients with Chronic Atrophic Gastritis

目的 以中医辨证分型为基础,将胃镜下黏膜改变及病理组织学变化等微观指标应用于辨证分析,寻求微观指标与慢性萎缩性胃炎证型之间的关系。方法 选取2021年1月1日至2021年12月31日就诊于中国中医科学院广安门医院门诊的慢性萎缩性胃炎患者190例。参考2010年《慢性萎缩性胃炎中医诊疗共识意见》进行辨证分型,对中医证型与胃镜下胃黏膜征象、中医证型与木村-竹本分类、中医证型与病理组织学变化进行相关分析。结果 对中医证型与胃镜下胃黏膜征象进行Logistic回归分析,提示胃络瘀阻证和胃黏膜白相与否呈正相关(P<0.05),肝胃不和证和胃黏膜变薄与否呈正相关(P<0.05),脾胃湿热证和胃黏膜水肿与否呈正相关(P<0.05),脾胃虚弱证和胃黏膜出血与否呈正相关(P<0.05)。对中医证型与胃镜下胃黏膜征象进行Logistic回归分析,表明胃络瘀阻证与木村-竹本分类具有相关关系(P<0.05),胃络瘀阻证患者相比非胃络瘀阻证患者木村-竹本分类为闭合型的概率更高。对中医证型与病理组织学变化进行相关性分析,提示肝胃不和证与OLGA、OLGIM具有相关性。结论 研究发现中医证型与慢性萎缩性胃炎的内镜下黏膜像变化、萎缩的范围及组织病理学变化存在一定的相关性。

Objective Based on the syndrome differentiation of traditional Chinese medicine,the microscopic indexes such as the changes of mucosa and histopathology under gastroscope were applied to the syndrome differentiation analysis to find the relationship between the microscopic indexes and the syndrome types of chronic atrophic gastritis.Methods 190 patients with chronic atrophic gastritis were selected from the outpatient department of Guang ′anmen Hospital,Chinese Academy of traditional Chinese medicine from January 1,2021 to December 31,2021.According to the consensus on TCM diagnosis and treatment of chronic atrophic gastritis in 2010,the TCM Syndrome Types and gastroscopic gastric mucosal signs,TCM Syndrome Types and Kimura bamboo classification,TCM Syndrome Types and histopathological changes were analyzed.Results Logistic regression analysis of TCM Syndrome Types and gastric mucosal signs under gastroscope showed that there was a positive correlation between gastric collateral stasis syndrome and gastric mucosal white phase(P<0.05).It can be concluded that the syndrome of disharmony between liver and stomach is positively correlated with the thinning of gastric mucosa(P<0.05),the syndrome of damp heat of spleen and stomach is positively correlated with the edema of gastric mucosa(P <0.05),and the syndrome of weakness of spleen and stomach is positively correlated with the bleeding of gastric mucosa(P<0.05).Logistic regression analysis of TCM Syndrome Types and gastric mucosal signs under gastroscope showed that there was a correlation between stomach collateral stasis syndrome and Kimura bamboo classification(P <0.05).Patients with stomach collateral stasis syndrome had a higher probability of Kimura bamboo classification as closed type than patients with non stomach collateral stasis syndrome.To analyze the correlation between TCM syndrome types and histopathological changes showed thatthe liver stomach disharmony syndrome was correlated with OLGA and OLGIM.Conclusion The study found that there is a certain correlation between the TCM syndrome types and the endoscopic mucosal image changes,atrophic range and histopathological changes of chronic atrophic gastritis.