慢性胃炎中医证型与胃镜下表现相关性探讨

发布时间：2018-05-22 14:19

本文选题：慢性胃炎 + 中医证型　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:通过对慢性胃炎患者的收集观察,进行前瞻性的研究,总结分析中医证型分布情况,并探讨其与性别、年龄、幽门螺杆菌(Helicobacter Pylori,HP)感染、诊断分类、胃黏膜糜烂、病理组织学等的相关性,为慢性胃炎的中医诊断、辩证分型、治疗提供依据,更好的服务于临床。研究方法:本次研究通过统一的临床调查表格,共收集197例慢性胃炎患者,包括患者的姓名、年龄、性别、病程、既往史、手术史、家族史等基本资料,并观察患者胃镜所见及病理诊断结果,以慢性胃炎中西医结合诊疗共识意见(2011年天津)[1]为标准,进行中医辨证分型,参考中华中医药学会慢性胃炎诊疗指南中标准,以确诊慢性胃炎。应用SPSS17.0软件进行统计分析,P0.05则认为比较差异具有统计学意义。研究结果:(1)本次研究共纳入病例197例,其中女性111例,男性86例,男女比例为(0.77:1)。年龄范围为17岁—83岁,平均年龄53.17±15.74岁。中年女性发病例数最多。(2)中医证型分布规律:脾胃虚寒证为28.4%,所占比例最高;肝胃郁热证为24.4%,居第二位;余证型依次为肝郁气滞证占19.3%,脾胃湿热证为16.7%,胃阴不足7.1%,胃络瘀阻最低为4.1%,与肝郁有关的证候可达到43.7%。(3)HP检出例数为159例,检出率为80.71%。各证型HP感染比例排序为胃络瘀阻证100%胃阴不足证92.9%肝郁气滞证81.6%肝胃郁热证79.2%脾胃湿热证78.8%脾胃虚寒证76.8%。经Fisher确切概率法检验,HP感染率在中医各证型间差异无显著性意义(P=0.651,P0.05)。(4)中医各证型中肝胃郁热证出现肠胃反流的比例最大,占27.08%,其余依次为脾胃湿热证15.15%、肝郁气滞证13.16%、胃络瘀阻证12.5%、脾胃虚寒证5.36%。胃阴不足证未检出肠胃反流。经Fisher确切概率法检验,肠胃反流在中医各证型间差异有统计学意义(P=0.016,P0.05)。肝郁气滞证、肝胃郁热证与脾胃虚寒证组间差异具有统计学意义。肝胃郁热证与胃阴不足证两组间有明显差异。(5)中医各证型中镜下出现糜烂相以脾胃湿热证最多为48.48%,其他证型依次为胃络瘀阻证37.50%=肝胃郁热证37.50胃阴不足证35.71%脾胃虚寒证28.57%肝郁气滞证13.16%。经Fisher确切概率法检验,胃黏膜糜烂在中医各证型间差异有统计学意义(P=0.030,P0.05)。肝胃郁热证、脾胃湿热证与肝郁气滞证组间比较有明显差异。(6)慢性萎缩性胃炎中医证型与病理组织学的相关性:轻度活动以脾胃虚寒证为主;中度活动以肝郁气滞证、肝胃郁热证为多。轻度萎缩以胃络瘀阻证最多,肝郁气滞证、脾胃湿热证次之;中度萎缩主要以胃阴不足证为主。轻度肠化以肝郁气滞证最多,脾胃虚寒证次之。中度肠化以肝郁气滞证为多。不典型增生以脾胃湿热证为主,脾胃虚寒证及肝郁气滞证次之,其他证型未检出。经Kruskal-Wallis H非参数检验,各证型间在病理组织学上改变无明显差异(P0.05)。结论:1.慢性胃炎的中医辨证分型的比例排序依次为脾胃虚寒证肝胃郁热证肝郁气滞证脾胃湿热证胃阴不足证胃络瘀阻证。2.胃黏膜糜烂与慢性胃炎的中医各证型的关系密切,脾胃湿热证、肝胃郁热证明显多于其他证型;肠胃反流与中医各证型关系密切,其中肝胃郁热证与其他证型差异明显。3.性别、年龄、分类、HP感染与中医证型无关。4.慢性萎缩性胃炎在病理组织学的改变与中医证型无关。
[Abstract]:Objective: through the collection and observation of patients with chronic gastritis, a prospective study was carried out to summarize and analyze the distribution of TCM syndrome types, and to explore the correlation between the sex, age, Helicobacter Pylori (HP) infection, diagnosis and classification, gastric mucosal erosion, histopathology, etc., for the diagnosis, dialectical typing and treatment of chronic gastritis. In this study, 197 patients with chronic gastritis, including the name, age, sex, course of disease, history, history, family history and other basic data, were collected through a unified clinical investigation form, and the results of the patients' gastroscopy and pathological diagnosis were observed and combined with the combination of Chinese and Western medicine in chronic gastritis. The consensus opinion (Tianjin in Tianjin, 2011) was the standard, the TCM syndrome differentiation was carried out, the chronic gastritis in the Chinese traditional Chinese Medicine Association was referred to the standard for the diagnosis and treatment of chronic gastritis. The statistical analysis was carried out by the SPSS17.0 software, and the difference was statistically significant by P0.05. (1) 197 cases were included in this study. There were 111 female cases, male 86 cases (0.77:1). The age range was 17 to 83 years old, the average age was 53.17 + 15.74 years old. The number of cases of middle-aged women was the most. (2) the distribution of TCM Syndrome Type: the spleen and stomach deficiency cold syndrome was 28.4%, the proportion was the highest, the liver and stomach heat syndrome was 24.4%, and second. The residual syndrome type was liver qi stagnation Qi 19.3%, spleen and stomach damp heat. The syndrome was 16.7%, the stomach yin was insufficient 7.1%, the stomach blood stasis was the lowest 4.1%, the syndrome related to the liver depression could reach 43.7%. (3) HP, the number of cases was 159, the detection rate was 80.71%., the proportion of HP infection was sorted in the stomach collaterals stasis syndrome, 100% of the stomach yin deficiency, the stagnation of the liver qi stagnation, 79.2% spleen and stomach damp heat syndrome, 78.8% spleen and stomach deficiency cold syndrome 76.8%. via Fish. There was no significant difference between the HP infection rate and the TCM syndrome types (P=0.651, P0.05). (4) the proportion of the liver and stomach heat syndrome in the TCM syndrome types was the largest, accounting for 27.08%, the others were spleen and stomach damp heat syndrome 15.15%, liver qi stagnation syndrome 13.16%, gastric stasis syndrome 12.5%, spleen stomach deficiency syndrome 5.36%. stomach yin deficiency syndrome unchecked. The difference of intestinal gastric reflux between the TCM syndrome types was statistically significant (P=0.016, P0.05). The difference between the liver qi stagnation syndrome and the spleen and stomach deficiency cold syndrome group was statistically significant. There were significant differences between the two groups of the liver and stomach heat syndrome and the deficiency syndrome of the stomach yin. (5) the appearance of surimi in the TCM syndrome types was found in the two groups. The spleen and stomach damp heat syndrome is 48.48%, the other syndrome types in turn are gastric stasis syndrome 37.50%= liver qi stagnation syndrome 37.50 stomach yin deficiency syndrome 35.71% spleen stomach deficiency syndrome 28.57% liver qi stagnation syndrome 28.57% liver qi stagnation syndrome test, the difference between the gastric mucosa erosion in the TCM syndrome types is statistically significant (P=0.030, P0.05). Liver and stomach heat syndrome, spleen and stomach damp syndrome. There were significant differences in heat syndrome and liver qi stagnation syndrome. (6) the correlation between TCM syndrome type and pathological histology of chronic atrophic gastritis: mild activity with spleen stomach deficiency cold syndrome; moderate activity with stagnation of liver qi stagnation, liver and stomach stagnation syndrome, mild atrophy with gastric stasis syndrome, liver stagnation and stagnation of spleen and stomach, damp heat syndrome of spleen and stomach; moderate atrophy main. It is necessary to give priority to the deficiency of stomach yin syndrome. Mild intestinal metaplasia with stagnation of liver qi stagnation, spleen and stomach deficiency cold, moderate intestinal metaplasia with stagnation of liver qi stagnation, atypical hyperplasia with spleen and stomach damp heat syndrome, spleen and stomach deficiency cold and stagnation of liver qi and qi stagnation, and other syndrome types not detected. By Kruskal-Wallis H non parameter test, each syndrome type is modified by histopathology. There is no obvious difference (P0.05). Conclusion: 1. the proportion of TCM syndrome differentiation of chronic gastritis is in order of spleen stomach deficiency cold syndrome, liver qi stagnation syndrome, liver qi stagnation syndrome, spleen and stomach damp heat syndrome, spleen and stomach damp heat syndrome, stomach yin deficiency syndrome of gastric Yin deficiency syndrome,.2. gastric mucosa erosion and chronic gastritis of TCM syndrome types, spleen and stomach damp heat syndrome, liver and stomach heat syndrome more than others Syndrome type, intestinal gastric reflux is closely related to various TCM syndrome types, among which the difference of liver and stomach heat syndrome and other syndrome types is obviously.3. sex, age, classification, HP infection and TCM syndrome type is not related to.4. chronic atrophic gastritis in histopathology and the TCM syndrome type.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

【相似文献】