反流性食管炎的胃镜分级与中医证型的调查研究

发布时间：2018-06-17 02:57

本文选题：反流性食管炎 + 胃镜分级　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:本研究通过设计调查表,收集胃镜下确诊的反流性食管炎(Reflux Esoph agitis,RE)患者的基本信息,总结275例反流性食管炎患者的中医证候以及胃镜下的表现,采用临床流行病学调查的方式,探讨反流性食管炎患者的胃镜分级与中医证候的分布规律,将西医“辨病论治”与中医“辨证论治”相结合,为反流性食管炎的中医辨证分型及患者下一步防治提供客观依据。方法:采用临床流行病学的方式设计问卷调查表,通过横断面研究的方法,对2015年04月-2017年03月云南省中医学院第三附属医院(昆明市中医医院)门诊及病房经胃镜确诊RE的患者,符合纳入标准的患者275例,对患者如实进行问卷调查并记录填写,将所得数据录入并进行统计,使用SPSS19.0统计软件,采用(x|-)±s、χ~2检验、构成比(%)、秩和检验、相关性分析等。结果:1.本研究经胃镜检查确诊并符合纳入标准的反流性食管炎患者275例,其中男性168例(61.09%),女性107例(38.91%);诱发因素以饮食因素109例(39.64%)为主,情志因素21例(7.64%)次之;患者平素多喜食辛辣、甜腻之品,多发病于餐后,且容易复发,患者夏季发病率较高。2.患者的中医证型分布,由多到少依次为肝胃不和99例(36.00%);肝胃郁热66例(24.00%);脾胃虚寒60例(21.82%);气郁痰热18例(6.54%);气滞血瘀13例(4.73%);脾虚痰阻11例(4.00%);胃阴不足8例(2.91%)。3.患者胃镜检查结果分布,0级55例(20.00%);I级(Ia、Ib)155例(56.36%);II级38例(13.82%);III级27例(9.82%)。4.本课题中患者胃镜检查分级与中医证型的调查研究,0级以肝胃不和、肝胃郁热证为主,I级以肝胃不和、肝胃郁热、脾胃虚寒证为主,II级以肝胃不和证为主,III级以肝胃郁热、气滞血瘀证为主。经秩和检验(Kruskal-Wallis),P=0.030.05,患者胃镜分级与中医证型存在显著差异;经相关性分析,得出Pearson系数为0.121,P=0.0460.05,不同胃镜分级与中医证型分布具有统计学意义。结论:1.从患者基本信息来看,中年男性发病率较高,患者多为已婚,职业分布以职员多发,文化水平多为中学,且长期居住于城镇,多为饮食不适引起,多喜嗜辛辣、甜腻之品,喜饮酒,常于餐后症状明显,病程多小于3年,且反复发作。2.从患者中医症状分布来看:本病以气机不调为主。3.从患者中医证候分布来看:多为肝胃不和、肝胃郁热证。虚证多为脾气虚、气阴阳两虚,实证多为痰、热、气、瘀互结。4.从患者胃镜下分级来看:胃镜下分级的分布情况为I级(Ia、Ib)0级II级III级。5.胃镜下分级对反流性食管炎的中医辨证分型及指导患者的下一步防治具有一定的临床意义。
[Abstract]:Objective: to collect the basic information of patients with reflux esophagitis (RER) diagnosed by gastroscopy and summarize the TCM syndromes of 275 patients with reflux esophagitis. By means of clinical epidemiological investigation, the distribution of gastroscope classification and TCM syndromes in patients with reflux esophagitis was discussed. To provide objective basis for TCM syndrome differentiation and prevention and treatment of reflux esophagitis. Methods: a questionnaire was designed by clinical epidemiology, and a cross-sectional study was carried out. From April 2015 to March 2017, 275 patients with RE confirmed by gastroscopy in outpatients and wards of the third affiliated Hospital of Yunnan Institute of traditional Chinese Medicine (Kunming traditional Chinese Medicine Hospital) were investigated by questionnaire and recorded. The data were inputted and counted, SPSS 19.0 software was used, X -) 卤s, 蠂 ~ 2 test was used to make up ratio, rank sum test, correlation analysis and so on. The result is 1: 1. In this study, 275 patients with reflux esophagitis were confirmed by gastroscopy and met the inclusion criteria, including 168 male patients with reflux esophagitis, 107 women with 38.91C, 109 patients with dietary factors (39.64), and emotional factors with 21 patients (7.64). Sweet and greasy products, frequent after meals, and easy to relapse, the summer incidence of patients is higher. 2. 2. The distribution of TCM syndromes from more to less was as follows: liver and stomach disharmony in 99 cases (36.00); stagnation of liver and stomach in 66 cases (P < 24.00); deficiency of spleen and stomach in 60 cases; Qi stagnation and phlegm heat in 18 cases; Qi stagnation and blood stasis in 13 cases; spleen deficiency and phlegm obstruction in 11 cases; spleen deficiency and phlegm obstruction in 11 cases; stomach yin deficiency in 8 cases. The results of gastroscopy were distributed in 55 cases of grade 0 (20. 00) and 155 cases of Iahe Ibma of grade I (56.36) and 38 cases of grade II (13. 82%) and 27 cases of grade III (9. 82%). Investigation on the classification of gastroscopy and TCM syndromes in this subject; grade 0 was divided into liver and stomach disharmony, liver and stomach stagnation heat syndrome was mainly divided into liver and stomach disharmony, liver and stomach stagnation heat, spleen and stomach deficiency cold syndrome were mainly divided into liver and stomach disharmony syndrome and grade III was liver and stomach stagnation heat. Qi stagnation and blood stasis syndrome. By rank sum test, there was a significant difference between the grade of gastroscope and the type of TCM syndrome, and the Pearson coefficient was 0.121%, 0.0460.05. The distribution of different grades of gastroscope and TCM syndromes was statistically significant. Conclusion 1. According to the basic information of the patients, the incidence rate of middle-aged men is relatively high, the patients are mostly married, the occupation distribution is mainly by the staff, the education level is mostly middle school, and the long-term living in the town is caused by the food discomfort, more happy and spicy, sweet and greasy products. Like drinking, often obvious symptoms after the meal, the course of disease is less than 3 years, and repeated attacks. 2. From the distribution of TCM symptoms of patients: this disease is mainly intonation of Qi. 3. From the distribution of TCM syndromes of patients: liver and stomach discord, liver and stomach stagnation heat syndrome. Deficiency syndrome is mostly spleen qi deficiency, qi yin and yang deficiency, and the empirical evidence is phlegm, heat, qi and blood stasis. According to the classification of the patients under gastroscope, the distribution of the grade was Iahe, Ib0, grade II, grade III, and grade 5. The classification under gastroscope has certain clinical significance for TCM syndrome differentiation of reflux esophagitis and guiding the next step of prevention and treatment of reflux esophagitis.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】