慢性萎缩性胃炎并胃黏膜糜烂的中医证候研究

发布时间：2018-06-28 02:38

本文选题：慢性萎缩性胃炎 + 胃黏膜糜烂　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究目的:本研究旨在探讨慢性萎缩性胃炎并胃黏膜糜烂的中医证型分布规律,并研究其与血型、饮食、季节、幽门螺旋杆菌感染、黏膜萎缩等因素的相关性,为本病在临床的预防和治疗提供参考依据,也可以为社区全科医生对居民进行本病的健康宣传教育提供借鉴。研究方法:在导师的指导与帮助下,通过阅读学习大量的文献资料,设计该研究病种的临床调查表,在亚运村社区、东方医院及北京中医药大学第三附属医院收集165例慢性萎缩性胃炎并胃黏膜糜烂患者的临床资料,参考2011年《慢性胃炎中西医结合诊疗共识意见》提供的标准进行辨证分型,运用SPSS软件统计分析数据,总结探讨慢性萎缩性胃炎并胃黏膜糜烂的证型分布规律,并初步分析该分布规律与季节,饮食,血型,幽门螺旋杆菌感染、黏膜萎缩等因素的关系。研究结果:1.本次研究共纳入病例样本量为165例,其中男性78例,女性87例,女性多于男性,男女构成比为:1:1.2。经卡方检验P=0.4840.05,说明慢性萎缩性胃炎并胃黏膜糜烂的患者男女性别差异无统计学意义。2.在纳入本次研究的165例患者中,年龄最小者28岁,年龄最大者89岁,平均年龄59.00±11.03岁。年龄在50-79岁之间的人们得本病的多,共占85.4%。3.在慢性萎缩性胃炎并胃黏膜糜烂的发病人群中,0型血的人数最多,共77例,其次是B型血的患者51例,AB型和A型分别为24例和13例。经过卡方检验,P0.05,表明慢性萎缩性胃炎并胃黏膜糜烂的患者的血型差异有统计学意义。4.根据胃镜及病理报告,本次收集的165例患者中,单纯胃窦部存在糜烂的有102例,单纯胃角处存在糜烂的有1例,单纯胃底部存在糜烂的有4例,单纯胃体部存在糜烂的有7例,剩下的51例患者均存在两个部位或多个部位散在的糜烂,且多部位的糜烂以胃角、胃窦部散在糜烂的居多。经卡方检验,P=0.0000.05,说明慢性萎缩性胃炎并胃黏膜糜烂的患者糜烂部位的差异有统计学意义。5.慢性萎缩性胃炎并胃黏膜糜烂的中医各证型分布,通过卡方检验,P=0.0000.05,说明慢性萎缩性胃炎并胃黏膜糜烂的各个证型间存在统计学差异。6.饮食方面,饮食过烫者脾胃湿热型比较多见;饮食辛辣者胃络瘀血型比较多见;食速过快者脾胃湿热、肝胃郁热以及肝郁气滞型比较多见;三餐不规律者肝胃郁热和肝郁气滞型比较多见。7.慢性萎缩性胃炎并胃黏膜糜烂的中医证型与性别的关系:经卡方检验,P=0.0850.05,说明慢性萎缩性胃炎并胃黏膜糜烂的患者中医证型分布与性别无显著性差异。8.慢性萎缩性胃炎并胃黏膜糜烂的中医证型与年龄段的关系:以年龄段为分组标准,经卡方检验,P=0.1730.05,差异没有统计学意义,表明各年龄段患者的中医证型分布无显著性差异。以中医证型为分组标准,经Kruskal-Wallis H检验,P=0.2420.05,说明中医各证型的年龄段分布无统计学差异。9.慢性萎缩性胃炎并胃黏膜糜烂的中医证型与季节的关系:经卡方检验,P=0.0010.05,说明中医证型的分布与季节有显著性差异。10.慢性萎缩性胃炎并胃黏膜糜烂的中医证型与血型的关系:经卡方检验,P=0.0700.05,说明中医证型分布与血型无显著性差异。11.慢性萎缩性胃炎并胃黏膜糜烂的中医证型与Hp感染的关系:以中医证型为分组标准,经Kruskal-Wallis H检验,P=0.1810.05,表明慢性萎缩性胃炎并胃黏膜糜烂的中医各证型的Hp感染分级无显著性差异。以Hp感染分级为分组标准,进行卡方检验,P=0.0370.05,说明Hp感染的程度不同会影响中医证型的分布,Hp感染分级不同的患者中医证型的分布有显著性差异。12.慢性萎缩性胃炎并胃黏膜糜烂的中医证型与黏膜萎缩程度的关系:以证型为分组标准,经Kruskal-Wallis H检验,P=0.0260.05,说明慢性萎缩性胃炎并胃黏膜糜烂的中医各证型的黏膜萎缩程度有显著性差异。以胃黏膜萎缩程度为分组标准,进行卡方检验,P=0.04960.05,说明黏膜萎缩程度不同的各组间中医证型的分布有显著性差异。研究结论:1.慢性萎缩性胃炎并胃黏膜糜烂的各个证型间有统计学差异,其证型出现的频次由高到低依次为脾胃湿热型、肝胃郁热型、肝郁气滞型、胃络瘀血型、胃阴不足型和脾胃虚寒型。2.慢性萎缩性胃炎并胃黏膜糜烂的糜烂部位有统计学差异,糜烂部位以胃窦部最为多见。3.慢性萎缩性胃炎并胃黏膜糜烂的中医证型分布与性别及年龄段没有相关性。4.慢性萎缩性胃炎并胃黏膜糜烂的中医证型分布与季节有相关性。5.慢性萎缩性胃炎并胃黏膜糜烂的患者的血型有统计学差异,但是血型和本病的中医证型分布没有相关性。6.慢性萎缩性胃炎并胃黏膜糜烂中医证型与Hp感染有相关性,Hp感染的程度不同会影响中医证型的分布。7.慢性萎缩性胃炎并胃黏膜糜烂的中医证型与黏膜萎缩程度有相关性。
[Abstract]:The purpose of this study is to investigate the distribution of TCM syndrome types of chronic atrophic gastritis and gastric mucosal erosion, and to study the correlation of the factors such as blood group, diet, season, Helicobacter pylori infection and atrophy of mucous membrane, and provide the basis for the prevention and treatment of this disease and the community general practitioner. Health publicity and education of the disease provide reference. Research methods: under the guidance and help of the tutor, through reading and learning a large number of documents, design the clinical questionnaire of the disease type, collect 165 cases of chronic atrophic gastritis and gastric mucosa erosion in the Asian Sports Village community, the Oriental Hospital and the Third Affiliated Hospital of Beijing University of Chinese Medicine. Bed data, referring to the standard for diagnosis and treatment of chronic gastritis in 2011, the standard for diagnosis and treatment of traditional Chinese and Western medicine provided by the standard for differentiation, using SPSS software statistical analysis data to summarize and discuss the pattern distribution of chronic atrophic gastritis and gastric mucosa erosion, and preliminarily analyze the distribution rule and season, diet, blood type, Helicobacter pylori infection, mucous membrane The relationship between atrophy and other factors. 1. a total of 165 cases were included in this study, including 78 men, 87 women and more women than men. The ratio of male and female to male and female was 1:1.2. by chi square test P=0.4840.05. The sex difference between men and women in chronic atrophic gastritis and gastric mucosal erosion was not statistically significant.2. was included in the study Among the 165 patients, the youngest was 28 years old, the oldest was 89 years old, and the average age was 59 + 11.03 years. The people aged 50-79 years were more likely to have the disease. Among the patients with chronic atrophic gastritis and gastric mucosal erosion, the number of 0 type of blood was the largest, 77 cases, and the next of the patients with type B blood, and the AB type and the A type respectively. 24 cases and 13 cases. After the chi square test, P0.05, the difference of blood type of the patients with chronic atrophic gastritis and gastric mucosa erosion was statistically significant.4. according to the gastroscopy and pathological report. Among the 165 cases of this collection, there were 102 cases of erosion in the Dan Chunwei sinus, 1 cases of erosion in the simple gastric corner, and the erosion in the bottom of the stomach. In 4 cases, there were 7 cases of erosion in the body of the stomach, and the remaining 51 cases had two parts or many parts of the erosion, and the erosion of the gastric antrum in the multiple parts of the stomach and the gastric antrum scattered in the most erosive. P=0.0000.05, the difference between the chronic atrophic gastritis and the gastric mucous erosion of the patients with chronic atrophic gastritis was statistically significant. 5. the distribution of TCM syndrome types of chronic atrophic gastritis and gastric mucosa erosion through chi square test, P=0.0000.05, indicating that there are statistical differences in.6. diet between the various syndromes of chronic atrophic gastritis and gastric mucosa erosion. The spleen and stomach damp heat, liver and stomach depression and stagnation of liver qi stagnation are more common. The relationship between the liver and stomach depression and the stagnation of liver qi stagnation in the irregular three meals is more common in the.7. chronic atrophic gastritis and the relationship between the TCM syndrome type and the sex of the gastric mucosa erosion: through the chi square test, P=0.0850.05, the TCM syndrome distribution of the patients with chronic atrophic gastritis and gastric mucosa erosion There is no significant difference between sex and age in.8. chronic atrophic gastritis and gastric mucosa erosion: the age group is the standard, the chi square test and the P=0.1730.05 are not statistically significant, indicating that there is no significant difference in the distribution of TCM Syndrome Types in the patients of all ages. The standard of TCM Syndrome type as the standard of group, Kruskal-Wallis H test, P=0.2420.05, indicating that there is no statistical difference in the age distribution of each type of TCM syndrome, the relationship between the TCM syndrome type of chronic atrophic gastritis and gastric mucosa erosion in.9. and the season: P=0.0010.05, the distribution of TCM syndrome type and the seasonal variation of TCM syndrome type.10. chronic atrophic gastritis and gastric mucosa erosion Relationship of blood type: P=0.0700.05, the relationship between TCM Syndrome Distribution and blood type, the relationship between TCM syndrome type of chronic atrophic gastritis and gastric mucosa erosion and Hp infection in.11. chronic atrophic gastritis and gastric mucosal erosion: TCM syndrome type as group standard, Kruskal-Wallis H test and P=0.1810.05, the TCM syndrome of chronic atrophic gastritis and gastric mucosa erosion There was no significant difference in the classification of Hp infection in each type. Hp infection classification was divided into grouping criteria, chi square test, P=0.0370.05, indicating that the degree of Hp infection would affect the distribution of TCM syndrome type. The distribution of TCM syndrome types with different Hp infection classification had significant difference in the TCM Syndrome type of chronic atrophic gastritis and gastric mucosa erosion in.12. The relationship between the degree of atrophy of mucous membrane: the degree of atrophy of mucous membrane in the TCM syndrome types of chronic atrophic gastritis and gastric mucosa erosion by Kruskal-Wallis H test and P=0.0260.05, with the syndrome type as the standard of grouping, with the standard of gastric mucosa atrophy as the grouping standard, the chi square test, and P=0.04960.05, indicating that the degree of atrophy of mucous membrane is different. There were significant differences in the distribution of TCM syndrome types between each group. Conclusions: 1. there are statistical differences between the various syndromes of chronic atrophic gastritis and gastric mucosa erosion. The frequency of the syndrome is from high to low to spleen and stomach damp heat, liver and stomach depression, stagnation of liver qi, stomach and collateral blood stasis, gastric Yin deficiency and spleen stomach deficiency cold type.2. atrophy. There were statistical differences in the erosive sites of erosive gastric mucosa and gastric mucosal erosion. The most common.3. chronic atrophic gastritis in the antrum and the erosion of gastric mucosa in the erosive part of the erosive region was not related to the sex and age of.4.. The distribution of TCM syndrome in chronic atrophic gastritis and the erosion of gastric mucosa was associated with the chronic atrophy of.5. in the season. The blood types of patients with gastritis and gastric mucosal erosion were statistically different, but there was no correlation between the distribution of TCM syndrome of.6. chronic atrophic gastritis and the TCM syndrome type of gastric mucosa erosion and Hp infection. The different degree of Hp infection could affect the distribution of TCM syndrome type of chronic atrophic gastritis of.7. and the erosion of gastric mucosa. There is a correlation between the type of medical syndrome and the degree of atrophy of mucous membrane.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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