胃食管反流病中医证型分布规律及食管测压参数的相关性研究
发布时间：2018-10-25 17:18
【摘要】：目的:探讨胃食管反流病(GERD)中医证型分布规律及其影响因素,并基于高分辨率食管测压技术(HRM)研究各证型及其动力参数的相关性。方法:根据GERD西医诊断标准,纳入GERD患者114例,采集纳入患者信息,包括性别、年龄、身高、体重、幽门螺杆菌(HP)感染情况,并由副主任及以上职称医师根据中医诊断标准进行辨证分型,共分为寒热错杂证、肝胃郁热证、肝胃不和证、痰湿内阻证、中虚气逆证5组,并行高分辨率食管测压,记录食管上括约肌(UES)、食管下括约肌(LES)、食管体部的相关动力参数,分析不同中医证型及其动力参数的相关性。结果:1.中医证型分布规律及影响因素114例GERD患者中寒热错杂证组39例(占34.2%),肝胃郁热证组27例(占23.7%),肝胃不和证组21例(占18.4%),痰湿内阻证组16例(占14.0%),中虚气逆证组11例(占9.6%),证型分布与西医分型构成无统计学差异(P0.05)。年龄方面,肝胃不和证组及肝胃郁热证组男性发病率高于女性,其余三型男性低于女性,各组间无统计学差异(P0.05)。中虚气逆证平均发病年龄(60.45±9.99)岁明显高于其余四型(P0.05),各组年龄段分布存在差异(P0.05)。各组在体重指数、HP感染率均无统计学差异(P0.05)。2.食管动力参数研究(1)UES动力参数:在UES静息压方面,痰湿内阻证组要低于肝胃郁热证组及中虚气逆证组(P0.05);各组间在UES长度、UES残余压方面无统计学差异(P0.05)。(2)LES动力参数:在LES静息压方面,中虚气逆证组、寒热错杂证组明显低于其他3组,且与肝胃郁热证组及痰湿内阻证组有统计学差异(P0.05);各组间在LES长度、4s综合松弛压、LES低压占比方面均无统计学差异(P0.05)。(3)食管体部动力参数:在远端收缩积分(DCI)方面,肝胃郁热证组高于中虚气逆证组及寒热错杂证组(P0.05)。在蠕动中断方面,中虚气逆证组高于寒热错杂证组(P0.05)。在收缩前沿速度(CFV)、远端潜伏期(DL)方面均无统计学差异(P0.05)。(4)无效收缩:在收缩力度方面,痰湿内阻证组高于其他四组(P0.05)。在无效收缩占比方面,痰湿内阻证组低于其他四组(P0.05)。(5)在湿咽成功率方面,痰湿内阻证组高于寒热错杂证组、肝胃不和证组及肝胃郁热证组(P0.05),同时,中虚气逆证组低于寒热错杂证组、肝胃郁热证组及痰湿内阻证组(P0.05)。结论:GERD中医证型中以寒热错杂证最为常见,其次依次为肝胃郁热证、肝胃不和证、痰湿内阻证、中虚气逆证。GERD患者不同证型与年龄、UES静息压、LES静息压、DCI、无效收缩占比、食管收缩力度、湿咽成功率有一定相关性。
[Abstract]:Objective: to investigate the distribution of TCM syndromes of gastroesophageal reflux disease (GERD) and its influencing factors, and to study the correlation between these syndromes and their dynamic parameters based on high resolution esophageal manometry (HRM). Methods: according to the diagnostic criteria of western medicine for GERD, 114 patients with GERD were included in the study. The information including sex, age, height, weight, Helicobacter pylori (HP) infection was collected. According to the diagnostic criteria of TCM, the doctors with deputy director and above were divided into five groups: cold and heat disorder syndrome, liver and stomach stagnation syndrome, liver and stomach disharmony syndrome, phlegm dampness internal obstruction syndrome, middle deficiency qi inverse syndrome, and high resolution esophageal manometry. The dynamic parameters of the upper esophageal sphincter (UES),) lower esophageal sphincter (LES),) esophagus were recorded and the correlation of different TCM syndromes and their dynamic parameters were analyzed. The result is 1: 1. The distribution pattern of TCM syndromes and its influencing factors were 39 cases (34.2%) in the cold and heat disorder syndrome group, 27 cases (23.7%) in the liver and stomach stagnation syndrome group, 21 cases (18.4%) in the liver and stomach disharmony syndrome group, 16 cases (14.0%) in the phlegm dampness and internal obstruction syndrome group, and 11 cases in the middle deficiency and qi inverse syndrome group. There was no statistical difference between the distribution of syndromes and the composition of western medicine typing (P0.05). In terms of age, the incidence of liver and stomach disharmony syndrome and stagnation of heat of liver and stomach in male group was higher than that in female group, and the other three types of males were lower than female. There was no statistical difference among the three groups (P0.05). The average age of onset of the syndrome was (60.45 卤9.99) years old, which was significantly higher than that of the other four types (P0.05), and the age distribution of each group was different (P0.05). There was no significant difference in body mass index (BMI) and HP infection rate among the groups (P0.05). Study on esophageal dynamic parameters (1) UES dynamic parameters: in UES resting pressure, The phlegm dampness internal obstruction syndrome group was lower than the liver and stomach stagnation heat syndrome group and the middle deficiency qi inverse syndrome group (P0.05); there was no significant difference in UES length and UES residual pressure between the groups (P0.05). (2) LES dynamic parameters: in LES resting pressure group, middle deficiency Qi inverse syndrome group, The cold and heat disorder syndrome group was significantly lower than the other three groups, There was no significant difference in LES length, 4 s comprehensive relaxation pressure and LES hypobaric ratio between the groups (P0.05). (3), and in the distal contraction integral (DCI), there was no significant difference between the three groups (P0.05), and there was no significant difference between the two groups in the length of LES, the comprehensive relaxation pressure of 4 s, and the ratio of low pressure to low pressure of LES (P0.05). (3). The liver and stomach stagnation syndrome group was higher than the middle deficiency qi inverse syndrome group and the cold heat disorder syndrome group (P0.05). In the peristaltic interruption, the deficiency of qi in the syndrome group was higher than that in the cold and heat disorder syndrome group (P0.05). There was no significant difference in the (DL) of the distal latency of (CFV), (P0.05). (4). In the contractile intensity, the phlegm dampness resistance syndrome group was higher than the other four groups (P0.05). In the ratio of invalid contraction, phlegm dampness internal obstruction syndrome group was lower than other four groups (P0.05). (5) in wet pharynx success rate, phlegm dampness internal obstruction syndrome group was higher than cold and heat disorder syndrome group, liver and stomach disharmony syndrome group and liver stomach stagnation heat syndrome group (P0.05), at the same time, The central deficiency of qi inverses syndrome group was lower than that of cold and heat disorder syndrome group, liver and stomach stagnation syndrome group and phlegm dampness internal obstruction syndrome group (P0.05). Conclusion: the most common syndromes of GERD are cold and heat disorder, followed by liver and stomach stagnation, disharmony of liver and stomach, internal obstruction of phlegm and dampness, and inverses of middle deficiency and qi. Different types and ages of GERD patients, UES resting pressure, LES resting pressure, and invalid contraction of DCI, are the most common syndrome types. Esophageal contraction intensity, wet pharynx success rate has certain correlation.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259
[Abstract]:Objective: to investigate the distribution of TCM syndromes of gastroesophageal reflux disease (GERD) and its influencing factors, and to study the correlation between these syndromes and their dynamic parameters based on high resolution esophageal manometry (HRM). Methods: according to the diagnostic criteria of western medicine for GERD, 114 patients with GERD were included in the study. The information including sex, age, height, weight, Helicobacter pylori (HP) infection was collected. According to the diagnostic criteria of TCM, the doctors with deputy director and above were divided into five groups: cold and heat disorder syndrome, liver and stomach stagnation syndrome, liver and stomach disharmony syndrome, phlegm dampness internal obstruction syndrome, middle deficiency qi inverse syndrome, and high resolution esophageal manometry. The dynamic parameters of the upper esophageal sphincter (UES),) lower esophageal sphincter (LES),) esophagus were recorded and the correlation of different TCM syndromes and their dynamic parameters were analyzed. The result is 1: 1. The distribution pattern of TCM syndromes and its influencing factors were 39 cases (34.2%) in the cold and heat disorder syndrome group, 27 cases (23.7%) in the liver and stomach stagnation syndrome group, 21 cases (18.4%) in the liver and stomach disharmony syndrome group, 16 cases (14.0%) in the phlegm dampness and internal obstruction syndrome group, and 11 cases in the middle deficiency and qi inverse syndrome group. There was no statistical difference between the distribution of syndromes and the composition of western medicine typing (P0.05). In terms of age, the incidence of liver and stomach disharmony syndrome and stagnation of heat of liver and stomach in male group was higher than that in female group, and the other three types of males were lower than female. There was no statistical difference among the three groups (P0.05). The average age of onset of the syndrome was (60.45 卤9.99) years old, which was significantly higher than that of the other four types (P0.05), and the age distribution of each group was different (P0.05). There was no significant difference in body mass index (BMI) and HP infection rate among the groups (P0.05). Study on esophageal dynamic parameters (1) UES dynamic parameters: in UES resting pressure, The phlegm dampness internal obstruction syndrome group was lower than the liver and stomach stagnation heat syndrome group and the middle deficiency qi inverse syndrome group (P0.05); there was no significant difference in UES length and UES residual pressure between the groups (P0.05). (2) LES dynamic parameters: in LES resting pressure group, middle deficiency Qi inverse syndrome group, The cold and heat disorder syndrome group was significantly lower than the other three groups, There was no significant difference in LES length, 4 s comprehensive relaxation pressure and LES hypobaric ratio between the groups (P0.05). (3), and in the distal contraction integral (DCI), there was no significant difference between the three groups (P0.05), and there was no significant difference between the two groups in the length of LES, the comprehensive relaxation pressure of 4 s, and the ratio of low pressure to low pressure of LES (P0.05). (3). The liver and stomach stagnation syndrome group was higher than the middle deficiency qi inverse syndrome group and the cold heat disorder syndrome group (P0.05). In the peristaltic interruption, the deficiency of qi in the syndrome group was higher than that in the cold and heat disorder syndrome group (P0.05). There was no significant difference in the (DL) of the distal latency of (CFV), (P0.05). (4). In the contractile intensity, the phlegm dampness resistance syndrome group was higher than the other four groups (P0.05). In the ratio of invalid contraction, phlegm dampness internal obstruction syndrome group was lower than other four groups (P0.05). (5) in wet pharynx success rate, phlegm dampness internal obstruction syndrome group was higher than cold and heat disorder syndrome group, liver and stomach disharmony syndrome group and liver stomach stagnation heat syndrome group (P0.05), at the same time, The central deficiency of qi inverses syndrome group was lower than that of cold and heat disorder syndrome group, liver and stomach stagnation syndrome group and phlegm dampness internal obstruction syndrome group (P0.05). Conclusion: the most common syndromes of GERD are cold and heat disorder, followed by liver and stomach stagnation, disharmony of liver and stomach, internal obstruction of phlegm and dampness, and inverses of middle deficiency and qi. Different types and ages of GERD patients, UES resting pressure, LES resting pressure, and invalid contraction of DCI, are the most common syndrome types. Esophageal contraction intensity, wet pharynx success rate has certain correlation.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259
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