世界中医药

作者	单位
曹志军1，左明焕2	1 北京市丰台中西医结合医院消化科，北京，100072； 2 北京中医药大学东方医院肿瘤科，北京，100078

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中文摘要:

目的：分析慢性萎缩性胃炎的不同中医证型分布，并总结其与胃黏膜形态改变及病理变化之间的关系，为临床辨证论治提供客观依据，更早地进行癌前干预，防止癌变的发生。方法：选取2012年1月至2017年1月北京市丰台中西医结合医院消化科门诊及病房收治的慢性萎缩性胃炎患者230例，参照2011年中华医学会颁布的慢性萎缩性胃炎中西医结合诊疗共识进行辨证分型，并对患者的年龄、性别、胃镜变化及病理表现等进行分类分级。结果：230例患者中女130例，男100例，年龄18～85岁，平均年龄（54.25±14.25）岁，41～60岁有145例，占63.04%，其中以51~60岁的病例数最多，发病率高于其他年龄层，各年龄层男女性别分布差异无统计学意义（P>0.05）。230例中脾胃虚弱型81例，占35.22%；肝脾不和型69例，占30%；脾胃湿热型46例，占20%；胃阴不足型30例，占13.04%；胃络瘀血型4例，占1.74%。胃镜下萎缩程度I级，各证型间差异有统计学意义（P<0.05）；脾胃虚弱型与肝脾不和型差异有统计学意义（P<0.05），脾胃虚弱型与胃阴不足型差异有统计学意义（P<0.05），肝胃不和型、脾胃湿热型及胃阴不足型之间差异无统计学意义（P>0.05）；Ⅱ级及Ⅲ级，各证型之间差异无统计学意义（P>0.05）。胃镜下见单纯萎缩性变化，亦可伴出血、伴增生、伴糜烂、伴胆汁反流，各证型间差异无统计学意义（P>0.05）。胃黏膜病理表现轻度，各证型之间差异有统计学意义（P<0.05），其中脾胃虚弱型及脾胃湿热型发病率最高，但2种证型差异无统计学意义（P>0.05），脾胃虚弱型与胃阴不足型之间差异有统计学意义（P<0.05），肝脾不和型与胃阴不足型差异无统计学意义（P>0.05）；中度，各证型差异有统计学意义（P<0.01），两两比较中肝脾不和型、胃阴不足型及脾胃湿热型发病率差异无统计学意义（P>0.05），与脾胃虚弱型及胃络瘀血型比较，差异均有统计学意义（P<0.05）。重度，各证型之间差异有统计学意义（P<0.05），肝脾不和型及胃阴不足型差异有统计学意义（P<0.05），而脾胃虚弱型及胃阴不足型之间差异无统计学意义（P>0.05）。结论：慢性萎缩性胃炎存在脾胃虚弱型、肝脾不和型、脾胃湿热型、胃阴不足型及胃络瘀血型，不同证型间胃镜下形态与黏膜病理改变存在一定的差异。

English Summary:

To analyze the distribution of different Traditional Chinese Medicine (TCM) syndromes of chronic atrophic gastritis and summarize its relationship with the changes of gastric mucosa morphology and pathological changes and provide an objective basis for clinical syndrome differentiation.Methods:A total of 230 patients with chronic atrophic gastritis admitted to our department for gastroenterology and ward in the recent 5 years were diagnosed based on syndrome differentiation and classified according to the Consensus of diagnosis and treatment of chronic atrophic gastritis combined with traditional Chinese and western medicine issued by the Chinese Medical Association in 2011.The patients' age, sex, gastroscope changes and pathological features were classified and graded.SPSS 20.0 software was used to conduct statistical analysis of the above data, and the difference was statistically significant at P<0.05.Results: In 230 cases of patients, there were 130 female cases, 100 male cases, aged 18-85 years, with an average (54.25±14.25) years old.145 cases in 41 to 60 years age, accounted for 63.04%, of which 51-60 years old had the largest number of cases.The incidence was higher than other age groups.After testing, there was no significant difference in sex distribution between men and women of all ages (P>0.05). In 230 cases, there were 81 cases with spleen and stomach weakness, accounting for 35.22%; 69 cases with liver and spleen incompatibility, accounting for 30%; 46 cases with spleen and stomach dampness heat, accounting for 20%; 30 cases of stomach yin insufficiency, accounting for 13.04%; 4 cases of blood stasis in stomach, accounting for 1.74%. Comparison of degree of atrophy under gastroscopy：Grade I-There was a significant difference between each syndrome type (P<0.05).There was a statistically significant difference between spleen and stomach weakness and liver and spleen incompatibility (P<0.05), spleen and stomach weakness and stomach yin insufficiency (P<0.05), but there was no significant difference between liver and spleen incompatibility, spleen and stomach dampness heat and stomach yin insufficiency (P>0.05).There was no statistically significant difference between Grade II, Grade II and other syndromes (P>0.05).Gastroscopy showed a simple change of atrophy, but also with hemorrhage, hyperplasia, erosion, bile reflux, without significant difference between the various syndromes (P>0.05). Gastric mucosal pathological features were divided into 3 grades of mild, moderate and severe, there was statistically significant difference between mild and other syndromes (P<0.05), of which the incidence of spleen and stomach weakness and spleen and stomach dampness heat were the highest.There was no significant difference between these two syndromes (P>0.05).There was a significant difference between the spleen and stomach weakness and stomach yin insufficiency (P<0.05), but there was no significant difference between liver and spleen incompatibility and stomach yin insufficiency (P>0.05).There was significant difference between mild and other syndromes (P<0.01).There was a similar incidence for liver and stomach incompatibility, stomach yin insufficiency, and spleen and stomach dampness heat (P>0.05).There was significant difference between spleen and stomach weakness and blood stasis in stomach (P<0.05).There was significant difference between severe and other syndromes (P<0.01).There was significant difference between liver and spleen incompatibility and stomach yin insufficiency (P<0.05), while there was no significant difference between spleen stomach deficiency and stomach yin insufficiency (P>0.05).Conclusion:Chronic atrophic gastritis is characterized by spleen and stomach weakness, liver and spleen incompatibility, spleen stomach dampness heat, stomach yin insufficiency and blood stasis in stomach.There are some differences between the different forms of gastroscopy and pathological changes of mucosa.

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