137例活动期溃疡性结肠炎患者中医证型与肠黏膜象关系的研究

目的观察137例活动期溃疡性结肠炎(active ulcerative colitis,AUC)患者的证型分布特点,并分析其肠黏膜表现与证候的关系。方法对137例AUC患者进行辨证分型,行肠镜检查,观察其肠黏膜表现,分析其辨证分型和肠黏膜象的关系。结果主证型分布中,大肠湿热证>脾肾阳虚证>肝郁脾虚证>脾气亏虚证>血瘀肠络证>阴血亏虚证。肠黏膜象频率出现超过50%以上的为黏膜损害、黏膜颜色异常、充血、水肿、糜烂、溃疡、脓苔、血管模糊或消失。水肿、糜烂、溃疡以大肠湿热证、脾肾阳虚证、肝郁脾虚证居多(P<0.05,P<0.01);息肉、肠蠕动异常、颗粒感以大肠湿热证、肝郁脾虚证居多(P=0.010);皱襞变浅或结肠袋消失以脾肾阳虚证、大肠湿热证居多(P=0.002);黏膜桥以脾肾阳虚证、肝郁脾虚证为多(P=0.280);质脆或接触性出血以大肠湿热证、脾气亏虚证、肝郁脾虚证为多(P=0.045);肠出血淡红色血以脾气亏虚证为多,暗红色血以大肠湿热证为多(P=0.017);脓苔集中在大肠湿热证、脾肾阳虚证和肝郁脾虚证,白脓苔以脾肾阳虚证为多,黄脓苔以大肠湿热证为多(P<0.001);黏液以脾肾阳虚证、肝郁脾虚证、脾气亏虚证为多(P=0.012);肠腔狭窄或肠管纤维化、铅管样表现以血瘀肠络证为多(P=0.001),黏膜萎缩以血瘀肠络证和阴血亏虚证为多(P<0.001)。结论不同证型的肠黏膜具有不同的表现,从镜下肠黏膜的微观区别在一定程度上能印证中医宏观辨证。

Study on the Correlation between Chinese Medicine Syndrome and the Intestinal Mucosal Manifestations of 137 Patients with Active Ulcerative Colitis

Objective To observe the distribution features of Chinese medicine syndrome(CMS) in 137 patients with active ulcerative colitis(AUC),and to analyze the correlation between the intestinal mucosal manifestations and CMS.Methods Totally 137 AUC patients were syndrome typed.The intestinal mucosal manifestations were observed under endoscope,thus analyzing the correlation between the intestinal mucosal manifestations and CMS.Results In the distribution of main syndromes,the case numbers were sequenced as the damp-heat of Dachang syndrome> the yang deficiency of Pi-Shen syndrome>the Gan-depression and Pi-deficiency syndrome>the deficiency of Pi-qi syndrome>the blood stasis of the intestine meridian syndrome>the deficiency of blood and yin syndrome.The frequency of intestinal mucosal manifestations more than 50% covered mucosal damage,abnormal mucosa membrane color,congestion,edema,erosion,ulcer,pus tongue fur,and obscure or disappeared blood vessels.The edema,erosion,and ulcer occurred more in the damp-heat of Dachang syndrome,followed by the yang deficiency of Pi-Shen syndrome and the Gan-depression and Pi-deficiency syndrome(P<0.05,P<0.01).Polypi,abnormal enterokinesia,grainy occurred more in the damp-heat of Dachang syndrome and the Gan-depression and Pi-deficiency syndrome(P=0.010).Shallower plica or disappeared sacculations of colon occurred more in the yang deficiency of Pi-Shen syndrome and the damp-heat of Dachang syndrome(P=0.002).The mucosa bridge occurred more in the yang deficiency of Pi-Shen syndrome and Gan-depression and Pi-deficiency syndrome(P=0.280).Fragility or contact bleeding occurred more in the damp-heat of Dachang syndrome,the deficiency of Pi-qi syndrome,and Gan-depression and Pi-deficiency syndrome(P=0.045).Pale blood of the intestinal hemorrhage occurred more in the deficiency of Pi-qi syndrome while dark blood occurred more in the damp-heat of Dachang syndrome(P=0.017).Pus tongue fur occurred more in the damp-heat of Dachang syndrome,the yang deficiency of Pi-Shen syndrome,and the Gan-depression and Pi-deficiency syndrome.White pus tongue fur occurred more in the yang deficiency of Pi-Shen syndrome while yellow pus tongue fur occurred more in the damp-heat of Dachang syndrome(P<0.001).Mucus occurred more in the yang deficiency of Pi-Shen syndrome,the Gan-depression and Pi-deficiency syndrome,and the deficiency of Pi-qi syndrome(P=0.012).Narrow enteric cavity or intestinal canal fibrosis,lead pipe like manifestations occurred more in the blood stasis of the intestine meridian syndrome(P=0.001).Atrophic mucosa occurred more in the blood stasis of the intestine meridian syndrome and the deficiency of blood and yin syndrome(P<0.001).Conclusions The intestinal mucosal manifestations of AUC showed certain laws in CMS.The microscopic differences could verify macroscopic CMS to some extent.