262例慢性胃炎胃黏膜病变与中医辨证分型的相关性观察

目的研究慢性胃炎的胃黏膜病变与中医辨证分型的相关性,为临床观察慢性胃炎病情变化、判断疗效以及调整治疗方案提供参考依据。方法依据慢性胃炎的中医病因病机、西医发病机制等理论,通过对262例慢性胃炎患者的胃镜下胃黏膜改变和病理组织学改变的观察,比较不同证型之间各种胃黏膜病变的构成比和发生率。结果肝胃气滞证和脾胃虚寒证占慢性胃炎的大部分(66.8%);肝胃气滞证和胃热炽盛证以浅表性胃炎为主(P<0.01),脾胃虚寒证和胃阴亏虚证以萎缩性胃炎为主(P<0.01)。伴有肠上皮化生的胃炎多见于胃阴亏虚证(P<0.01),出现胆汁反流的胃炎中绝大部分见于肝胃气滞证(P<0.01),幽门螺旋杆菌感染率在各证之间无显著性差异。结论慢性胃炎的不同证型与胃黏膜病变之间存在一定的相关性,可参考辨证分型评估胃黏膜病变的情况。

Correlative observation between gastric mucosa pathological changes and differentiation of symptoms and signs for classification of syndrome with traditional Chinese medicine in 262 patients with chronic gastritis

Objective It is to study the relationship between gastric mucosa pathological change and differentiation of symptoms and signs for classification of syndrome with traditional Chinese medicine in chronic gastritis and to offer referred basis for observing pathogenetic condition change of chronic gastritis,judging curative effect and adjusting therapeutic regimen.Methods Based on pathogenesis of chronic gastritis on both traditional Chinese medicine and western medicine,262 patients were observed through gastroduodenoscopy and the gastric mucosa was biopsied to get a pathological diagnosis.The constituent ratio and incidence rate of gastric mucosa pathological changes in every type were compared with the others.Results Most types of chronic gastritis were stagnation of liver-Qi and stomach-Qi and deficiency cold of spleen and stomach syndrome(66.8%).Main type of stagnation of liver-Qi and stomach-Qi syndrome and hyperactivity of stomach-heat syndrome was superficial gastritis(P<0.01).Main type of deficiency cold of spleen and stomach syndrome and insufficiency of stomach-Yin syndrome was atrophic gastritis(P<0.01).Gastritis with intestinal metaplasia mainly belonged to insufficiency of stomach-Yin syndrome(P<0.01).Gastritis with bile-reflux mainly belonged to stagnation of liver-Qi and stomach-Qi syndrome(P<0.01).There was no significant difference on H.pylori infection rate among those types.Conclusion There is certain relationship among those types in chronic gastritis and gastric mucosa pathological changes.Gastric mucosa pathological changes can be evaluated with referring differentiation of symptoms and signs for classification of syndrome.