脾虚证183例分级与木糖及胰功肽试验的相关性研究

目的研究脾虚证分级量化与木糖及胰功肽试验的相关性及科学依据。方法内镜及活检确诊的浅表性胃炎115例,萎缩性胃炎15例,消化性溃疡19例及慢性结肠炎34例,把慢性胃肠病分为6型。即脾胃虚弱证(包括虚寒)、肝胃不和证、脾胃(大肠)湿热证、脾胃阴虚证、瘀血阻络证和脾肾阳虚证。进行证候分级量化,用木糖、胰功肽试验等指标同步检测。结果研究发现慢性胃肠病患者木糖、胰功肽含量均明显低于正常组(P<0.05-0.01),中医证型除脾胃(大肠)湿热证的木糖排泄率接近正常人外,其它证型的木糖、胰功肽水平均明显低于正常人(P<0.05-0.01)。对脾虚证及肝胃不和证进行分级量化,首次发现脾胃虚弱(寒)证随着症状分级的加重,木糖排泄率逐渐下降(P<0.01),肝胃不和证随着症状分级的加重,胰功肽都逐渐下降(P<0.001)。这为探讨证型的病理生理提供了可信的科学依据。结论木糖的变化规律较好地反映脾虚证的特异性,胰功肽的变化规律较好地反映肝胃不和证的特异性。

Pixu syndrome grading and its relationship with d-xylose and BT-PABA absorption in 183 patients

AIMS To study the grading of pixu(spleen deficiency)syn- drome and the scientific basis of its relationship with absorption of D-Xylose and BT-PABA. METHODS The present study included 115 cases of chronic su- perficial gastritis,15 cases of chronic atrophic gastritis,19 cases of peptic ulcer and 34 cases of chronic colitis.All of them were diagnosed by endoscopy and biopsies.Chronic gastrointestinal diseases could be categorized into six types,namely,spleen and stomach asthenia syndrome(including asthenia and cold),dishar- mony between liver and stomach,damp and heat of spleen and stomach(bowel)syndrome,spleen-stomach-Yin deficiency,blood stasis and spleen-kidney-Yang deficiency.Grading of these syn- dromes were made with concomitant estimation of d-xylose and BT-PABA tests. RESULTS Patients with chronic gastrointestinal diseases showed diminished urinary level of d-xylosc and that of BT- PABA,as compared with normal,(P<0.05),except those with damp and heat of spleen-bowel syndrome.The excretory rate of d-xylosc was neary normal,while the levels of d-xylose and BT-PABA were lower than those of the normal,(P<0.05-0. 01).In regard to the grading of spleen deficiency and the dishar- mony between liver and stomach syndromes,the excretory rate of D-Xylose decreased gradually(P<0.01 )as the severity of symp- toms increased;in disharmony between liver and stomach syndrome,the excretory rate of BT-PABA also decreased(P<0. 01)as symptoms worsened.These provided scientific proofs for appraisal of the pathophysiology of these syndromes. CONCLUSIONS Changes of d-xylose can reflect the specifici- ty of pixu syndrome whereas changes of BT-PABA reflect the specificity of disharmony between liver and stomach syndrome.