The correlation between Traditional Chinese Medical syndromes of autoimmune gastritis and its clinical features: a retrospective study
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摘要: 目的 研究自身免疫性胃炎证候类型与临床特征的关联性。方法 采用单中心回顾性横断面研究方法，共纳入69例自身免疫性胃炎患者。分析证候类型与人口学特征(性别、年龄、贫血史、甲状腺疾病史、糖尿病史、类风湿性疾病史、肿瘤史、Hp感染史)、内镜特征(胃窦萎缩、胃窦轮廓征、胃体黏膜岛、胃体白浊黏液、胃底白色隆起、增生性息肉、胆汁反流)、活检病理特征(胃体嗜铬样细胞增生、神经内分泌微巢、胃体小凹上皮增生、胃体黏膜肠上皮化生、胃体假幽门腺化生、胃体胰腺腺泡、胃体黏膜表层淋巴细胞浸润、胃体黏膜深层淋巴细胞浸润、胃体黏膜中性粒细胞浸润、胃体黏膜嗜酸粒细胞浸润、胃体黏膜胃底腺内淋巴细胞浸润、胃体黏膜成囊泡状腺管、胃窦黏化生膜小凹上皮增生、胃窦萎缩、胃窦纤维间质增生)的关联性。结果 脾胃虚弱证胃窦萎缩显著高于其他3组(P＜0.05)，胃体嗜酸粒细胞浸润显著低于其他3组(P＜0.05)；脾胃湿热证Hp感染史、胃镜下增生性息肉、胃体中性粒细胞浸润显著高于其他3组(P＜0.05)；肝胃不和证胃镜下胃体白浊黏液、胃底腺内淋巴细胞浸润比例显著低于其他3组(P＜0.05)；阴虚血瘀证糖尿病史比例显著高于其他3组(P＜0.05)。结论 自身免疫性胃炎患者不同证候类型各有其临床特征：脾胃虚弱证多存在胃窦萎缩，胃体嗜酸粒细胞浸润较少；脾胃湿热证多存在Hp感染史、增生性息肉、胃体中性粒细胞浸润；肝胃不和证较少出现胃体白浊黏液、胃底腺内淋巴细胞浸润；阴虚血瘀证多存在糖尿病史。Abstract: Objective To investigate the correlation between Traditional Chinese Medical syndromes of autoimmune gastritis and its clinical features.Methods A single center retrospective cross-sectional study was completed. A total of 69 autoimmune gastritis patients were enrolled in the study. The correlation between Traditional Chinese Medical Syndromes and demographic characteristics, endoscopic features and pathological characteristics of biopsy were analyzed.Results The atrophy of gastric antrum in group of spleen stomach weakness syndrome was significantly higher than that of the other three groups(P < 0.05), while the eosinophil infiltration of gastric body was significantly lower than that of the other three groups(P < 0.05). Hp infection history, hyperplastic polyp and neutrophil infiltration in gastric body in group of spleen stomach damp heat syndrome were significantly higher than those in the other three groups(P < 0.05). The proportion of white mucus and lymphocyte infiltration in gastric fundus glandin group of liver stomach disharmony syndrome were significantly lower than that in the other three groups(P < 0.05). The proportion of diabetes in group of Yin deficiency and blood stasis syndrome was significantly higher than that of the other three groups(P < 0.05).Conclusion Different syndrome types of patients with autoimmune gastritis have their own clinical characteristics: spleen stomach weakness syndrome is correlated with gastric antrum atrophy and correlated with eosinophil infiltration in the gastric body; spleen stomach damp heat syndrome is correlated with Hp infection history, hyperplastic polyp and neutrophil infiltration in gastric body; liver stomach disharmony syndrome is correlated with white mucus and lymphocyte infiltration in gastric fundus gland; Yin deficiency and blood stasis syndrome is correlated with the history of diabetes.
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表 1 证候类型与人口学特征
例，X±S，例(%) 证候 例数 男/女 年龄/岁 贫血史 甲状腺疾病史 糖尿病史 类风湿病史 肿瘤史 Hp感染史 脾胃虚弱证 23 11/12 59.61±15.95 6(26.09) 9(39.13) 3(13.04) 1(4.35) 3(13.04) 7(30.43) 脾胃湿热证 17 5/12 61.06±12.61 8(47.06) 7(41.18) 2(11.76) 1(5.88) 2(11.76) 11(64.71)1) 肝胃不和证 13 2/11 56.31±14.02 6(46.15) 8(61.54) 2(15.38) 1(7.69) 0 3(23.08) 阴虚血瘀证 16 5/11 61.06±9.78 5(31.25) 8(50.00) 7(43.75)1) 0 4(25.00) 6(37.50) χ2/F 4.363 0.383 2.624 1.957 6.387 1.796 5.314 6.823 P 0.225 0.766 0.453 0.581 0.094 0.616 0.150 0.078 组间两两比较，1)P＜0.05。 
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表 2 证候类型与内镜特征
例(%) 证候 例数 胃窦萎缩 胃体黏膜岛 胃体白浊黏液 胃底白色隆起 胃窦轮廓征 增生性息肉 胆汁反流 脾胃虚弱证 23 13(56.52) 4(17.39) 12(52.17) 1(4.35) 3(13.04) 1(4.35) 5(21.74) 脾胃湿热证 17 10(58.82) 2(11.76) 10(58.82) 1(5.88) 4(23.53) 5(29.41)1) 2(11.76) 肝胃不和证 13 9(69.23) 2(15.38) 2(15.38)1) 0 1(7.69) 2(15.38) 3(23.08) 阴虚血瘀证 16 7(43.75) 1(6.25) 11(68.75) 0 2(12.50) 0 3(18.75) χ2 1.953 1.223 9.041 2.272 1.636 9.523 0.891 P 0.582 0.748 0.029 0.518 0.651 0.023 0.828 组间两两比较，1)P＜0.05。
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表 3 证候类型与病理特征
例(%) 病理特征 脾胃虚弱证
(n=23)脾胃湿热证
(n=17)肝胃不和证
(n=13)阴虚血瘀证
(n=16)χ2 P 胃体 ECL增生 17(73.91) 9(52.94) 9(69.23) 10(62.50) 2.032 0.566 ECM 23(100.00) 16(94.12) 13(100.00) 16(100.00) 2.847 0.416 小凹上皮增生 12(52.17) 8(47.06) 10(76.92) 7(43.75) 3.779 0.286 肠上皮化生 17(73.91) 10(58.82) 9(69.23) 11(68.75) 1.027 0.795 假幽门腺化生 22(95.65) 17(100.00) 12(92.31) 15(93.75) 1.921 0.589 胰腺腺泡化生 4(17.39) 2(11.76) 4(30.77) 3(18.75) 1.719 0.633 表层淋巴细胞浸润 16(69.57) 8(47.06) 7(53.85) 8(50.00) 2.527 0.471 深层淋巴细胞浸润 23(100.00) 17(100.00) 13(100.00) 15(93.75) 2.972 0.396 中性粒细胞浸润 3(13.04) 6(35.29) 1(7.69) 1(6.25) 6.123 0.106 嗜酸粒细胞浸润 21(91.30) 17(100.00) 13(100.00) 16(100.00) 4.515 0.211 胃底腺内淋巴细胞浸润 23(100.00) 17(100.00) 11(84.62) 15(93.75) 6.037 0.110 囊泡状腺管 15(65.22) 12(70.59) 7(53.85) 10(62.50) 0.922 0.820 胃窦 小凹上皮增生 16(69.57) 8(47.06) 8(61.54) 10(62.50) 2.346 0.504 萎缩 13(56.52) 5(29.41) 5(38.46) 4(25.00) 4.936 0.177 纤维间质增生 16(69.57) 8(47.06) 9(69.23) 11(68.75) 2.761 0.430
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