Characteristic analysis of Traditional Chinese Medicine syndrome elements of chronic atrophic gastritis based on OLGIM systems
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摘要: 目的 比较不同可操作的与胃癌风险联系的肠上皮化生评价(operative link for gastric intestinal metaplasia assessment，OLGIM)分期的慢性萎缩性胃炎(chronic atrophic gastritis，CAG)患者中医证素分布特征，探索影响CAG患者病情进展的中医证素。方法 对CAG患者进行问卷调查，采用证素辨证方法，分析其证素分布特征，探讨不同OLGIM证素分布特征与差异。结果 共纳入640例CAG患者，其中OLGIM低危组367例，OLGIM高危组273例。获得中医病位证素5个：胃、脾、肝、心(神)、肾；病性证素8个：气滞、湿阻、气虚、血瘀、热郁、阳虚、食积、阴虚。OLGIM低危组与高危组之间中医病位证素分布差异无统计学意义(P>0.05)；OLGIM高危组气虚、血瘀、阳虚证素占比较高，与低危组比较差异有统计学意义(P < 0.05)。OLGIM高危组患者复合证素比例显著高于OLGIM低危组(P < 0.05)。结论 CAG的病位主要在胃，与脾、肝、心(神)、肾密切相关；病性上总体呈现“虚实夹杂”的复合证候特点；随着CAG病情加重，虚、瘀的证素占比增加，可能在CAG患者胃癌风险增高中起了推动作用。Abstract: Objective To investigate and compare the distribution characteristics of Traditional Chinese Medicine(TCM) syndrome elements in patients with chronic atrophic gastritis(CAG) with different stages of operative link for gastric intestinal metaplasia assessment(OLGIM) systems associated with the risk of gastric cancer, and to explore the TCM syndrome elements affecting the progression of CAG.Methods Patients with CAG were investigated by questionnaire, syndrome factor differentiation method was used to analyze the distribution characteristics of syndrome factors, and the distribution characteristics and differences of different OLGIM syndrome factors were discussed.Results A total of 640 CAG patients were included, including 367 in the OLGIM low risk group and 273 in the OLGIM high risk group. Five TCM syndrome elements were obtained, which were stomach, spleen, liver, heart(spirit), kidney; there are 8 pathogenic syndromes, namely Qi stagnation, dampness, Qi deficiency, blood stasis, heat stagnation, Yang deficiency, food accumulation and Yin deficiency. There was no difference in the distribution of TCM disease location syndrome elements between OLGIM low-risk group and high-risk group(P>0.05), and the proportion of Qi deficiency, blood stasis and Yang deficiency syndrome elements in OLGIM high-risk group was increased, while the difference between low-risk group was statistically significant(P < 0.05). The proportion of complex syndrome in OLGIM high-risk group was significantly higher than that in OLGIM low-risk group(P < 0.05).Conclusion The disease position of CAG locates in the stomach, closely related to the spleen, liver, heart and kidney. The disease generally presents the characteristics of complex syndrome with "deficiency and solid inclusion"; with the aggravation of CAG, the proportion of syndrome elements of deficiency and stasis increases, which may play a role in promoting the increased risk of gastric cancer in CAG patients.
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表 1 患者的既往史和家族史分布情况
例(%) 既往史和家族史 OLGIM低危组(n=367) OLGIM高危组(n=273) HP感染史 是 176(47.96) 129(47.25) 否 191(52.04) 144(52.75) 消化性溃疡史 是 51(13.90) 39(85.71) 否 316(86.10) 234(14.29) 胃肠息肉史 是 75(20.44) 64(23.44) 否 292(79.56) 209(76.56) 胃癌史 是 0 0 否 367(100.00) 273(100.00) 消化道肿瘤家族史 是 63(17.17) 56(20.51) 否 304(82.83) 217(79.49) 
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表 2 患者的中医病位证素分布情况
例(%) 病位 OLGIM低危组(n=367) OLGIM高危组(n=273) 胃 367(100.00) 273(100.00) 脾 251(68.39) 197(72.16) 肝 192(52.32) 134(49.08) 心(神) 129(35.15) 109(39.93) 肾 66(17.98) 43(15.75)
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表 3 患者的中医病性证素分布情况
例(%) 病性 OLGIM低危组(n=367) OLGIM高危组(n=273) P 气滞 266(72.48) 203(74.36) 0.595 湿阻 118(32.15) 101(37.00) 0.170 气虚 105(28.61) 117(42.86) < 0.001 血瘀 98(26.70) 96(35.16) 0.021 热郁 87(23.71) 79(28.94) 0.135 阳虚 61(16.62) 69(25.27) 0.007 食积 53(14.44) 43(15.75) 0.646 阴虚 48(13.08) 33(12.09) 0.064
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表 4 OLGIM风险分期多因素相关性分析
因素 B 标准误差 P OR OR的95%CI 气虚 0.507 0.177 0.004 1.660 1.174~2.348 血瘀 0.412 0.177 0.020 1.510 1.067~2.138 阳虚 0.462 0.206 0.025 1.587 1.060~2.375 阴虚 -0.191 0.281 0.498 0.827 0.477~1.433 常量 -0.679 0.131 < 0.001 0.507
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