Research on correlation between risk factors, distribution of traditional Chinese medicine syndromes and endoscopic pathology of chronic atrophic gastritis in Chongqing area
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摘要: 目的 探讨慢性萎缩性胃炎(chronic atrophic gastritis，CAG)患者的相关危险因素、中医证素与内镜病理的相关性。方法 以重庆地区经胃镜、病理确诊的606例CAG患者为研究对象，收集患者的临床资料、危险因素、中医症状、胃镜及病理诊断结果。先对危险因素进行描述性分析，然后对CAG相关的危险因素、中医证素与萎缩范围及肠化进行单因素相关性分析，最后对相关性分析中差异有统计学意义的因素进一步采用二项logistic回归分析风险比。结果 描述性统计分析显示，危险因素中辛辣饮食、油腻饮食、饮酒、吸烟、幽门螺杆菌感染与CAG相关，且CAG伴发失眠的比例为55.0%，其中部分患者合并焦虑、抑郁；病位证素上，脾、胃为主；病性证素上，气滞证最高，湿证、热证、气虚证、气逆证、燥证、瘀血证占比次之。单因素相关分析显示，胆汁反流、瘀血证、燥证与萎缩范围相关，吸烟、饮酒、胆汁反流、瘀血证、热证与肠化相关，饮酒与热证相关，吸烟与燥证相关，胆汁反流与气逆证、热证相关；二项logistic回归分析显示，胆汁反流有引起萎缩范围增大的风险(OR=3.098)，燥证、瘀血证与萎缩范围大小密切相关(OR=2.935、1.885)；胆汁反流、吸烟、饮酒、瘀血证、热证与肠化密切相关(OR=13.638、1.551、2.142、1.886、2.301)。结论 危险因素中年龄、辛辣饮食、油腻饮食、饮酒、吸烟、幽门螺杆菌感染与CAG相关，应加强健康宣教；CAG病位重在脾、胃，病性以气滞证、气虚证、湿证、热证、燥证、瘀血证为主，治疗可从益气健脾和胃，行气活血，清热利湿，润燥兼顾入手。Abstract: Objective To investigate the correlation of risk factors, traditional Chinese medicine(TCM) syndrome elements and endoscopic pathology in patients with chronic atrophic gastritis(CAG).Methods Six hundred and six patients with CAG diagnosed by gastroscopy and pathology in Chongqing area were collected. The general data, risk factors, TCM symptoms, gastroscopy and pathological diagnosis of the patients were collected. First, descriptive analysis of risk factors was carried out, and then univariate correlation analysis was conducted for CAG related risk factors, TCM syndrome elements, atrophy scope and enterosis. Finally, binomial logistic regression was used to analyze risk ratio when correlation analysis was statistically significant.Results Descriptive statistical analysis showed that among the risk factors, spicy diet, greasy diet, drinking, smoking and Helicobacter pylori(HP) infection were related to CAG, and CAG was associated with insomnia in 55.0% of the cases, some of these patients have anxiety and depression. In terms of disease location syndrome, spleen and stomach were the main symptoms, and in terms of disease syndrome, Qi stagnation syndrome was the highest, followed by dampness syndrome, heat syndrome, Qi deficiency syndrome, Qi reverse syndrome, internal dryness syndrome and blood stasis syndrome. Single factor correlation analysis showed that bile reflux, blood stasis syndrome and dryness syndrome were related to atrophy range, smoking, drinking, bile reflux syndrome, blood stasis syndrome and heat syndrome were related to intestinal conversion, drinking was related to heat syndrome, smoking was related to dryness syndrome, bile reflux was related to Qi reversal syndrome and heat syndrome. Binomial logistic regression analysis showed that the risk of increased atrophy area caused by bile reflux(OR=3.098), and dryness syndrome and blood stasis syndrome were closely related to the size of atrophy area(OR=2.935, 1.885). Bile reflux, smoking, drinking, the syndrome of blood stasis and heat were closely related to intestinal metaplasia(OR=13.638, 1.551, 2.142, 1.886, 2.301).Conclusion Among the risk factors, age, spicy diet, greasy diet, drinking, smoking and HP infection are related to CAG, should be strengthened health education, the disease is mainly in the spleen and stomach, and the diseases are mainly Qi stagnation, Qi deficiency, dampness, heat, internal dryness and blood stasis. Treatment can be started from invigorating Qi and invigorating spleen and stomach, promoting Qi and blood circulation, clearing heat and dampness, moistening dryness.
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表 1 危险因素、病性证素与萎缩范围的单因素分析
例 影响因素 萎缩C1~C3(544例) 萎缩O1~O3(62例) χ2 P 否 是 否 是 吸烟 397 147 41 21 1.303 0.254 饮酒 345 199 36 26 0.684 0.408 辛辣饮食 256 288 33 29 0.848 0.357 高盐饮食 484 60 52 10 1.417 0.234 油腻饮食 315 229 35 27 0.048 0.826 失眠 247 297 26 36 0.271 0.603 HP感染 395 149 45 17 < 0.001 0.996 焦虑 455 89 56 6 1.880 0.170 抑郁 514 30 61 1 1.746 0.186 胆汁反流 457 87 39 23 16.685 < 0.001 气虚证 245 299 25 37 0.501 0.479 气滞证 59 485 8 54 0.240 0.624 气逆证 326 218 41 21 0.896 0.344 燥证 392 152 29 33 16.777 < 0.001 瘀血证 447 97 44 18 4.542 0.033 湿证 89 455 9 53 0.140 0.709 热证 185 359 20 42 0.076 0.783 
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表 2 危险因素、病性证素与肠化的单因素分析
例 影响因素 无肠化(371例) 肠化(235例) χ2 P 否 是 否 是 吸烟 281 90 157 78 5.729 0.017 饮酒 259 122 112 113 19.740 ＜0.001 辛辣饮食 182 189 107 128 0.716 0.397 高盐饮食 330 41 206 29 0.234 0.629 油腻饮食 213 158 137 98 0.046 0.830 失眠 157 214 116 119 2.833 0.089 HP感染 270 101 170 65 0.014 0.907 焦虑 313 58 198 37 0.001 0.971 抑郁 348 23 227 8 2.316 0.128 胆汁反流 354 17 142 93 118.572 ＜0.001 气虚证 172 199 98 137 1.264 0.261 气滞证 36 335 31 204 1.780 0.182 气逆证 222 149 145 90 0.209 0.647 燥证 266 105 155 80 2.236 0.135 瘀血证 315 56 176 59 9.380 0.002 湿证 60 311 38 197 ＜0.001 0.999 热证 151 220 54 181 20.186 ＜0.001
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表 5 胆汁反流与气逆证、热证的相关性分析
例 无胆汁反流(496例) 胆汁反流(110例) χ2 P 气逆证 否 335 32 55.727 < 0.001 是 161 78 热证 否 183 22 11.484 0.001 是 313 88
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表 6 胆汁反流、燥证、瘀血证与萎缩范围的回归分析
指标 B SE P OR 95%CI 胆汁反流 1.131 0.288 < 0.001 3.098 1.762~5.445 燥证 1.077 0.272 < 0.001 2.935 1.722~5.000 瘀血证 0.634 0.301 0.035 1.885 1.044~3.403
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表 7 吸烟、饮酒、胆汁反流、瘀血证、热证与肠化的回归分析
指标 B SE P OR 95%CI 吸烟 0.439 0.184 0.017 1.551 1.082~2.225 饮酒 0.762 0.174 < 0.001 2.142 1.527~3.005 胆汁反流 2.613 0.282 < 0.001 13.638 7.849~23.696 瘀血证 0.634 0.209 0.002 1.886 1.252~2.840 热证 0.833 0.188 < 0.001 2.301 1.593~3.323
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