Study on Traditional Chinese Medicine constitution distribution in patients with chronic atrophic gastritis with intestinal metaplasia
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摘要: 目的 分析慢性萎缩性胃炎(CAG)伴肠化(IM)患者中医体质分布规律。方法 纳入2019年1月—2021年11月安徽中医药大学第一附属医院诊断为CAG伴IM的患者300例。记录患者一般资料，采用中医体质分类量表判定体质类型，对分类结果进行统计学分析。结果 本研究发现CAG伴IM患者以偏颇体质居多，尤其以气虚、气郁及湿热体质较常见。其中在性别发病方面差异无统计学意义(P>0.05)。发病年龄段以中老年人较为多见。男性以湿热质较多见，其次为气虚质及气郁质。40~60岁的人群发生CAG伴IM的患者比较多(P< 0.01)。不同肠化程度的CAG体质分布差异有显著性意义。轻、中度肠化的CAG体质差异无统计学意义(P>0.05)；中、重度肠化的CAG体质差异有统计学意义(P< 0.01)。轻、重度肠化的CAG体质差异有统计学意义(P< 0.05)。CAG伴IM患者体质Hp感染分布差异无统计学意义(P>0.05)。CAG伴IM患者伴糜烂及胆汁反流的体质分布，差异有显著统计学意义(P< 0.01)。结论 CAG伴IM患者以气虚质占比最多，其次为气郁质、湿热质。女性发病率高于男性，发病年龄段中老年人多见，轻中度患者较多见气虚、湿热及气郁体质。重度患者多见于气郁及阴虚体质。气虚质及湿热质易发生Hp感染。伴胆汁反流与糜烂主要存在于气虚，其次气郁、湿热较多见糜烂及胆汁反流。Abstract: Objective To analyze the distribution of TCM constitution in patients with chronic atrophic gastritis(CAG) and intestinal metaplasia(IM).Methods A total of 300 patients diagnosed with CAG with IM from January 2019 to November 2021 were enrolled. The general data of patients were recorded, the constitution types were determined by TCM constitution classification scale, and the classification results were statistically analyzed.Results In this study, it was found that the patients with CAG and IM were mostly biased constitution, especially Qi deficiency, Qi depression and damp-heat constitution. There was no significant difference in gender(P>0.05). The onset age is more common in the elderly. In males, damp-heat were more common, followed by Qi deficiency and Qi stagnation. There were more patients with chronic atrophic gastritis accompanied by intestinal metaplasia in 40-60 years old group(P< 0.01). There are obvious differences in constitution distribution of patients with chronic atrophic gastritis with different degrees of intestinal metaplasia. There was no difference in the constitution of chronic atrophic gastritis between mild and moderate intestinal metaplasia(P>0.05). There were differences between moderate and severe cases of chronic atrophic gastritis(P< 0.01). There were differences between mild and severe cases of chronic atrophic gastritis(P< 0.05). There was no significant difference in Hp infection distribution in CAG patients with IM(P>0.05). There was significant difference in constitution distribution of chronic atrophic gastritis patients with erosion and bile reflux(P< 0.01).Conclusion In CAG patients with IM, Qi-deficiency is most common followed by Qi-stagnation and damp-heat. The incidence rate in females is higher than that in males, and the incidence is more common in middle-aged and elderly people, and the physique of Qi deficiency, damp-heat and Qi stagnation are more common in mild and moderate patients. Severe patients are more common in Qi depression and Yin deficiency constitution. Qi deficiency and damp-heat are prone to helicobacter pylori infection. Bile reflux and erosion mainly occurred in Qi deficiency, followed by Qi depression and dampness and heat.
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表 1 CAG伴IM体质分布情况
阳虚质 气虚质 气郁质 痰湿质 阴虚质 血瘀质 湿热质 平和质 特禀质 合计 例数 31 68 55 37 22 19 53 10 5 300 频率/% 10.3 22.7 18.3 12.3 7.3 6.3 17.7 3.3 1.6 100.0 
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表 2 不同性别CAG伴IM中医体质分布情况
例 性别 阳虚质 气虚质 气郁质 痰湿质 阴虚质 血瘀质 湿热质 平和质 特禀质 合计 男性 15 25 22 14 8 8 32 6 2 132 女性 16 43 33 23 14 11 21 4 3 168 合计 31 68 55 37 22 19 53 10 5 300
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表 3 不同年龄CAG伴IM中医体质分布情况
例 年龄/岁 阳虚质 气虚质 气郁质 痰湿质 阴虚质 血瘀质 湿热质 平和质 特禀质 合计 ≤40 2 3 9 4 1 1 6 8 1 35 41~60 16 26 30 18 7 6 29 1 3 136 ≥61 13 39 16 15 14 12 18 1 1 129 总计 31 68 55 37 22 19 53 10 5 300
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表 4 不同程度肠化的CAG伴IM体质分布情况
例 程度 阳虚质 气虚质 气郁质 痰湿质 阴虚质 血瘀质 湿热质 平和质 特禀质 合计 轻度 11 29 20 8 5 2 21 7 3 106 中度 15 29 24 26 6 9 27 2 1 139 重度 5 10 11 3 11 8 5 1 1 55 总计 31 68 55 37 22 19 53 10 5 300
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表 5 CAG伴IM患者Hp感染体质分布情况
例 Hp感染 阳虚质 气虚质 气郁质 痰湿质 阴虚质 血瘀质 湿热质 平和质 特禀质 合计 无 23 25 31 20 11 11 17 5 4 147 有 8 43 24 17 11 8 36 5 1 153 合计 31 68 55 37 22 19 53 10 5 300
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表 6 CAG伴IM伴或不伴糜烂、胆汁反流分布情况
例 组别 阳虚质 气虚质 气郁质 痰湿质 阴虚质 血瘀质 湿热质 平和质 特禀质 合计 伴糜烂、胆汁反流 19 51 44 23 14 4 41 3 1 200 不伴糜烂、胆汁反流 12 17 11 14 8 15 12 7 4 100 合计 31 68 55 37 22 19 53 10 5 300
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