Relationship between distribution of Traditional Chinese Medicine syndrome types of chronic atrophic gastritis and precancerous lesions of gastric cancer and gastroscopic findings and pathological changes
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摘要: 目的 研究慢性萎缩性胃炎(chronic atrophic gastritis，CAG)及CAG癌前病变中医证型分布，探讨中医证型与胃镜下表现及病理改变的相关性，为CAG及CAG癌前病变的诊疗提供客观依据。方法 采用回顾性研究方法，对牛兴东教授专家门诊收治的271例患者的病历资料进行总结分析，采用SPSS 22.0统计软件分析探讨发病情况及证型分布，采用logistic回归分析不同中医证型与胃镜下表现及病理表现的相关性。结果 271例患者中医证型分布占比由高到低依次为脾胃虚弱型、肝胃气滞型、脾胃湿热型、胃络瘀阻型、肝胃郁热型、胃阴不足型。在证型与病理变化的相关性分析中，肝胃气滞型以食管反流偏多，脾胃湿热型伴发糜烂者居多，胃络瘀阻型则多伴发异型增生，余证型与胃镜下表现及病理改变未见相关性。结论 CAG中医证型主要为脾胃虚弱型、肝胃气滞型等，其中肝胃气滞型、脾胃湿热型、胃络瘀阻型与胃镜下表现及病理表现存在相关性，可为中医辨证提供参考。临床中可通过中医宏观辨证与微观辨证相结合进行准确辨证，注重“调气活血解毒”，对于改善患者生活质量及截断病势、延缓恶化有积极意义。Abstract: Objective To study the distribution of Traditional Chinese Medicine(TCM) syndromes of chronic atrophic gastritis(CAG) and precancerous lesions of CAG, and to explore the correlation between syndromes and gastroscopic findings and pathological changes, so as to provide objective basis for the diagnosis and treatment of precancerous lesions of CAG and CAG.Methods Through a retrospective study of the medical records of 271 patients in Professor NIU Xingdong's expert clinic, a CAG database of NIU Xingdong Studio was established. The data were statistically analyzed using SPSS 22.0 statistical software to analyze the incidence and distribution of the syndrome of the disease. Logistic regression was used to analyze the correlation between different TCM syndromes and gastroscopic findings and pathological findings.Results Two hundred and seventy-one cases of TCM syndrome distribution ratio from high to low were spleen and stomach weakness type, liver and stomach Qi stagnation type, spleen and stomach damp-heat type, stomach collateral stasis type, liver and stomach stagnation heat type, stomach yin deficiency type. In the correlation between syndrome types and pathological changes, esophageal reflux was more common in liver-stomach Qi stagnation syndrome, erosion was more common in spleen-stomach damp-heat syndrome, and dysplasia was more common in stomach-collateral stasis syndrome. The remaining syndromes were not correlated with gastroscopic findings and pathological changes.Conclusion CAG TCM syndrome types are mainly spleen and stomach weakness type, liver and stomach Qi stagnation type, etc., of which liver and stomach Qi stagnation syndrome, spleen and stomach damp-heat syndrome, stomach collateral blood stasis syndrome and gastroscopic performance and pathological performance are correlated, which can provide a reference for TCM syndrome differentiation. Through the combination of macroscopic syndrome differentiation and microscopic syndrome differentiation of TCM for accurate syndrome differentiation, combined with the pathogenesis of TCM, the application of "regulating Qi, activating blood circulation and detoxifying method" treatment is of positive significance for improving the clinical quality of life of patients and truncating the disease, delaying deterioration.
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表 1 CAG患者年龄与性别构成情况
例(%) 年龄/岁 女 男 合计 < 35 7(2.50) 6(2.21) 13(4.80) 35~50 30(11.07) 48(17.71) 78(28.78) >50~65 76(28.04) 53(19.56) 129(47.60) >65 30(11.07) 21(7.75) 51(18.82) 合计 143(52.77) 128(47.23) 271(100.00) 
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表 2 CAG患者Hp感染情况
例 性别 Hp感染 合计 感染率/% 无 有 男 80 48 128 37.50 女 85 58 143 40.56 合计 165 106 271 39.11
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表 3 CAG患者Hp感染和年龄构成情况
例 年龄/岁 Hp感染 合计 感染率/% 无 有 < 35 6 7 13 53.85 35~50 47 31 78 39.74 >50~65 80 49 129 37.98 >65 32 19 51 37.25
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表 4 CAG患者病理表现和性别构成情况
例 性别 CAG癌前病变 合计 癌前病变比例% 有 无 男 75 53 128 58.59 女 64 79 143 44.76 合计 139 132 271 51.29
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表 5 CAG患者病理表现和年龄构成情况
例 年龄/岁 CAG癌前病变 合计 癌前病变比例% 有 无 < 35 4 9 13 30.77 35~50 44 34 78 56.41 >50~65 68 61 129 52.71 >65 23 28 51 45.10 合计 139 132 271 51.29
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表 6 CAG患者不同性别中医证型分布情况
例(%) 证型 男 女 合计 肝胃气滞型 31(41.89) 43(58.11) 74(27.31) 脾胃虚弱型 54(50.46) 53(49.53) 107(39.48) 肝胃郁热型 9(40.91) 13(59.09) 22(8.12) 脾胃湿热型 15(51.72) 14(48.27) 29(10.70) 胃络瘀阻型 15(55.56) 12(44.44) 27(9.96) 胃阴不足型 4(33.33) 8(66.67) 12(4.43) 合计 128(47.23) 143(52.77) 271(100.00)
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表 7 CAG患者不同年龄中医证型分布情况
例(%) 证型 年龄/岁 合计 < 35 35~50 >50~65 >65 肝胃气滞型 4(5.41) 19(25.68) 42(56.76) 9(12.16) 74(27.31) 脾胃虚弱型 6(5.61) 36(33.64) 51(47.66) 14(13.08) 107(39.48) 肝胃郁热型 1(4.55) 5(22.73) 9(40.91) 7(31.82) 22(8.12) 脾胃湿热型 1(3.45) 8(27.59) 14(48.28) 6(20.69) 29(10.70) 胃络瘀阻型 1(3.70) 6(22.22) 11(40.74) 9(33.33) 27(9.96) 胃阴不足型 0 4(33.33) 2(16.67) 6(50.00) 12(4.43) 合计 13(4.80) 78(28.78) 129(47.60) 51(18.82) 271(100.00)
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表 8 肝胃气滞型与胃镜下表现及病理变化的相关性分析
病理特征 B SE Wals df P Exp(B) 95%CI 下限 上限 肠化 0.180 0.304 0.350 1 0.554 1.197 0.660 2.172 糜烂 -0.367 0.288 1.619 1 0.203 0.693 0.394 1.219 息肉 -0.174 0.377 0.214 1 0.644 0.840 0.401 1.758 食管反流 1.084 0.418 6.733 1 0.009 2.955 1.304 6.700 胆汁反流 -0.202 0.681 0.088 1 0.767 0.817 0.215 3.105 异型增生 -0.771 0.357 4.664 1 0.031 0.462 0.230 0.931 黏膜内出血 -0.257 0.932 0.076 1 0.783 0.773 0.124 4.806 溃疡 -0.023 0.569 0.002 1 0.967 0.977 0.320 2.981 常量 -0.670 0.274 5.978 1 0.014 0.511
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表 9 脾胃虚弱型与胃镜下表现及病理变化的相关性分析
病理特征 B SE Wals df P Exp(B) 95%CI 下限 上限 肠化 0.287 0.280 1.054 1 0.305 1.332 0.770 2.304 糜烂 -0.258 0.265 0.948 1 0.330 0.773 0.460 1.298 息肉 0.025 0.339 0.005 1 0.942 1.025 0.528 1.990 食管反流 -0.802 0.459 3.051 1 0.081 0.448 0.182 1.103 胆汁反流 0.440 0.565 0.608 1 0.435 1.553 0.514 4.698 异型增生 -0.444 0.309 2.064 1 0.151 0.641 0.350 1.176 黏膜内出血 -0.362 0.861 0.176 1 0.674 0.696 0.129 3.766 溃疡 -0.106 0.513 0.043 1 0.836 0.899 0.329 2.459 常量 -0.168 0.257 0.426 1 0.516 0.895
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表 10 肝胃郁热型与胃镜下表现及病理变化的相关性分析
病理特征 B SE Wals df P Exp(B) 95%CI 下限 上限 肠化 -0.119 0.478 0.061 1 0.804 0.888 0.348 2.268 糜烂 0.262 0.504 0.270 1 0.603 1.299 0.484 3.488 息肉 -1.557 1.043 2.228 1 0.136 0.211 0.027 1.628 食管反流 -0.227 0.793 0.082 1 0.775 0.797 0.168 3.772 胆汁反流 0.476 0.815 0.342 1 0.559 1.610 0.326 7.953 异型增生 -1.031 1.073 0.924 1 0.336 0.357 0.044 2.918 黏膜内出血 1.459 0.882 2.735 1 0.098 4.300 0.763 24.221 溃疡 0.767 0.700 1.202 1 0.273 2.153 0.546 8.484 常量 -2.477 0.479 26.695 1 0 0.084
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表 11 脾胃湿热型与胃镜下表现及病理变化的相关性分析
病理特征 B SE Wals df P Exp(B) 95%CI 下限 上限 肠化 -0.503 0.442 1.293 1 0.256 0.605 0.254 1.439 糜烂 1.944 0.632 9.468 1 0.002 6.985 2.025 24.093 息肉 0.572 0.478 1.435 1 0.231 1.772 0.695 4.521 食管反流 0.452 0.579 0.609 1 0.435 1.571 0.505 4.883 胆汁反流 -0.846 1.086 0.608 1 0.436 0.429 0.051 3.603 异型增生 0.517 0.460 1.265 1 0.261 1.677 0.681 4.127 黏膜内出血 0.480 1.166 0.170 1 0.680 1.616 0.165 15.880 溃疡 0.433 0.727 0.354 1 0.552 1.542 0.370 6.415 常量 -3.654 0.640 32.598 1 0 0.026
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表 12 胃络瘀阻型与胃镜下表现及病理变化的相关性分析
病理特征 B SE Wals df P Exp(B) 95%CI 下限 上限 肠化 -0.481 0.486 0.979 1 0.322 0.618 0.238 1.603 糜烂 -0.239 0.440 0.296 1 0.586 0.787 0.333 1.863 息肉 0.475 0.531 0.802 1 0.371 1.608 0.568 4.550 食管反流 -1.582 1.059 2.233 1 0.135 0.206 0.026 1.637 胆汁反流 -0.537 1.096 0.240 1 0.624 0.584 0.068 5.007 异型增生 1.913 0.486 15.495 1 0 6.776 2.614 17.569 黏膜内出血 1.012 1.010 1.003 1 0.317 2.750 0.380 19.911 溃疡 -1.085 1.098 0.977 1 0.323 0.338 0.039 2.904 常量 -2.510 0.456 30.261 1 0 0.081
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表 13 胃阴不足型与胃镜下表现及病理变化的相关性分析
病理特征 B SE Wals df P Exp(B) 95%CI 下限 上限 肠化 -0.754 0.717 1.105 1 0.293 0.470 0.115 1.919 糜烂 -0.114 0.635 0.032 1 0.858 0.892 0.257 3.098 息肉 -0.105 0.836 0.016 1 0.900 0.900 0.175 4.635 食管反流 0.473 0.833 0.323 1 0.570 1.605 0.314 8.213 胆汁反流 1.511 0.896 2.846 1 0.092 4.530 0.783 26.204 异型增生 0.357 0.698 0.262 1 0.609 1.429 0.364 5.615 黏膜内出血 1.468 1.183 1.539 1 0.215 4.341 0.427 44.132 溃疡 1.353 0.778 3.028 1 0.082 3.871 0.843 17.774 常量 -3.236 0.606 28.520 1 0 0.039
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