慢性胃炎胃脘痛证型与胃镜黏膜表现相关性Logistic回归分析
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摘要
目的:分析慢性胃炎胃脘痛证型与胃镜下黏膜表现的相关性。方法:使用χ2检验和多项Logistic回归分析,分析273例以胃脘痛为主要症状的慢性胃炎患者证型、镜下黏膜表现分布及其相关性。结果:肝胃不和证与黏膜红肿或红斑(OR=2.201E-009,P=0.000)、胆汁反流或黏液湖色黄(OR=59.035,P=0.041)相关;脾胃虚弱(寒)证与黏膜苍白或红白相间(OR=18.862,P=0.040)、黏膜粗糙(OR=32.091,P=0.039)、黏膜出血点(OR=5.024E-009,P=0.000)相关;胃阴不足证与黏液湖量少(OR=38.541,P=0.049)相关;胃络瘀阻证与黏膜出血点(因变量参考组)相关;脾胃湿热证未得到有意义结果。结论:胃镜黏膜视诊引入到胃脘痛中医诊断望诊是一条有效途径,但仍需扩大样本数量,纳入复杂交互因素,完善Logit模型,所以现阶段以胃脘痛为主要表现的慢性胃炎胃镜下黏膜表现可作为胃脘痛辨证的充分条件但不是必要条件,作为望诊的补充。
Objective:To analyze the relationship between syndrome and gastroscopic mucosa manifestations of epigastric pain of chronic gastritis. Methods:Chi-square test and multiple Logistic regression analysis were used to analyze the distribution and correlation of syndrome and gastroscopic mucosa manifestations in total 273 patients with chronic gastritis,epigastric pain as the main symptom. Results:Liver-stomach disharmony syndrome was associated with mucosal redness or erythema(OR= 2.201 E-009,P= 0.000),bile reflux or mucus lake yellow(OR= 59.035,P= 0.041);Spleen and stomach deficiency(cold) syndrome was associated with pale or red and white mucosa(OR= 18.862,P= 0.040),rough mucosa(OR= 32.091,P= 0.039),mucosal bleeding point(OR= 5.024 E-009,P= 0.000);Stomach yin deficiency was associated with less mucus lake(OR= 38.541,P= 0.049);Stasis in stomach collateral syndrome was associated with mucosal bleeding point(dependent variable reference group);Spleen-stomach damp-heat syndrome did not get meaningful results. Conclusions:It is an effective way to introduce the gastroscopic mucosal visual examination into the traditional Chinese diagnosis of epigastric pain. However,it is still necessary to expand the sample size,incorporate complex interaction factors,and improve the Logit model. Therefore,at this stage,the gastroscopic mucosa manifestation as the supplement to the traditional Chinese diagnostic method was a sufficient but not the necessary condition for the epigastric pain of chronic gastritis.
Objective:To analyze the relationship between syndrome and gastroscopic mucosa manifestations of epigastric pain of chronic gastritis. Methods:Chi-square test and multiple Logistic regression analysis were used to analyze the distribution and correlation of syndrome and gastroscopic mucosa manifestations in total 273 patients with chronic gastritis,epigastric pain as the main symptom. Results:Liver-stomach disharmony syndrome was associated with mucosal redness or erythema(OR= 2.201 E-009,P= 0.000),bile reflux or mucus lake yellow(OR= 59.035,P= 0.041);Spleen and stomach deficiency(cold) syndrome was associated with pale or red and white mucosa(OR= 18.862,P= 0.040),rough mucosa(OR= 32.091,P= 0.039),mucosal bleeding point(OR= 5.024 E-009,P= 0.000);Stomach yin deficiency was associated with less mucus lake(OR= 38.541,P= 0.049);Stasis in stomach collateral syndrome was associated with mucosal bleeding point(dependent variable reference group);Spleen-stomach damp-heat syndrome did not get meaningful results. Conclusions:It is an effective way to introduce the gastroscopic mucosal visual examination into the traditional Chinese diagnosis of epigastric pain. However,it is still necessary to expand the sample size,incorporate complex interaction factors,and improve the Logit model. Therefore,at this stage,the gastroscopic mucosa manifestation as the supplement to the traditional Chinese diagnostic method was a sufficient but not the necessary condition for the epigastric pain of chronic gastritis.
引文
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[2]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:190-192.
[3]张声生,唐旭东,黄穗平,等.慢性胃炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(7):3060-3064.
[4]中华医学会消化内镜学分会.慢性胃炎的内镜分型分级标准及治疗试行意见[J].中华消化内镜杂志,2004,21(2):77-78.
[5]TYTGAT G N.The Sydney system:endoscopic division,endoscopic appearances in gastritis/duodenitis[J].J Gastroenterol Hepatol,1991,6(3):223-234.
[6]TOLJAMO K,NIEMELA S,KARVONEN A L,et al.Histopathology of gastric erosions association with etiological factors and chronicity[J].Helicobacter,2011,16(6):444-451.
[7]ZOU T H,ZHENG R H,GAO Q Y,et al.Factors affecting occurrence of gastric varioliform lesions:a case-control study[J].World J Gastroenterol,2016,22(22):5228-5236.
[8]周登远,崔壮,焦振山.临床医学研究中的统计分析和图形表达实例详解[M].北京:军事医学科学出版社,2011:118-148.
[9]DANIEL A POWERS,谢宇.分类数据分析的统计方法[M].北京:社会科学文献出版社,2009:234-241.
[10]沈自尹.微观辨证和辨证微观化[J].中医杂志,1986,27(2):55-57.
[11]唐伟,周正光,王欢欢.胃脘痛中医辨证与胃镜表现的关联规则分析[J].中国中西医结合杂志,2013,33(3):303-306.
[12]代二庆,杨楠,沈志红,等.64例慢性萎缩性胃炎中医证型与胃镜象、病理象相关性研究[J].辽宁中医杂志,2016,43(3):458-461.
[13]胡晓平.262例慢性胃炎胃黏膜病变与中医辨证分型的相关性观察[J].现代中西医结合杂志,2007(8):1013-1015.
[14]赵东升,赵东杰,周毅萍,等.慢性平坦糜烂性胃炎中医分型及其与胃镜像的关系[J].山东中医杂志,2008,27(3):160-161.
[15]吕静静,王彦刚,董环,等.慢性糜烂性胃炎胃镜像及病理分型与中医证型相关性研究[J].山东中医杂志,2017,36(1):11-12,28.
[16]史周华,何雁.中医药统计学与软件应用[M].北京:中国中医药出版社,2015:99-107.
[17]邱宏,余德新,王晓蓉,等.Logistic回归模型中交互作用的分析及评价[J].中华流行病学杂志,2008,29(9):934-937.