胃食管反流病的中医证型分布规律及其相关因素的研究
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摘要
研究目的：本课题通过回顾性分析观察胃食管反流病(gastroesophageal reflux disease, GERD)的中医证型的分布情况,并通过利用现代统计学方法,探索胃食管反流病的中医证候分布规律及其发病的相关因素,完善其辨证分型标准,并进一步分析其与年龄、性别、病程、幽门螺杆菌(HP)、胃镜下的表现等因素的相关性,总结出GERD患病的相关因素,为GERD的病因研究有所补充,为GERD的辨证论治和科研提供依据。
研究方法：采用回顾性分析的调查方法并结合理论研究,采集GERD患者的中医望、闻、问、切的资料并用SPSS17.0建立数据库；运用描述性统计方法以及秩和检验进行统计分析,找出GERD的中医证型的分布规律及与各相关因素的关系。
研究结果：共收集193例病例,其中男性106例(54.9%),女性87例(45.1%),男女比例为1.22：1；其中年龄最小的为15岁,最大的为82岁,平均年龄为51.85±15.10岁。其中RE118例(61.14%)、NERD74例(38.34%)、BE1例(0.52%)。其中RE胃镜下又分为A级45例(占38.14%),B级35例(占29.66%),C级20例(占16.9598),D级18例(占15.25%)。中医证型分为六型,其中肝胃郁热59例(30.57%),肝胃不和49例(25.39%),脾虚湿热30例(15.54%),脾胃虚寒28例(14.51%),痰气交阻14例(7.25%),胃热阴虚13例(6.74%)。肝胃郁热、肝胃不和证较脾胃虚寒、胃热阴虚证的患者年龄要轻。肝胃郁热与肝胃不和及痰气交阻证较脾胃虚寒、脾虚湿热证的病程要短。肝胃郁热、痰气交阻证的胃镜下表现较脾胃虚寒、脾虚湿热、胃热阴虚证的要轻。
研究结论：将胃食管反流病(GERD)辨证分为六型,已经能够概括临床上大多数的病例。其中肝胃郁热证最多。本病在临床上以实证多见。
Objective: The research aims to,through observation of clinical manifestations of different syndromes of Traditional Chinese Medicine in GERD,by means of modern statistics,explore the regularity of syndrome distribution,sum up the method of syndrome differentiation which is relatively objective and regular,and further analyze the correlation of GERD Syndromes with age,gender,disease course,Hp infection,gastroscopic manifestations and other correlation factors,thus adding the cause of GERD research and providing a foundation for syndrome differentiation and scientific research.
Methods:The data of patients'symptoms and signs are got through four diagnostic methods and data base is established by applying retrospective analysis method of combining theory research.Descriptive statistics and Kruskal-Wallis are used for statistic purpose,to find out the distribution of TCM syndrome types of GERD rules and the correlation of relative factors.
Resutls:Among gathered193cases,106are male,while87are female.The age ranges from15to82years old,mean age is51.85±15.10years old. Reflux esophagitis(RE) accounts for61.14%,Nonerosive reflux disease(NERD) accounts for38.34%, and Barrett's esophagus(BE) for0.52%.The RE includes four grades,grade A accounts for38.14%,grade B accounts for29.66%,grade C accounts for16.95%,and grade D accounts for15.25%.The syndromes can be categorized into six patterns,heat accumulation in both liver and stomach accounts for30.57%,disharmony between liver and stomach accounts for25.39%,spleen insufficiency and heat accumulation accounts for15.54%,spleen-stomach deficiency type accounts for14.51%,obstruction of phlegm and qi accounts for7.25%,deficiency of stomach-yin accounts for6.74%. The patients of heat accumulation in both liver and stomach and disharmony between liver and stomach are younger than spleen-stomach deficiency type and deficiency of stomach-yin. Heat accumulation in both liver and stomach、disharmony between liver and stomach and obstruction of phlegm and qi have short disease course.The gastroscopic manifestation of heat accumulation in both heat accumulation in both liver and stomach and obstruction of phlegm and qi is better than spleen-stomach deficiency type and deficiency of stomach-yin.
Conclusion:It is advisable to classify GERD into six syndromes which may cover a vast majority of clinical cases. Heat accumulation in both liver and stomach type is at the most GERD manifest frequently with excess syndrome in clinical.
研究方法：采用回顾性分析的调查方法并结合理论研究,采集GERD患者的中医望、闻、问、切的资料并用SPSS17.0建立数据库；运用描述性统计方法以及秩和检验进行统计分析,找出GERD的中医证型的分布规律及与各相关因素的关系。
研究结果：共收集193例病例,其中男性106例(54.9%),女性87例(45.1%),男女比例为1.22：1；其中年龄最小的为15岁,最大的为82岁,平均年龄为51.85±15.10岁。其中RE118例(61.14%)、NERD74例(38.34%)、BE1例(0.52%)。其中RE胃镜下又分为A级45例(占38.14%),B级35例(占29.66%),C级20例(占16.9598),D级18例(占15.25%)。中医证型分为六型,其中肝胃郁热59例(30.57%),肝胃不和49例(25.39%),脾虚湿热30例(15.54%),脾胃虚寒28例(14.51%),痰气交阻14例(7.25%),胃热阴虚13例(6.74%)。肝胃郁热、肝胃不和证较脾胃虚寒、胃热阴虚证的患者年龄要轻。肝胃郁热与肝胃不和及痰气交阻证较脾胃虚寒、脾虚湿热证的病程要短。肝胃郁热、痰气交阻证的胃镜下表现较脾胃虚寒、脾虚湿热、胃热阴虚证的要轻。
研究结论：将胃食管反流病(GERD)辨证分为六型,已经能够概括临床上大多数的病例。其中肝胃郁热证最多。本病在临床上以实证多见。
Objective: The research aims to,through observation of clinical manifestations of different syndromes of Traditional Chinese Medicine in GERD,by means of modern statistics,explore the regularity of syndrome distribution,sum up the method of syndrome differentiation which is relatively objective and regular,and further analyze the correlation of GERD Syndromes with age,gender,disease course,Hp infection,gastroscopic manifestations and other correlation factors,thus adding the cause of GERD research and providing a foundation for syndrome differentiation and scientific research.
Methods:The data of patients'symptoms and signs are got through four diagnostic methods and data base is established by applying retrospective analysis method of combining theory research.Descriptive statistics and Kruskal-Wallis are used for statistic purpose,to find out the distribution of TCM syndrome types of GERD rules and the correlation of relative factors.
Resutls:Among gathered193cases,106are male,while87are female.The age ranges from15to82years old,mean age is51.85±15.10years old. Reflux esophagitis(RE) accounts for61.14%,Nonerosive reflux disease(NERD) accounts for38.34%, and Barrett's esophagus(BE) for0.52%.The RE includes four grades,grade A accounts for38.14%,grade B accounts for29.66%,grade C accounts for16.95%,and grade D accounts for15.25%.The syndromes can be categorized into six patterns,heat accumulation in both liver and stomach accounts for30.57%,disharmony between liver and stomach accounts for25.39%,spleen insufficiency and heat accumulation accounts for15.54%,spleen-stomach deficiency type accounts for14.51%,obstruction of phlegm and qi accounts for7.25%,deficiency of stomach-yin accounts for6.74%. The patients of heat accumulation in both liver and stomach and disharmony between liver and stomach are younger than spleen-stomach deficiency type and deficiency of stomach-yin. Heat accumulation in both liver and stomach、disharmony between liver and stomach and obstruction of phlegm and qi have short disease course.The gastroscopic manifestation of heat accumulation in both heat accumulation in both liver and stomach and obstruction of phlegm and qi is better than spleen-stomach deficiency type and deficiency of stomach-yin.
Conclusion:It is advisable to classify GERD into six syndromes which may cover a vast majority of clinical cases. Heat accumulation in both liver and stomach type is at the most GERD manifest frequently with excess syndrome in clinical.
引文
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[2]Ronkainen J, Aro P,Storskrubb T,et al. Prevalence of Barrett'sesopha-gus in the gene-ral population:an endoscopic study.Gastroenterology,2005,129:1825-1831.
[3]Wong BC, Kinoshita Y.Systematic review on epidemiology of gastroes-ophageal reflux di-sease in Asia.Clin Gastroenterol Hepatol,2006; 4:398-407.
[4]潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化志,1999,19：223-226.
[5]胡兆元,周丽雅.林三仁,等.十年2088例反流性食管炎临床分析[J].中华消化杂志,2005,25：717-719.
[6]Vakil N,van Zanten SV, Kahrilas P,et al.The Montreal definition and classification of gastroesophageal reflux disease:a global evidence-based consensus. Am J Gastroenterol, 2006, 101 (8):1900-1920.
[7]林三仁,许国铭,胡品津.中国胃食管反流病共识意见[J].胃肠病学,2007,12(4)：233-239.
[8]Bollschweiler E, Knoppe K, Wolfgarten E. et al. Prevalence of reflux symptoms in thegeneral population of Cologne. Z Gastroenterol 2007,45: 177-181.
[9]Nouraie M. Radmard AR. Zaer-Rezaii H, et al.Hygiene could affect GERD prevalence independently:a population-based study in Tehran. Am J Gastroenterol 2007; 102:1353-1360.
[10]瞿国强,王巧民.安徽省铜陵地区胃食管反流病临床流行病学调查[J].中国临床保健志2009,12：377-379.
[11]朱键,周力,王岚,等.贵州省安顺地区人群胃食管反流病流行病学调查[J].世界华人消化杂志,2009,17：2087-2090.
[12]Dent J,El-Serag HB,Wallander MA,et al.Epidemiology of gastrooesophageal reflux disease:a systematic review.Gut 2005; 54:710-717.
[13]章宏,徐晶,厉有名,等.浙江省内科门诊人群胃食管反流病及危险因素流行病学调查[J].中华消化杂志,2007,27(7)：443-446.
[14]Kim N, Lee SW, Cho SIet al. The prevalence of and risk factors for erosive esophagitis and non-erosive reflux disease:a nationwide multicentre prospective study in Korea[J].Aliment Pharmacol Ther,2008,27(2): 173-185.
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