摘要
目的:通过调查幽门螺杆菌(H.pylori)相关性胃炎患者中医体质类型的分布特点,探讨H.pylori相关性胃炎与中医体质类型的关系,为中医药防治H.pylori提供可以借鉴的依据。
方法:采用问卷调查的方法,收集H.pylori相关性胃炎患者365例,按中医体质量表分别判定为平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、瘀血质、气郁质、特禀质等9种体质类型。采用Microsoft Excel建立数据库,使用SPSS13.0统计软件,分析患者的年龄、性别、职业、居住地、胃镜征象及组织病理学表现与中医体质类型的关系。
结果:
1、H.pylori相关性胃炎患者中医体质类型出现的频率依次为阳虚质(20.3%)>气郁质(17.3%)>气虚质(14.5%)>湿热质(13.7%)>平和质(13.4%)>瘀血质(11.2%)>痰湿质(5.5%)>阴虚质(3.8%)>特禀质(0.3%)。
2、性别、年龄与中医体质类型密切相关:湿热质、平和质、痰湿质多见于男性,气郁质、瘀血质多见于女性;湿热质多见于青年,阴虚质多见于中年,气虚质多见于老年。
3、未发现H.pylori相关性胃炎患者的居住地及职业与中医体质类型的相关性。
4、胃镜征象、组织病理学表现与中医体质类型有一定的关系:充血红斑、水肿多见于气虚质;胆汁反流多见于湿热质、气郁质;慢性炎症在痰湿质、湿热质、气郁质、瘀血质中程度较重;气虚质、瘀血质、平和质、阳虚质的萎缩程度较重;气虚质、阳虚质、瘀血质伴肠化多见。
结论:H.pylori相关性胃炎与中医体质存在一定的相关性,多见于阳虚质、气郁质、气虚质、湿热质,与H.pylori相关性胃炎的病机基本一致,即脾胃虚弱为本,湿热中阻为标。不同体质类型的患者胃粘膜病变程度也存在一定的差异性。本研究从体质角度启示中医药治疗H.pylori相关性胃炎,不能局限于H.pylori的根除,而应从邪正两方面入手,通过扶助正气,调整体质,也是H.pylori相关性胃炎治疗的关键。
Objective:to investigate distribution of TCM Constitution in H.pylori-related Gastritis patients, explore the relationship between H.pylori-related Gastritis and TCM Constitution, and hence to provide a referable data for prevention and treatment of H.pylori (Helicobacter Pylori) infection.
Methods:By means of question investigation,365 patients with Hp-related Gastritis are gathered.They are categorized into nine constitution types,namely,gentleness type, gentleness type,qi-deficiency type,qi-depression type,wetness-heat type,phlegm-wet type, special inherited type,yang-deficiency type,yin-deficiency type and blood-stasis type.Data base was established,the relationship of TCM constitution with age,gender, occupation,residence,gastroscopic manifestation and biopsy were analyzed by SPSS statistical software.
Results:
1.The frequency of TCM Constitution types in H.pylori-related Gastritis in descending order is:yang-deficiency type(20.3%)>qi-depression type(17.3%)>qi-deficiency type(14.5%)>wetness-heat type(13.7%)>gentleness type(13.4%)>(17.3%)>blood-stasis type(11.2%)>phlegm-wet type(5.5%)>yin-deficiency type(3.8%)>special inherited type (0.3%).
2.There is a close relationship between TCM Constitution types with age and sex, wetness-heat type,gentleness type and phlegm-wet type are more common seen in male, while qi-depression type and blood-stasis type have a high frequency in female,wetness-heat type is common in youngsters,yin-deficiency type is most observed in middle-aged people and qi-deficiency type is frequent in the elderly.
3.No correlation is found between TCM Constitution types in H.pylori-related Gastritis and the patients' residence and occupation.
4.Gastroscopoic and pathological manifestations have a bearing on TCM Constitution types.Congestion,erythema and edema are common in qi-deficiency type,bile reflux is common in wetness-heat type and qi-depression type,chronic inflammation is frequent in phlegm-wet type,wetness-heat type,qi-depression and blood-stasis type.Severe atrophy is seen in qi-deficiency type,blood-stasis type,gentleness type and yang-deficiency type,and intestinal metaplasia is seen in Qi-deficiency type,yang-deficiency type and blood-stasis type.
Conclusion:H.pylori-related Gastritis is correlated with TCM Constitution types,abnormal constitution is common in Yang-deficiency type,qi-depression type,qi-deficiency type and wetness-heat type,which conforms to the pathogenesis of H.pylori-related Gastritis.There is also difference between different TCM Constitution types and the degree of gastric mucosa pathological changes.It is indicative by this study that treatment of H.pylori-related Gastritis should not be localized only by eradication of H.pylori,but intervention be given through removing evil-qi and invigorating genuine-qi by readjusting abnormal constitution.It is key to treat H.pylori -related Gastritis.
引文
1.张万岱,萧树东,胡伏莲.对幽门螺杆菌若干问题共识意见[J].世界华人消化杂志,2004,12(10):2457-2458.
2.Correa P.Human gastric carcinogenesis:A Multistep and multifactorial process-First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention[J].Cancer Res,1992;52:6735-6740.
3.刘为纹.幽门螺杆菌与胃癌[J].中华消化杂志,1993,13(2):100.
4.王琦.中医体质学说研究现状与展望[J].中国中医基础学杂志,2002,8(2):13-14.
5.王琦.中医体质学[M].北京:人民卫生出版社,2005:(1)2,11,(3)36-41,44,45,(4)61-62,(5)67-71,(6)78.
6.刘向哲,王永炎,王新志.论《黄帝内经》的禀赋学思想[J].中医杂志,2007,48(12):1131-1133.
7.曲黎敏.黄帝内经[M].厦门:鹭江出版社,2007.
8.王琦.东方生命科学的架构[J].中医药通报,2004,3(5):3.
9.朱燕波,王琦,折笠秀树.中医体质表的信度和效度评价[J].中国行为医学科学,2007,1(7):651-654.
10.王琦.辨体-辨病-辨证诊疗模式[M].北京:中国中医药出版社,2006:3-6,16,17,21-30,32-36.
11.灵枢经[M].北京:人民卫生出版社,1994.98-99,121.
12.冯全生.从体质深化中医感染病学研究的思考[J].中医杂志,2008,49(6):485-487.
13.汉·张仲景.伤寒论[M].北京:人民卫生出版社,2005.
14.盛增秀.略论温病的传变因素[J].吉林中医药,1986,2:4-6.
15.陈旻湖,彭铁立.幽门螺杆菌的传播途径[J].临床消化病杂志,2006,18:68-70.
16.张子昭,吴淑钦,张俊,等.幽门螺杆菌感染与萎缩性胃炎--附193例分析[J1.临床消化病学杂志,1999,11(4):192.
17.洪流,吴开春.幽门螺杆菌感染的粘膜损伤免疫机制和免疫治疗的研究进展[J].胃肠病学,2007,12(9):563-564.
18.EI-Omar EM,Carrington M,Chow WH,et al.Interleukin-1 polymorphisms associated with increased risk of gastric cancer[J].Nature,2000,404(6776):398-402.
19.杨婕,湖之滨,徐耀初,等.IL1B及IL1RN基因多态性与胃癌易感性的关系[J].世界华人消化杂志,2004,12(8):1769-1773.
20.Blaser MJ.Linking Helicobacter pylori to gastric cancer[J].Nat Med,2000,6(4):376-377.
21.Peek RM Jr,Blaser MJ.Helicobacter pylori and gastrointestinal tract adenocarcinomas[J].Nat Rev Cancer,2002,2(1):28-37.
22.Furuta T,EI-Omar EM,Xiao F,et al.Interleukin lbeta polymorphisms increase risk of hypochlorhydria and atrophic gastritis and reduce risk of duodenal ulcer recurrence in Japan[J].Gastroenterology,2002,123(1):92-105.
23.Azuma T,ITo Y,Miyaji H,et al.Immunogenetic analysis of the human leukocyte antigen DQA1 locus in patients with duodenal ulcer or chronic atrophic gastritis harbouring Helicobacter Pylori[J].Eur J Gastroenterol Hepatol,1995,7(suppl 1):71.
24.Sakai T,Aoyama N,Satonaka K,et al.HLA-DQB1 locus and the development of atrophic gastritis with Helicobacter Pylori infection[J].J Gastroenterol,1999,34(suppl 1):24-27.
25.许春娣,奚容平,陈舜年,等.幽门螺杆菌感染的患儿人类白细胞抗原-DQA1的免疫遗传学分析[J].中华儿科杂志,2000,38(12):746.
26.陈强.幽门螺杆菌与胃癌[J].中华消化杂志,1995,15(增刊):59260.
27.Nq EK,Sunq JJ,Linq TK,et al.Helicobacter pylod and the null genotype of glutathione-S-transferase-mu in patients with gastric adenocarcinoma[J].Cancer,1998,82(2):268-273.
28.景奉能,李聪,李莉.清幽益胃汤结合灸法治疗幽门螺杆菌相关性胃病116例[J].中国中医急症,2007,16(7):875-876.
29.周正华,杨强,陈大权.清胃合剂治疗幽门螺杆菌感染相关胃病湿热壅滞型的临床研究[J].中华中医药杂志,2006,21(8):504-505.
30.王胜英,刘悦明,陈鹏,等.消幽颗粒治疗幽门螺杆菌相关性慢性胃炎40例临床观察[J].中医杂志,2005,46(12):907-909.
31.马锡金,于世良,陈萍,等.胃康胶囊治疗幽门螺杆菌相关性消化性溃疡100例临床研究[J].中医杂志,2006,47(3):187-189.
32.陈岚,周镇苏,黄金华,等.中药清幽片治疗幽门螺旋杆菌胃病的临床体会[J].铁道医学,1997,25(6):388.
33.卢涛.半夏泻心汤治疗幽门螺杆菌相关性胃炎63例[J].新中医,1995,27(6):54.
34.陈芝芸,项柏康,周享德.胃乐汤治疗慢性胃病幽门螺旋菌感染的疗效观察[J].新中医,1995,27(9):21.
35.叶云生,汤仕伟,刘献祥.健胃和肠丸治疗幽门螺旋菌相关胃炎138例[J].陕西中医,1996,17(1):5.
36.王立,赵荣莱,陈正松.慢性胃炎、消化性溃疡中医证候与幽门螺杆菌的关系[J].中国中西医结合脾胃杂志,1995,3(1):27-28.
37.冯莲君,延文.幽门螺杆菌与胃脘痛中医分型的关系[J].现代中西医结合杂志,2000,9(2):105-106.
38.危北海,龚琼模.中国中西医结合消化系统疾病学术交流会纪要[J].中西医结合杂志,1999,10(5):314-317.
39.蔡子鸿,洪清娴,肖冰.慢性胃病中医分型与Hp感染两种检测的相关分析[J].湖北中医杂志,2002,24(9):7-9.
40.武和平.740例胃病辨证分型与幽门螺杆菌的关系[J].上海中医药杂志,1995(6):18-19.
41.历兰娜,孔繁智,李端阳.脾虚大鼠螺杆菌模型的实验研究[J].中国中西医结合杂志,1993,6(3):156.
42.沈鹰,刘正民,韦高,等.中医脾虚与胃私膜防御功能关系研究[J].中医杂志,1997,39(12):734.
43.马伟明,黄晓峰.红藤愈萎理气汤治疗Hp阳性慢性萎缩性胃炎观察[J].浙江中医杂志,1997,32(8): 347.
44.韦艳碧,覃冬林,陈树光.辨证治疗幽门螺杆菌阳性消化性溃疡76例观察[J].浙江中医杂志,2002,22(1):8.
45.于鹰.从湿热探讨Hp相关性胃炎的病机及用药[J].山东中医杂志,2004,23(11):650.
46.李瑜元,曹元平,舒伟群,等.中医治疗幽门螺杆菌相关性胃炎[J].广州中医药大学学报,1997,14(2):65.
47.白光.清幽汤加味治疗幽门螺杆菌相关性胃炎临床观察[J].辽宁中医杂志,2005,32(1):42.
48.何小琦,罗承锋,刘月婵,等.中西医结合治疗Hp相关性慢性胃炎的疗效分析[J].广州医药,2006,37(3):77-78.
49.钟伟润,黄元熹,崔嘉培.衍化四君子汤治疗Hp相关性胃炎85例[J].新消化病学杂志,1997,5(1):456.
50.王昊,孙星亮.Hp相关性疾病辨证分型及治疗[J].辽宁中医杂志,2003,30(3):194.
51.邵宁,崔新成,刘希华.愈胃汤治疗幽门螺杆菌相关性胃炎30例[J].山东中医杂志,2000,19(7):412.
52.范静.半夏泻心汤治疗幽门螺杆菌相关性胃炎64例临床观察[J].云南中医药杂志,2002,23(2):23.
53.李川.益气养阴活血法治疗幽门螺杆菌感染性慢性胃炎57例疗效观察[J].中医药学报,2005,33(3):33.
54.刘旸,潘健.黄芪建中汤加减治疗幽门螺杆菌相关性胃炎疗效观察[J].中华今日医学杂志,2004,4(6):68.
55.刘玫,刘英茹,刘英,等.胃安乐胶囊治疗慢性胃炎68例[J].中国中西医结合杂志,2004,24(3):25.
56.李秩伦,何丽芳.巫氏溃疡散加味治疗幽门螺杆菌相关性消化性溃疡41例临床观察[J].中医杂志,2004,45(1):31-33.
57.覃丕恩.和胃解毒汤治疗幽门螺杆菌相关性胃病116例[J].河北中医,2005,27(10):733-734.
58.张俊杰,周庚生,顾伟忠,等.芩连合剂对幽门螺杆菌感染性胃溃疡大鼠氧自由基参数的影响[J].中国中医药科技,2006,13(3):157-158.
59.王茵萍,范刚启.健脾疗法对慢性萎缩性胃炎患者胃壁屏障作用的研究[J].中医杂志,2002,41(10):601-603.
60.中华医学会消化病学分会.第三次全国H.pylori感染若干问题共识报告[J].胃肠病学,2008,13(1):42-46.
61.中华医学会消化病学分会.中国慢性胃炎共识[J].现代消化及介入诊疗,2007,12(1):55-62.
62.The WHOQOL Group.The World Health Organization Quality of Life Assessment(WHOQOL):Development and general psychometric properties[J].Soc Sci Med 1998,46(12):1569-1585.
63.The WHOQOL Group.Development of the World Health Organization WHOOL-BREF quality of life assessment[J].Psychol Med 1998,28(3):551-558.
64.陆为民,单兆伟,沈洪.关于幽门螺杆菌感染中医药治疗对策的思考[J].中国中西结合脾胃杂志,2000,8(4):232-233.
65.清·叶天士.临证指南医案[M].北京:人民军医出版社,2006.
66.钱会南.两虚相得乃客于形-兼论体质与发病的关系[J].北京中医药大学学报(临床版),2003,(4):34-36.
67.周天寒.老年人的体质和病的治疗特点[J].浙江中医学院学报,1990,(1):51.
68.王金荣.187例老年虚证的临床研究[J].辽宁中医杂志,1993,(5):1.
69.徐冰河.乳腺癌[M].北京:北京大学医学出版社,2005,1:15.
70.郑海文.辨舌象辨体质治疗乙型肝炎病毒标志物阳性96例观察[J].河北中医,1998,20(6):335-336.
71.符小艳,张永蓉.体质的五态分型应用于无症状乙型肝炎的治疗体会[J].四川中医,2004,22(2):12-13.
72.邓光远.论体质分型法治疗无症状乙型肝炎[J].中国中医药信息杂志,1997,4(1):22-23.
73.张平安,李艳,向萍霞,等.TNF-α基因启动子多态性与HBV感染转归的关系[J].世界消化华人杂志,2004,12(9):2086-2090.
74.陆为民,单兆伟,杨学文,等.仁术健胃颗粒对慢性萎缩性胃炎患者幽门螺杆菌及其cagA基因的影响[J].天津中医药,2003,20(1):26-29.