更年期女性慢性萎缩性胃炎中医证候分布规律研究
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摘要
目的:探讨更年期女性慢性萎缩性胃炎的中医证型分布规律,以加深对本病的认识,为中医临证诊治提供理论参考。方法:选取2016年1月至2017年12月在南京中医药大学附属江苏省中医院就诊符合更年期综合征诊断的经胃镜病理确诊为慢性萎缩性胃炎女性患者100例,填写《更年期女性慢性萎缩性胃炎中医临床观察表》以及库珀曼指数(kupperman index,KI)量表。纪录患者的一般情况、症状体征、镜下黏膜情况、病理、幽门螺杆菌(Helicobacter pylori,Hp)检测结果等,后期采用统计学软件进行统计分析,得出结论。结果:随着年龄的增加,更年期女性慢性萎缩性胃炎的发病率逐渐升高,中医证型以肝郁气滞证最为常见。肝胃郁热证胆汁反流发生率最高,脾胃湿热证HP的感染率最高,精神及情绪因素在诱发肝郁气滞证中比率最高,气候因素在诱发脾胃虚寒证中比率最高。证型分布受KI量表、HP感染、胆汁反流影响,与进食习惯、肠上皮化生、异型增生无关。结论:建立统一的中医病名、证型分类标准及评价体系,有助于更好地认识疾病,开展临床研究,比较、评价疗效。
Objective: To explore the distribution regularity of TCM syndromes of menopausal women with chronic atrophic gastritis,deepen the understanding of this disease,and provide theoretical reference for the diagnosis and treatment of TCM. Methods: From January 2016 to December 2017,100 women with chronic atrophic gastritis diagnosed by gastroscopy and pathology were selected from Jiangsu Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine. The " Clinical Observation Form of Chinese Medicine for Menopausal Women with Chronic Atrophic Gastritis" and Kupperman Index( KI) scales were filled in. The general condition,symptoms and signs,microscopic mucosal condition,pathology,Helicobacter pylori( Hp) test results of the patients were recorded. Statistical software was used for statistical analysis in the later period to draw conclusions. Results: With the increase of age,the incidence of chronic atrophic gastritis in menopausal women was gradually increasing,and syndrome of liver depression and qi stagnation was the most common syndromes in Chinese medicine. The incidence of bile reflux was the highest in the stagnated heat of liver and stomach syndrome. The HP infection rate of the dampness-heat of spleen and stomach syndrome was the highest. The mental and emotional factors were the highest in the liver qi stagnation syndrome. The climatic factors were the highest in the syndrome of deficient cold of spleen and stomach. The distribution of syndrome type was affected by KI scale,HP infection,and bile reflux,and was not related to eating habits,intestinal metaplasia,and dysplasia. Conclusion: Establishing a unified TCM disease name,syndrome classification criteria and associated evaluation system will help to better understand the disease,carry out clinical research,compare and evaluate the curative effect.
Objective: To explore the distribution regularity of TCM syndromes of menopausal women with chronic atrophic gastritis,deepen the understanding of this disease,and provide theoretical reference for the diagnosis and treatment of TCM. Methods: From January 2016 to December 2017,100 women with chronic atrophic gastritis diagnosed by gastroscopy and pathology were selected from Jiangsu Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine. The " Clinical Observation Form of Chinese Medicine for Menopausal Women with Chronic Atrophic Gastritis" and Kupperman Index( KI) scales were filled in. The general condition,symptoms and signs,microscopic mucosal condition,pathology,Helicobacter pylori( Hp) test results of the patients were recorded. Statistical software was used for statistical analysis in the later period to draw conclusions. Results: With the increase of age,the incidence of chronic atrophic gastritis in menopausal women was gradually increasing,and syndrome of liver depression and qi stagnation was the most common syndromes in Chinese medicine. The incidence of bile reflux was the highest in the stagnated heat of liver and stomach syndrome. The HP infection rate of the dampness-heat of spleen and stomach syndrome was the highest. The mental and emotional factors were the highest in the liver qi stagnation syndrome. The climatic factors were the highest in the syndrome of deficient cold of spleen and stomach. The distribution of syndrome type was affected by KI scale,HP infection,and bile reflux,and was not related to eating habits,intestinal metaplasia,and dysplasia. Conclusion: Establishing a unified TCM disease name,syndrome classification criteria and associated evaluation system will help to better understand the disease,carry out clinical research,compare and evaluate the curative effect.
引文
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[19]王超.胆囊切除术与胆汁反流性胃炎关系研究[D].银川:宁夏医科大学,2015.
[2]魏玮,杨洋,史海霞.慢性萎缩性胃炎中医诊疗现状、挑战及展望[J].中国中西医结合杂志,2015,35(12):1424-1426.
[3]刘晶晶,代二庆,朱姣,等.慢性萎缩性胃炎中医证候调查问卷的设计思路与内容[J].中医学报,2015,30(3):430-432.
[4]王洪彬,崔建美,赵舒,等.更年期女性Kupperman评分与中医体质相关性研究[J].北京中医药大学学报,2014,37(4):277-279.
[5]国家中医药管理局医政司. 22个专业95个病种中医诊疗方案(合订本)[M].北京:中国中医药出版社,2011:523.
[6]陈淑娇,李灿东,廖凌虹,等.柴胡疏肝散对围绝经期综合征肝郁证大鼠海马雌激素受体和神经递质的影响[J].中华中医药杂志,2013,28(5):1232-1236.
[7]张万岱,李军祥,陈治水,等.慢性胃炎中西医结合诊疗共识意见(2011·天津)[J].现代消化及介入诊疗,2012,17(3):172-177.
[8]房静远,杜奕奇,刘文忠,等.中国慢性胃炎共识意见(2017年,上海)[J].胃肠病学,2017,22(11):670-687.
[9]李兴.内镜黏膜切除术(EMR)在内镜下治疗的应用[C].郑州:第九届国际治疗内镜和消化疾病学术会议论文汇编,2008:1.
[10]练晶晶.内镜黏膜下剥离术治疗早期胃癌的临床评价[D].上海:复旦大学,2010.
[11]黄蓝洋.中医治疗慢性萎缩性胃炎临床近况[J].实用中医内科杂志,2005,19(3):202-203.
[12]晁俊,刘绍能.慢性萎缩性胃炎中医病因病机及证候研究进展[J].中国中医药信息杂志,2015,22(8):133-136.
[13]刘明兰,王馨园,熊丹,等.妇女围绝经期健康状况调查研究[J].中国妇幼保健,2012,27(29):4602-4605.
[14]孔岩君,魏睦新.慢性萎缩性胃炎复发的危险因素[J].世界华人消化杂志,2015,23(4):623-628.
[15]陆为民.徐景藩教授诊治脾胃病用药经验拾萃[J].江苏中医药,2006,27(6):14-15.
[16]许丽绵,欧阳惠卿,卢如玲.更年期综合征病因病机及其证治述要[J].中医药学刊,2003,21(9):1550-1552.
[17]陆启滨.更年期综合征病因病机探源[J].中医药学刊,2001,19(2):139-140.
[18]中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J].临床肝胆病杂志,2015,31(1):7-11.
[19]王超.胆囊切除术与胆汁反流性胃炎关系研究[D].银川:宁夏医科大学,2015.