主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2015, Vol. 38 ›› Issue (5): 310-314.doi: 10.3969/j.issn.1006-2157.2015.05.005

• 博士之光 • 上一篇    下一篇

非萎缩性胃炎到萎缩性胃炎的中医证候演变研究*

陈润花1,张厂1,苏泽琦2,李培彩2,丁霞3#   

  1. 1 北京中医药大学东方医院脾胃肝胆科 北京 100078;
    2 北京中医药大学东直门医院;
    3 北京中医药大学医疗管理处
  • 收稿日期:2014-12-21 出版日期:2015-05-15 发布日期:2015-05-15
  • 通讯作者: 丁霞,女,博士,教授,主要研究方向:中西医结合治疗消化系统疾病研究,E-mail: dingx@bucm.edu.cn
  • 作者简介:陈润花,女,博士,主治医师
  • 基金资助:
    *国家自然科学基金重大研究计划项目(No.91129714),国家自然科学基金项目(No.81270466),北京中医药大学自主选题项目(No.2014-JYBZZ-JS-053)

Evolution of TCM patterns from non-atrophic to atrophic gastritis*

CHEN Run-hua1, ZHANG Chang1, SU Ze-qi2, LI Pei-cai2, DING Xia3#   

  1. 1 Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078;
    2 Dongzhimen Hospital, Beijing University of Chinese Medicine;
    3 Department of Medical Management, Beijing University of Chinese Medicine
  • Received:2014-12-21 Online:2015-05-15 Published:2015-05-15

摘要: 目的 研究非萎缩性胃炎(CSG)到萎缩性胃炎(CAG)的中医证候演变。方法 对400例慢性胃炎患者的中医证候进行分析,采用χ2检验比较从CSG到CAG的中医证候演变。结果 慢性胃炎有9个病性要素:气虚、气滞、湿、热、阴虚、阳虚、瘀血、食积、寒;8个基本证型:类肝胃不和证、类肝胃郁热证、类脾寒胃热证、类湿热蕴结证、类脾胃虚弱证(气虚、阳虚)、类瘀阻胃络证、类饮食停滞证、类胃阴不足证。经χ2检验,CSG与气虚、气滞、热、阳虚、瘀血、食积、寒相关性较高,而CAG则与阴虚和湿相关性较高,尤其与阴虚关系密切;9个病性要素与幽门螺杆菌(Hp)阳性的CSG的相关性依次为:食积>热>阴虚,食积>气滞>阴虚,食积>寒>阴虚,食积>湿,瘀血>湿,气虚>阴虚,阳虚>阴虚,瘀血>阴虚;Hp阳性的CAG则刚好相反。经χ2检验,类胃阴不足证与CAG相关性较高,CSG则与除类湿热蕴结证之外的其余6个基本证型相关性较高;8个基本证型与Hp阳性的CSG的相关性依次为:类饮食停滞证>类肝胃郁热证>类胃阴不足证,类饮食停滞证>类脾胃虚弱证>类胃阴不足证,类饮食停滞证>类湿热蕴结证,类瘀阻胃络证>类湿热蕴结证,类肝胃不和证>类胃阴不足证,类瘀阻胃络证>类胃阴不足证;Hp阳性CAG则刚好相反。结论 饮食积滞,是慢性胃炎最早出现的中医证候,其后渐次出现湿、热、瘀血等。正虚贯穿慢性胃炎发病的整个过程,CSG阶段以邪实为主,或是虚实夹杂,至CAG阶段,则以正虚为主。

关键词: 慢性胃炎, 幽门螺杆菌, 证候, 证候演变

Abstract: Objective To examine the evolution of TCM patterns from Non-atrophic gastritis (CSG) to atrophic gastritis (CAG). Methods We analyzed TCM patterns in 400 cases of chronic gastritis. χ2 test was used to compare the evolution of TCM patterns from CSG to CAG. Results There were nine essential pattern elements for chronic gastritis, namely, Qi deficiency, Qi stagnation, dampness, heat, Yin deficiency, Yang deficiency, blood stasis, food accumulation, and cold. Eight basic pattern categories for chronic gastritis were liver-stomach disharmony, liver-stomach constraint heat, spleen cold and stomach heat, retention of heat in the interior, spleen-stomach weakness (including Qi deficiency and yang deficiency), phlegm obstructing the stomach collaterals, food accumulation, and stomach-Yin deficiency, respectively. Chi-square test showed that CSG was closely related to Qi deficiency, Qi stagnation, heat, Yang deficiency, blood stasis, food accumulation and coldness while CAG was related to dampness, particularly to Yin deficiency. The correlation between nine essential pattern elements and Hp-positive CSG were: food accumulation > Heat > Yin deficiency; food accumulation > Qi stagnation > Yin deficiency; indigestion > coldness > Yin deficiency; food accumulation > dampness; blood stasis > dampness; Qi deficiency > Yin deficiency; Yang deficiency> Yin deficiency; blood stasis > Yin deficiency. Hp-positive CAG was just the opposite. Chi-square test also showed that stomach-Yin deficiency pattern was related to CAG and that CSG was related to other six basic pattern types except the pattern of heat retention in the interior. The correlation between the eight basic pattern categories and Hp-positive CSG were: food accumulation > liver-stomach constraint heat > stomach-Yin deficiency; food accumulation > pattern of spleen-stomach weakness > stomach-Yin deficiency; food accumulation > accumulation of damp-heat; stasis obstructing stomach collateral > pattern of heat retention in the interior; liver-stomach disharmony > stomach-Yin deficiency; stasis obstructing stomach collaterals > stomach-Yin deficiency. Hp-positive CAG was just the opposite. Conclusion Food accumulation is the earliest TCM pattern in chronic gastritis, thereafter dampness, heat, and blood stasis. Pattern of heat retention in the interior and deficiency of Healthy Qi is present throughout the development of chronic gastritis. In CSG stage, excess of pathogenic factors is often dominant. Sometimes, deficiency and excess patterns may coexist. In CAG stage, deficiency of Healthy Qi is dominant.

Key words: Chronic gastritis, Helicobacter pylori, pattern, evolution of TCM patterns

中图分类号: 

  • R259.733