Chronic Gastritis Syndrome, The Distribution Of Syndrome Elements And Their Correlation With Serum Pepsinogen And Gastrin

Objective:Chronic gastritis is divided into two categories:chronic non-atrophic gastritis and chronic atrophic gastritis;meanwhile,non-atrophic gastritis may progress to atrophic gastritis,and then develop to gastric cancer.Based on previous studies regarding the syndrome distribution of chronic gastritis,this study optimized the research program to obtain a syndrome distribution of chronic gastritis that was more objective and consistent with the clinical practice,and to explore new research methods for syndrome distribution.At the same time,the expression difference of serum pepsinogen and gastrin in various syndrome types was investigated by determining the indexes in "serological biopsy" including pepsinogen and gastrin for early gastric cancer screening,combined with syndrome distribution results,to explore a new way of combination of Chinese traditional and Western medicine to improve early gastric cancer screening rate in clinic.Methods:This study was divided into two parts.In the first part,a multi-center and large-sample cross-sectional survey was applied to collect the four diagnostic information of patients with chronic gastritis and to establish a database for four diagnostic information.Factor analysis optimization was combined with the complex system entropy clustering method to analyze the four diagnostic information of the patients with chronic gastritis,and thereby obtaining the syndrome distribution rules and differences of chronic non-atrophic gastritis and chronic atrophic gastritis.In the second part,enzyme-linked immunosorbent assay was used for detecting serum pepsinogen and gastrin in the patients with chronic gastritis.Combined with clinical research results,difference analysis was conducted for the expression level of serum pepsinogen and gastrin in the common syndrome types of patients with chronic non-atrophic gastritis and chronic atrophic gastritis,to analyze the expression difference of serum pepsinogen and gastrin among various syndrome types in the patients with chronic gastritis.Results:①In this study,a total of 1,770 eligible chronic gastritis patients were collected,among which 1,088 patients had chronic non-atrophic gastritis and 682 had chronic atrophic gastritis;in addition,140 serum samples were collected,including 57 samples from chronic non-atrophic gastritis and 83 from chronic atrophic gastritis.②Chronic gastritis had a total of 8 common syndrome types.Among them,chronic non-atrophic gastritis had 6 common syndrome types:syndrome of incoordination between liver and stomach,syndrome of stagnation of liver-qi and spleen deficiency,syndrome of dampness-heat of spleen and stomach,syndrome of heat-stagnation in liver and stomach,syndrome of deficient cold of spleen and stomach,and syndrome of static blood in stomach collaterals,successively;chronic atrophic gastritis had 7 common syndrome types:syndrome of deficient cold of spleen and stomach,syndrome of dampness stagnancy due to spleen deficiency,syndrome of heat-stagnation in liver and stomach,syndrome of incoordination between liver and stomach,stomach yin-deficiency syndrome,syndrome of stagnation of liver-qi and spleen deficiency,and syndrome of static blood in stomach collaterals,successively·③Syndrome locations of chronic non-atrophic gastritis involved the stomach,liver,spleen,heart,large intestine,small intestine,lung and gallbladder,successively;and syndrome elements contained qi-stagnation,heat,dampness,yin-deficiency,qi-deficiency,yang-deficiency,blood-stasis,blood-deficiency,yang-hyperactivity and phlegm,successively.Syndrome locations of chronic atrophic gastritis involved the stomach,spleen,liver,heart,large intestine,small intestine,gallbladder and lung,successively;and syndrome elements included qi-stagnation,yang-deficiency,qi-deficiency,heat,yin-deficiency,dampness,blood-stasis,phlegm and blood-deficiency,successively.④In chronic non-atrophic gastritis,excess syndrome was common in males while syndrome of intermingled deficiency and excess to excess syndrome was frequent in females;in chronic atrophic gastritis,syndrome of intermingled deficiency and excess to excess syndrome was common in both males and females.⑤The syndrome distribution of chronic gastritis was not obviously related to age;however,syndrome locations in chronic non-atrophic gastritis presented an increasing trend with the increase of age,and syndrome elements in chronic atrophic gastritis mainly showed qi-stagnation,dampness and heat in young population while qi-stagnation,qi-deficiency and heat in the middle-aged and elderly.⑥Syndrome of heat-stagnation in liver and stomach and syndrome of incoordination between liver and stomach were common in Helicobacter pylori-positive patients,with syndrome elements of qi-stagnation and heat;however,the syndrome distribution of current negative and positive infection showed no evident difference from the distribution of syndrome elements.⑦Syndrome of heat-stagnation in liver and stomach was common among patients with chronic gastritis accompanied by erosion,and syndrome of incoordination between liver and stomach was common among patients with chronic gastritis accompanied by bile reflux;syndrome of incoordination between liver and stomach and syndrome of stagnation of liver-qi and spleen deficiency in chronic non-atrophic gastritis,as well as syndrome of heat-stagnation in liver and stomach and syndrome of dampness stagnancy due to spleen deficiency in chronic atrophic gastritis were the most easily misdiagnosed syndrome types.⑧Based on the distribution of syndrome locations and elements,a clinical treatment method of "phased treatment for chronic gastritis,treatment determination after syndrome determination,syndrome element identification for prognosis" was proposed.⑨There were differences in the expression levels of serum pepsinogen and gastrin among various syndrome types in the patients with chronic gastritis,with the difference in excess-heat syndrome more obvious.Conclusion:① Syndrome distribution showed a difference between the two pathological stages of chronic gastritis,presenting a pathogenesis change of "intermingled deficiency and excess,from excess to deficiency" with disease progression.②Serum pepsinogen and gastrin for early gastric cancer screening could be applied by combining with TCM syndrome differentiation;and excess-heat syndrome had higher detection accuracy as compared with deficiency-cold syndrome.