| BackgroundGastric xanthelasma is a lipid deposition disease that occurs in the gastric mucosa.Histopathology is formed by accumulation of lipid-filled foam cells.The etiology and pathogenesis of gastric xanthelasmas are currently unclear.In recent years,studies have shown that gastric xanthelasmas may be an early warning signal for early gastric cancer.It is closely related to the atrophy and intestinal transformation of gastric mucosa,and it can also indicate chronic atrophic The extent and scope of gastritis lesions.There is currently no clinical study of traditional Chinese medicine for gastric xanthelasma.Clinical research on gastric xanthelasma and chronic atrophic gastritis combined with gastric xanthelasma can help to clarify the correlation between the location and extent of chronic atrophic gastritis and gastric xanthelasma,and improve the sensitivity of microscopic diagnosis of chronic atrophic gastritis.The research on TCM syndromes of chronic atrophic gastritis combined with gastric xanthelasma has a certain groundbreaking,can more accurately grasp the pathogenesis of the disease,guide the clinical selection of medication,and precise treatment.Research 1 Gastroscopy and pathological analysis of patients with gastric xanthelasmaObjectiveExplore the characteristics of gastric xanthelasma,and explore the epidemiological characteristics and pathological changes of gastric xanthelasma.MethodsAccording to the report of 11245 cases of gastroscopy in the Endoscopic Center of Guang’anmen Hospital from 2017 to 2019,382 cases of all patients with gastric xanthelasma were included.The gastroscopy report and pathological examination results of the included cases were collected.A database was established to analyze the incidence and characteristics of gastric xanthelasma.Pathological changes.SPSS20.0 statistical software was used for the above data,descriptive statistics were used for general data,x2 test was used for counting data;rank sum test was used for grade data.Results1.In this study,there were 226 males and 156 females;the minimum age was 26 years old and the maximum age was 85 years old.The average age was 56.52 ± 10.94 years old Compared with the gender and age distribution of patients in our hospital’s endoscopy center during the same period,the proportion of men with gastric xanthelasmas and the proportion of patients>50 years old were higher than those with nongastric xanthelasmas.2.Gastric xanthelasmas are common in single cases,accounting for 83.51%;the detection rates of xanthelasmas in various parts of the stomach are gastric antrum(49.00%),stomach body(25.61%),and gastric angle(11.26%)),Cardia(8.39%),stomach fundus(5.74%).3.In this study,the detection rates of gastric xanthelasma combined with microscopic manifestations were as follows:322 cases(84.29%)of chronic atrophic gastritis>56 cases of bile reflux(14.66%)>46 cases of erosion(12.04%)>44 cases of gastric polyps(11.52%)>34 cases of reflux esophagitis(8.90%)>12 cases of duodenal ulcer(3.14%)>9 cases of gastric ulcer(2.36%)>4 cases of gastric cancer(1.05%)>2 cases of residual gastritis(0.52%).Gastric xanthelasma with chronic atrophic gastritis accounted for the highest proportion4.There were 252 patients with gastric xanthelasma with mucosal atrophy,accounting for 65.97%;322 patients with mucosal intestinal metaplasia,accounting for 84.29%.5.The detection rates of mucosal atrophy and intestinal mucosa in patients with multiple gastric xanthelasmas(82.54%and 95.24%,respectively)were higher than those in single gastric xanthelasma patients(62.70%,82.13,respectively)%).The risk of mucosal atrophy and intestinal metastasis in multiple gastric xanthelasmas is 2.81 times and 4.35 times that of a single gastric xanthelasma,respectively.The detection rate of severe atrophy and severe bowelization in patients with multiple gastric xanthelasmas(32.69%and 28.33%,respectively)was higher than the detection rate of severe atrophy and severe bowelization in patients with single xanthelasmas(25.50%and 20.99%,respectively).ConclusionsThe occurrence of gastric xanthelasma is closely related to age and gender factors Among them,men>50 years old,the detection rate of gastric xanthelasma is high.Gastric xanthelasmas are closely related to chronic atrophic gastritis,in which multiple gastric xanthelasmas with mucosal atrophy and mucosal intestinal metaplasia risk are higher than single gastric xanthelasmas,and the detection rate of multiple gastric xanthelasmas with severe atrophy and severe bowel metastases is higher than single Stomach xanthelasma.The detection rate of mucosal atrophy in gastric antrum xanthelasma is lower than that in non-gastric antrum xanthelasma.This study initially confirmed that the occurrence and distribution of gastric xanthelasma can be used as a biological indicator of the occurrence and degree of chronic atrophic gastritis.If gastric xanthelasma is found during endoscopic examination,especially for the elderly,the operator should be vigilant.It is recommended to perform biopsy or serological examinations such as gastrin and pepsin to confirm the diagnosis and emphasize to the patient that the gastroscopy should be reviewed regularly.The importance of vigilance against tumors.Research 2 Clinicopathological analysis of chronic atrophic gastritis with gastric xanthelasma and distribution of TCM syndromesObjectiveExplore the pathological features and distribution of traditional Chinese medicine syndromes of chronic atrophic gastritis with gastric xanthelasma.MethodsAccording to the results of gastroscopy and pathological examination of the patients,104 patients with chronic atrophic gastritis and gastric xanthelasma were included.Informed consent was obtained.The questionnaire was completely filled out to collect gastroscopy and pathology data.Pathological characteristics and distribution of TCM syndromes.SPSS20.0 statistical software was used for the above data,descriptive statistics were used for general data,and χ2 test was used for counting data.Results1.In patients with chronic atrophic gastritis complicated with gastric xanthelasma,the distribution ratio of single xanthelasma group and multiple xanthelasma group in each stage of OLGA/OLGIM is different.Among them,the proportion of OLGA stages Ⅲ and Ⅳ in the multiple xanthelasma group(40.91%and 27.27%respectively)was higher than the proportion of OLGA stages Ⅲ and Ⅳ in the single xanthelasma group(25.61%and 15.85%respectively);The proportion of OLGIM stages Ⅲ and Ⅳ in the multiple xanthelasma group(45.45%and 22.73%,respectively)was higher than the proportion of OLGIM stages Ⅲ andⅣ in the single xanthelasma group(30.49%and 20.73%,respectively).2.In this study,there were 61 cases with extensive intestinal metaplasia,accounting for 58.65%.The detection rate of extensive intestinal metaplasia in the multiple xanthelasma group(72.72%)was higher than that in the single xanthelasma group(54.88%).The detection rate of extensive intestinal metaplasia in patients with xanthelasma at different sites is as follows:gastric fundus(100%)>gastric body(70.73%)>cardia(62.50%)>gastric angle(58.82%)>gastric antrum(50.94%).3.The proportion of syndrome distribution in patients with chronic atrophic gastritis with gastric xanthelasma from high to low is as follows:spleen and stomach weakness syndrome(34.90%)>spleen and stomach dampness syndrome(16.15%)>liver and stomach stagnation syndrome(15.62%)>liver and stomach Qi stagnation syndrome(14.85%)=stomach collateral stasis syndrome(14.85%)>stomach yin deficiency syndrome(4.17%).Among them,43 cases were single syndrome(28 cases with spleen and stomach weakness syndrome,9 cases with spleen and stomach dampness-heat syndrome,5 cases with liver-stomach stagnation syndrome,3 cases with liver-stomach qi stagnation syndrome,0 cases with stomach-yin deficiency syndrome,and 0 cases with stomach-collateral stasis syndrome),accounting for The total number of cases is 41.35%;the compound syndrome is 61,accounting for 58.65%of the total number of cases.Among the compound syndromes,there are up to 12 cases with liver and stomach qi stagnation syndrome+spleen and stomach weakness syndrome,accounting for 19.67%;followed by spleen and stomach weakness syndrome+stomach The blood stasis syndrome,liver-stomach depression-heat syndrome+spleen-gastric damp-heat syndrome accounted for 13.1 1%and 8.20%,respectively.4.The proportion of syndrome distribution in the multiple xanthelasma group is as follows:spleen and stomach weakness syndrome>liver and stomach stagnation and heat syndrome=spleen and stomach damp heat syndrome>liver and stomach qi stagnation syndrome=weiluoyu blood syndrome>stomach deficiency syndrome;single xanthelasma group syndrome distribution proportion The order is spleen and stomach weakness syndrome>liver and stomach qi stagnation syndrome=weiluoyu blood syndrome>spleen and stomach dampness syndrome>liver and stomach stagnation syndrome>stomach deficiency syndrome.The proportion of compound syndromes in the multiple xanthelasma group(63.64%)was higher than that in the single xanthelasma group(58.54%).5.The frequency of syndromes in the extensive intestinal group accounted for the top three:spleen and stomach weakness syndrome(39.90%),gastric collateral stasis syndrome(18.80%),liver and stomach stagnation syndrome(15.38%);non-extensive intestinal syndrome group accounted for the frequency of syndromes Compared with the first three:spleen and stomach weakness syndrome(33.33%),spleen and stomach dampness syndrome(20.00%),liver and stomach qi stagnation syndrome(16.00%).ConclusionsThis study shows that the detection rate and risk of canceration of patients with chronic atrophic gastritis complicated with multiple gastric xanthelasmas are higher than those with chronic atrophic gastritis complicated with single gastric xanthelasma.According to the distribution characteristics of syndromes in this study,it can be seen that the pathogenesis of chronic atrophic gastritis combined with gastric xanthelasma is a combination of deficiency and solidity,based on weakness of the spleen and stomach,with phlegm and dampness,heat and blood stasis as the standard.Gastric xanthelasma can affect the syndrome distribution of chronic atrophic gastritis,and the syndrome distribution of patients with chronic atrophic gastritis combined with gastric xanthelasma is related to the mucosal atrophy,the degree of intestinal metastasis,and the distribution of gastric xanthelasma.The key to gastric xanthelasma;blood stasis is the key to atrophy and intestinal development.Therefore,in the treatment of patients with chronic atrophic gastritis combined with gastric xanthelasma,the spleen is the mainstay,and according to the mucosal atrophy,intestinal metastasis and gastric xanthelasma,"tongyu","phlegm dampness","Qing Yu fever" prescription.This study enriches the content of microscopic syndrome differentiation of traditional Chinese medicine and provides a reference for the clinical diagnosis and treatment of chronic atrophic gastritis with gastric xanthelasma. |
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