Research On The Relationship Between Chronic Atrophic Gastritis With Intestinal Metaplasia And Syndromes Of Traditional Chinese Medicine

Objective:According to the methods and principles of clinical epidemiology,by analysing clinical symptoms of chronic atrophic gastritis with intestinal metaplasia with the fator analysis to summarize traditional Chinese medicine syndrome distribution and to further explore syndromes rules of chronic atrophic gastritis with intestinal metaplasia and to provide clinical guidance for clinical diagnosis ,legislation and prescription .Methods:1 Making up unified clinical investigation form on the basis of literature study, expert consultation ,feasibility analysis and quantitating clinical symptoms accord to the unified standards.2 Collecting 207 cases with chronic atrophic gastritis with intestinal metaplasia in the outpatien of hebei hospital of TCM from December 2008 to December 2010.3 Collecting patients'general information such as name, sex, age, duration, dietary habits, inducing factors, past medical history, surgeries, family history etc,and TCM four diagnostic data and gastroscop performance and pathological diagnosis results accord to the methods and principles of clinical epidemiology,4 By descriptive statistics to study the relationship between chronic atrophic gastritis with intestinal metaplasia and age, sex,duration , inducing factors, bad habits and Hp infection .5 Exploring traditional Chinese medical syndrome rule of chronic atrophic gastritis with intestinal metaplasia by analysising TCM diagnostic data with the factor analysis . Results:1 Among 207 cases of CAG with IM,101 are male,while 106 are female,the proportion of men to women is 1:1.04.The mean age of patients was approximate to 56. Age group of 51~60 occupies the largest proportion of the total number(36.71%) in age distribution , age group of 61~70 and age group 41~50 accounted for 24.64% and 17.84% respectively, there is on significant statistical difference in the proportion of gender among groups of different age.The most common course of this disease is 5 ~ 10 years,account for 43.96%, the course group of 1 ~ 5 years are usually to seen, account for 29.95%.2 Dietary factors (41.06%) and gentle disposition factors (25.12%) play an important role in inducing factors.Bad habits such as high salt diet, hotting food, smoking, drinking occupy more proportion of the total number, accounted for 30.92%,24.15%, 21.74%, 18.84% respectively.3 White gastric mucosa and gastric mucosal rough are most commonly seen in changes of gastroscop performance, detection rate is 57% and 48.79% respectively, vasoganglion under gastroscope and gastric mucosal uplift are usually seen, detection rate is 42.51% and 28.02% respectively.4 The main symptoms of CAG with IM are flatulence (71.01%), gastralgia (63.29%),anorexia(47.83%),the main accompanying symptoms are fatigue (40.0%), thirsty (30.0%), bitterness (20.0%), the character of tongue and pulse of CAG with IM: red tongue occupied 38.65%, yellow coat occupied 54.11%,thready pulse occupied 59.42%, wiry pulse occupied 46.86%,smooth pulse occupied 28.99% .5 Using the fator analysis,9 TCM syndromes of chronic atrophic gastritis with intestinal metaplasia are summarised: para-deficiency of spleen-yang and kidney-yang,para-damp heat in the spleen with blood stasis,para-blood stasis with deficiency in kidney, para-qi deficiency in spleen with blood stasis , para- spleen deficiency and qi stagnation, para-liver stagnation and defiency of the spleen,para-deficiency fire due to insufficiency of stomach-yin, para-disharm ony between liver and stomach ,para-stomach aggregated heat. 6 There is an remarkable statistical difference between the patient who infected by helicobacter pylori and non-infected and TCM syndromes distribution(P<0.01).patients of h. Pylori infection are most seen in para-damp-heat in the spleen with blood stasis and para-stomach aggregated heat ,Infected rate is 67.6% and 60% respectively .7 There is an remarkable statistical difference in different degree of intestinal epithelium over the classification of the TCM syndromes(P<0.01),Para-damp-heat in the spleen with blood stasis,para-qi deficiency in spleen with blood stasis,para-disharmony between liver and stomach ,para-stomach aggregated heat are the main syndromes in mild intestinal metaplasia.Para-qi deficiency in spleen with blood stasis ,para-damp heat in the spleen with blood stasis,para-spleen deficiency and qi stagnation, para-blood stasis with deficiency in kidney are the main syndromes in moderate intestinal metaplasia.Para-blood stasis with deficiency in kidney,para-deficiency of spleen-yang and kidney-yang,Para-qi deficiency in spleen with blood stasis,para-deficiency fire due to insufficiency of stomach-yin are the main syndromes in severe intestinal metaplasia.Conclusions:1 The characteristics of TCM syndrome of chronic atrophic gastritis with intestinal metaplasia is mixed with deficiency and excess. Blood stasis,damp with heat , qi stagnation are most commonly seen in the excessive syndrome.qi deficiency, yin deficiency, yang deficiency are most commonly seen in deficiency syndrome.The excessive syndrome, including damp heat in the spleen with blood stasis,disharmony between liver and stomach ,stomach aggregated heatare are the main syndrome in the initial stage.The syndrome mixed with deficiency and excess,including qi deficiency with blood stasis,damp heat with blood stasis,spleen deficiency and qi stagnation are the main syndrome in the middleand final stage.The visceral position is mainly in spleen and stomach,relatedto liver and kidney.2 There is on significant difference between males and females in the incidence of this disease. middle-aged people and elderly are the high-risk groups so they should pay more attention to prevente and treat this disease. CAG with IM usually experience a very long period of onset,so early diagnosing and early treating is significant to block the development of this disease and to prevent gastric cancer.3 Bad habits such as high salt diet, hotting food, smoking, drinking and gentle disposition disorders are likely to cause the chronic atrophic gastritis with intestinal metaplasia easily. Family history of cancer and Hp infection are the risk factors of the chronic atrophic gastritis with intestinal metaplasia.4 When gastroscope photograph changes such as white gastric mucosa, gastric mucosal rough ,vasoganglion under gastroscope are appeared, we should consider intestinal metaplasia has occurred.5 chronic atrophic gastritis with intestinal metaplasia diagnosis as"weipi","weitong","nadai"in TCM by the distribution of main symptoms.6 There is a closely relationship between the Hp infection and damp-heat in the spleen with blood stasis and stomach aggregated heat.7 Para-damp heat in the spleen with blood stasis is most commonly seen in mild intestinal metaplasia.Para-deficiency in spleen with blood stasis is most commonly seen in moderate intestinal metaplasia.Para-blood stasis with deficiency in kidney is most commonly seen in Severe intestinal metaplasia.