| Objectives:In this study,211 cases of HP positive and 147 cases of HP negative peptic ulcer(PU)hospitalized in the same period were compared in terms of epidemiology,diet habits,disease inducements,endoscopic manifestations,gastrointestinal symptoms,especially TCM syndrome and syndrome elements,to explore the risk factors of Helicobacter pylori(HP)infection,the significance of TCM syndrome elements analysis in determining TCM syndrome,and to lay a theoretical foundation for the prevention of HP infection,the treatment of TCM syndrome differentiation,the auxiliary eradication of HP,the promotion of ulcer healing and the prevention of ulcer recurrence.Methods:1.358 patients with peptic ulcer diagnosed by endoscopy in the digestive department of Nankai hospital in Tianjin in 2019 were collected as the preliminary study object to carry out HP test,which was divided into HP positive group and HP negative group.2.To compare and analyze the gender,age,marriage,occupation,education level,initial onset,recurrence and family history of the two groups.3.Comparative analysis of the two groups of patients' diet habits and predisposing factors.4.Compare and analyze complications and the score of digestive tract symptoms between the two groups.5.To compare and analyze the endoscopic features of the two groups.6.Using the system cluster analysis and factor analysis to analyze the four diagnosis information of the two groups of patients,extract and compare the syndrome and syndrome elements of the two groups.7.Compare and analyze the similarities and differences between the two groups of patients' syndrome and syndrome elements according to the opinion of experts and the TCM syndrome element analysis.8.To analyze the risk factors of HP infection.Results:1.The HP test results of 358 patients with peptic ulcer were 211 HP positive and 147 HP negative.2.There were more males than females in the two groups(P>0.05);the peak age of ulcer in HP positive group was 60-69 years old,and that in HP negative group was 50-59 years old(P <0.05);the proportion of workers,farmers and drivers in HP positive group was higher than that in HP negative group;the positive rate of HP was negatively correlated with the education level of patients(P<0.05);the recurrence rate in HP positive group and those with family history of ulcer disease was higher than that in HP negative group and those without family history History(P<0.01).3.The comparison of eating habits between the two groups showed that the proportion of HP positive group was higher than that of HP negative group(P<0.01);the proportion of HP positive group was higher than that of HP negative group(P< 0.01)The proportion of habitual eating and overeating in HP positive group was higher than that in HP positive group(P< 0.01),and the proportion of mental stimulation in HP positive group was higher than that in HP negative group(P<0.01).4.The score of gastrointestinal symptoms and the probability of gastrointestinal bleeding and obstruction in HP positive group were significantly higher than those in HP negative group(P< 0.01).5.Endoscopic comparison: the proportion of Du,Cu,multiple ulcer,gastric body ulcer,giant ulcer and deep concave ulcer in HP positive group was significantly higher than that in HP negative(P<0.05);the mucosal punctate redness,diffuse redness,hyperemia,edema and erythema in HP positive group were significantly higher than those in HP negative group(P< 0.05),and the proportion with bile reflux was lower than that in HP negative(P<0.05).6.By cluster analysis,the syndrome elements of HP positive patients were stomach,liver and spleen.The syndrome elements of HP positive patients were Qi stagnation,dampness,heat and blood stasis,while those of HP positive patients were Yin deficiency and yang deficiency.There are six types of syndrome extracted,which are spleen and stomach dampness heat type,liver and stomach depression heat type,liver and stomach disharmony type,stomach collaterals stasis type,stomach yin deficiency type and spleen and stomach Yang deficiency type.The syndrome elements of HP negative patients were stomach,spleen and liver.The syndrome elements of the disease were Qi stagnation,dampness,heat and blood stasis,while those of deficiency were Yin deficiency and yang deficiency.There are 5 kinds of diseases extracted,which are the syndrome of stagnation of stomach collaterals,deficiency of stomach yin,weakness of spleen and stomach,stagnant heat of liver and stomach,disharmony of liver and stomach.By factor analysis,the syndrome elements of HP positive patients were stomach,liver and spleen.The syndrome elements of HP positive patients were Qi stagnation,heat,dampness and blood stasis,while those of HP positive patients were Yin deficiency,Yang deficiency and Qi deficiency.There are 6types of syndrome extracted,which are spleen and stomach damp heat type(25.1%)> spleen deficiency damp heat type(17.1%)= liver and stomach stagnant heat type(17.1%)> stomach yin deficiency type(16.5%)> liver and stomach disharmony type(13.3%)> stomach collaterals stasis type(10.9%).The syndrome elements of HP negative patients were stomach,liver and spleen.The syndrome elements of the disease were heat,qi stagnation,dampness and blood stasis.The syndrome elements of deficiency were Yin deficiency,Yang deficiency and Qi deficiency.There are 6 types of syndromes extracted,they are liver stomach disharmony(24.5%)> deficiency of stomach yin(19.7%)> damp heat of spleen and stomach(15.6%)> stagnation of liver and stomach(15.0%)>weakness of spleen and stomach(14.3%)> stagnation of stomach collaterals(10.9%).Statistical analysis showed that there were statistical differences in the distribution of syndrome elements andsyndrome analysis between the two groups(P < 0.01).According to the consensus opinion,the syndrome distribution of TCM based on syndrome differentiation is: HP positive group: spleen stomach damp heat syndrome(32.7%)> liver stomach disharmony syndrome(21.8%)> deficiency of stomach yin syndrome(15.2%)> liver stomach stagnation heat syndrome(14.7%)> spleen stomach weakness syndrome(8.1%)> gastric collaterals stasis syndrome(7.6%).HP negative group: disharmony of liver and stomach(36.1%)> deficiency of stomach yin(14.2%)> weakness of spleen and stomach(13.6%)> damp heat of spleen and stomach(12.2%)> stagnation of liver and stomach(12.2%)> stasis of stomach collaterals(11.6%).Statistical analysis showed that there was statistical difference in the distribution of syndrome analysis between the two groups(P < 0.05).7.The results of syndrome differentiation of HP positive patients were statistically analyzed and compared with those of syndrome differentiation by using statistics(P < 0.01).However,there was no significant difference between HP negative patients' physician syndrome differentiation and syndrome element syndrome differentiation(P > 0.05).The results of factor analysis showed that the proportion of spleen stomach damp heat syndrome and liver stomach stagnant heat syndrome was significantly higher.8.The risk factors of HP infection(P < 0.05)were low culture,pungent and greasy,over cold and over heated diet,excessive drinking,unsanitary habits,regular meals,irregular diet(possibly related to occupation such as driver),smoking,mental stimulation,etc.Conclusion:1.HP infection and low education,poor health and eating habits,such as smoking and drinking,spicy and greasy,over cold and over hot irregular diet,and mental stimulation factors.2.HP positive peptic ulcer has characteristic mucosal manifestations.Its ulcer is often multiple,deep and large.Duodenal bulb,stomach body and fundus are more common.It is more likely to have complications.Its clinical symptoms are relatively severe.3.The most common syndrome elements of HP positive PU patients are stomach,liver and spleen.The syndrome elements of the disease are Qi stagnation,heat,dampness and blood stasis,while those of deficiency are Yin deficiency,Yang deficiency and Qi deficiency.The content of damp and heat syndrome elements was significantly higher than that of HP negative patients.The most common TCM Syndromes of HP positive PU patients are spleen stomach damp heat syndrome and liver stomach stagnant heat syndrome.The most common syndromes of HP negative patients are disharmony of liver and stomach and deficiency of stomach yin.It is suggested that damp and heat may be the characteristic manifestations of HP infection.4.There are differences between HP positive patients' doctors' syndrome differentiation and syndrome element differentiation,suggesting that more standardized research and training are still needed for the diagnosis and treatment of PU patients. |
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