Study On The Correlation Between The Distribution Of Syndromes, Syndrome Elements And Cold-heat Syndromes Of Chronic Gastritis And Tongue Fur Flora

Objective:Chronic gastritis is the dominant disease treated by traditional Chinese medicine?TCM?.According to the pathological diagnosis of gastric mucosa,it can be divided into 2 basic types of chronic non-atrophic gastritis?CNAG?and chronic atrophic gastritis?CAG?.Because the diagnosis of chronic gastritis needs gastroscopy and pathological biopsy,which greatly limits the clinical diagnosis efficiency;Meanwhile,there are also great difficulties in TCM syndrome differentiation due to many clinical symptoms of chronic gastritis,so it is of great significance to actively carry out relevant researches,clarify the etiology and pathogenesis of chronic gastritis,and seek a simple method of clinical diagnosis.This study intends to analyze the distribution of TCM syndromes and syndrome elements in patients with CNAG and CAG through a multi-center,large-sample cross-sectional study.It further focuses on the 2 syndromes of cold syndrome and heat syndrome,and observes the characteristics of tongue coating microbiota of cold syndrome and heat syndrome.This study provides reference for clarifying the internal correlation among pathological changes of chronic gastritis,TCM syndrome elements and tongue coating microbiota,and provides basis for the establishment of diagnosis and treatment methods of chronic gastritis by TCM and western medicine that combines macroscopic and microcosmic.Methods:In the first part of this study,we used cross-sectional method to collect the general data and four-diagnostic information of CNAG and CAG patients,established the information database of four diagnosis,and used descriptive analysis,difference test and factor analysis to explore the syndrome and syndrome elements characteristics of CNAG and CAG patients.In the second part,the chronic gastritis patients were divided into cold syndrome and heat syndrome.By using 16SrRNA technology combined with alpha diversity analysis,beta diversity analysis and species composition difference analysis,the differences of tongue coating microbiota between CNAG and CAG patients with cold syndrome and heat syndrome were analyzed to explore its relationship between diseases and syndromes.Results:Through the analysis of syndrome and syndrome elements,it was found that:?the syndrome types of CNAG patients were mainly dampness-heat of spleen and stomach syndrome,stomach-yin deficiency syndrome,incoordination between liver and stomach syndrome,deficient cold of spleen and stomach syndrome,dampness stagnancy due to spleen deficiency syndrome,and heat stagnation in liver and stomach syndrome.The syndrome elements of disease location were stomach,spleen,heart,lung,small intestine,large intestine,gallbladder,and liver.The syndrome elements of disease nature were dampness,qi stagnation,heat,yin deficiency,qi deficiency,phlegm,blood deficiency,yang hyperactivity,food accumulation,dryness,and blood heat.? The syndrome types of CAG patients were mainly deficient cold of spleen and stomach syndrome,qi stagnation in liver and stomach syndrome,stomach-yin deficiency syndrome,dampness stagnancy due to spleen deficiency syndrome,heat stagnation in liver and stomach syndrome,and dampness-heat of spleen and stomach syndrome.The syndrome elements of disease location were stomach,liver,spleen,large intestine,kidney,gallbladder,heart,lung,and small intestine.The syndrome elements of disease nature were qi stagnation,yang deficiency,heat,yin deficiency,qi deficiency,dampness,phlegm,blood heat,dryness,food accumulation,blood deficiency,blood stasis and yang hyperactivity.The results of tongue coating microbiota study showed that:? A total of 321 common OTUs,65 and 28 unique OTUs were found in CNAG and CAG patients,and the number of Firmicutes in CNAG group was higher than that in CAG group at phylum level?P<0.05?;?295 common OTUs were found in the CNAG cold syndrome group and heat syndrome group,and 42 unique OTUs were respectively found in the CNAG cold syndrome group and heat syndrome group,with no statistically significant difference in the number of phylum and genera;? 262 common OTUs,and 41 and 46 unique OUTs were found in the CAG cold syndrome group and heat syndrome group.The number of Proteobacteria in the CAG cold syndrome group was higher than that in the heat syndrome group at phylum level?P<0.05?.The number of Haemophilus and Neisseria in the cold syndrome group were higher than that in the heat syndrome group at genus level?P<0.05?.The number of prevotella₇ in the heat syndrome group was higher than that in the cold syndrome group?P<0.05?Conclusion:?1?In CNAG stage,the proportion of excess heat syndrome is higher than that of deficiency cold syndrome.However,as the disease progresses to CAG stage,the proportion of deficiency cold syndrome increases and the proportion of excess heat syndrome decreases,which is in line with the pathogenesis transformation law of "from excess to deficiency" in the development of chronic gastritis.?2?Firmicutes may be the potential feature to distinguish CNAG from CAG;Proteobacteria,Haemophilus,Neisseria,prevotella₇ maybe the potential features to distinguish CAG cold syndrome from CAG heat syndrome.