| PurposeThrough statistical analysis of the TCM syndrome types,anxiety and depression,endoscopic manifestations,and the distribution of Helicobacter pylori(H.pylori)in patients with reflux esophagitis(Reflux Esophagitis,RE),to explore the TCM syndrome types and anxiety of RE The correlation between depression,endoscopic manifestations,and H.pylori infection provides ideas and methods for the diagnosis and treatment of RE.MethodA questionnaire survey was conducted on 300 patients with reflux esophagitis who were treated at the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from April 2019 to December 2020 and underwent gastrointestinal endoscopy to design a questionnaire for reflux esophagitis.Including the patient’s age,gender,occupation,living conditions,H.pylori infection,and four-diagnosis information of traditional Chinese medicine,the investigator will fill in the information through questioning and conduct syndrome differentiation,and perform the Hamilton Anxiety Scale(HAMA)on the patient through observation and communication.Hamilton Depression Rating Scale(HAMD)score to assess the patient’s anxiety and depression state.After the questionnaire was retrieved,the data was entered into a computer,a database was established,and SPSS 24.0 software was used to perform statistical analysis,and methods such as descriptive analysis,2 test,non-parametric test,and factor analysis were selected according to the type of data.Result1.Among the 300 RE patients in this study,115 were women,accounting for 38.3% of the total number,and 185 were men,accounting for 61.7%;the oldest was 84 years old,the youngest was 27,and the counterpoise age was 57±12 years.The age group is 60-69 years old;the patients with a course of less than half a year are the most,with 148 cases,accounting for49.3%,and 40 cases with 1-3 years,accounting for 13.3%;from the past history,a total of 38patients(12.7%).No past history,and the remaining 262(87.3%)have past history.Among patients with previous history,chronic diseases such as hypertension,peptic ulcer,fatty liver,diabetes,coronary heart disease,gallbladder disease,cerebrovascular disease,and thyroid disease accounted for 45.0%,29.8%,26.3%,19.0%,respectively.14.1%,12.6%,11.5%,11.5%,pharyngitis,hepatic cysts,sleep apnea hypopnea syndrome,fatty liver,and asthma accounted for relatively small proportions;occupational nature is mainly mental workers,accounting for 53.7%;in terms of the cause of the disease,99 cases had no obvious inducement,201 cases had obvious inducement,96 cases of uneasy mood,60 cases of irregular diet,followed by fatigue,fatigue and climate change;in terms of diet preference,the patients who addicted to sweets were the most,with a total of 91 cases,accounting for 30.3%of the total number of people,87 cases without food preference,accounting for 29.0%,the rest are spicy,greasy,and cold;in terms of bad habits,201 cases have no history of smoking,99 cases have a history of smoking,and those without a history of drinking Among 221 cases,79 cases had a history of drinking.In terms of BMI index,132 cases were overweight,accounting for 44%,101 cases were normal weight,accounting for 33.7%,obesity and underweight accounted for 14.0% and 8.3%,respectively.2.Among the 300 RE patients in this study,57 were positive for H.pylori,accounting for19.0%,and 243 were negative for H.pylori,accounting for 81.0%.There were more H.pylori-negative patients in RE.It is speculated that H.pylori is in RE does not play a role in promoting the development of the disease.The proportion of H.pylori infection in RE patients of different genders is different.According to statistical analysis,H.pylori infection has nothing to do with gender(P>0.05).3.Research on the distribution of TCM syndromes: using factor analysis to analyze the rules of RE TCM syndromes,it is concluded that the disease location is mainly in the liver,gallbladder,spleen,and stomach,and the disease includes Qi deficiency,Yang deficiency,Yin deficiency,Qi stagnation,phlegm,and dampness.,Heat and other aspects.The preliminary proposed syndrome types include six types: liver-stomach-like discordance syndrome,liver-like(gallbladder)stagnation-heat syndrome,spleen-stomach-like weakness syndrome,spleen-stomach-like damp-heat syndrome,phlegm-like stagnation syndrome,and stomach-yin deficiency syndrome.Therefore,combining the results of factor analysis and clinical syndrome differentiation,300 cases of RE patients were classified into 6 syndrome types,and the distribution characteristics of TCM syndrome types of RE patients in this study were:liver-stomach discord(43.0%)>spleen-stomach weakness syndrome(22.0%)> Spleen and stomach damp-heat syndrome(14.0%)> Liver-stomach stagnation-heat syndrome(9.7%)>Phlegm-qi stagnation syndrome(7.3%)> Stomach Yin deficiency syndrome(4.0%).Among them,the main syndromes are liver-stomach discord,spleen-stomach weakness,and differences between different syndrome types and age,sex,inducement,occupation,and diet preference are statistically significant(P<0.05),and are different from H.pylori infection.No statistical significance(P>0.05).4.Anxiety and depression and the relationship between TCM syndromes and anxiety and depression: Anxiety and depression: the average HAMA score is 10.08±3.744 points,32.7%of those without anxiety,48.6% may have anxiety,18.7% must have anxiety;HAMD average With a score of 10.36±4.054,36.0% were without depression,56.7% were likely to be depressed,and 7.3% were definitely depressed.The degree of anxiety and depression of women was higher than that of men,and the difference was significant(P<0.001).Anxiety and depression of 300 RE patients were concentrated in 60-69 years old,and it was also common in 50-59 years old.There was a statistically significant difference between the scores of anxiety and depression and age group(P<0.001).The relationship between TCM syndromes and anxiety and depression: Liver-stomach discord and phlegm-qi stagnation syndrome are more closely related to anxiety;HAMA scores are higher in liver-stomach discord and phlegm-qi stagnation syndrome;phlegm-qi stagnation syndrome,liver-stomach discord and syndrome are more closely related to anxiety;Depression is more closely related;HAMD scores for liver-stomach discord and liver-stomach stagnation-heat syndrome have higher scores.5.Gastroscopy results and research on the correlation with TCM syndrome types:Among 300 RE patients,LA-A patients with esophagitis accounted for the largest proportion,accounting for 78.0% of the total number,and LA-B patients with esophagitis accounted for 16.0% There are fewer patients with esophagitis LA-C and esophagitis LA-D.The detection rate of esophageal congestion was the highest at 70.7%,and the detection rates of esophageal edema,esophageal erosion,esophageal mucosa roughness,esophageal granule adhesion,and esophageal ulcer were 49.0%,28.7%,26.0%,6.3%,and 2.3%,respectively.Chronic gastritis with erosion was the most common under endoscopic comorbidity,with a detection rate of40.7%.Gastric polyps(24.3%),duodenitis(14.7%),and duodenal bulbs were also detected with a higher detection rate.Ulcers(12.3%),bile reflux gastritis(10.7%),etc.Among the pathological types of gastritis associated with RE: 61 cases of chronic atrophic gastritis,accounting for 20.3%,and 239 cases of non-atrophic gastritis,accounting for 79.7%.There was a statistically significant difference in the endoscopic grading of different TCM syndromes in RE(P <0.05).The patients with LA-A grade mainly had liver-stomach discordance,the LA-B grade mainly had spleen and stomach damp-heat syndrome,and the LA-C grade The main syndrome is deficiency of stomach yin,and the main syndrome of deficiency of spleen and stomach in LA-D grade.There was no significant difference in esophageal mucosal inflammation in different TCM syndromes of RE(P>0.05).Esophageal congestion and esophageal granule attachments were most often with red tongue,esophageal edema was most often due to thin and white fur,and esophageal erosion and esophageal granules were most attached to yellow and greasy fur.The difference was statistically significant(P<0.05).There was no significant difference between the appearance of the remaining esophageal mucosa and the appearance of tongue coating(P>0.05).In conclusion1.RE patients have more obvious anxiety and depression.The liver-stomach discord syndrome,phlegm-qi stagnation syndrome and liver-stomach stagnation-heat syndrome are more closely related to anxiety and depression than other syndromes,suggesting that the disease can be treated clinically.Emphasize on the treatment of the liver,the emotions are comfortable,the liver qi is stable,and there is no chance of violating the stomach.2.Most of the RE patients are H.pylori-negative patients.It is speculated that H.pylori does not promote the development of the disease in reflux esophagitis.There is no statistical difference between the TCM syndrome of RE and H.pylori infection.Academic significance(P<0.001).3.RE’s endoscopic classification is mainly based on esophagitis LA-A,followed by esophagitis LA-B,esophagitis LA-C and esophagitis LA-D are less numerous,and different TCM syndrome types are classified by endoscopy.The difference was statistically significant(P<0.05).There was no statistically significant difference in esophageal mucosal inflammation with different TCM syndrome types(P>0.05).The results of this study suggest that TCM treatment of RE should combine disease,syndrome,and emotions,and at the same time combine TCM syndromes with endoscopic micro-diagnosis to improve clinical diagnosis and treatment,reduce recurrence rate,and achieve the treatment of this disease And prevention. |
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