| Research Objectives:1.To explore the characteristics of TCM syndromes of Chronic atrophic gastritis(CAG);2.To explore the relationship between TCM syndrome of chronic atrophic gastritis and gastroscopy image,so as to provide objectified basis and new diagnosis and treatment ideas for TCM microscopic syndrome differentiation.Research methods:1.Case collection: Observation tables were designed and cases were collected.A total of 240 patients with chronic atrophic gastritis who met the inclusion criteria in the First Affiliated Hospital of Yunnan University of Chinese Medicine and the outpatients Department of Yunnan University of Chinese Medicine from November 2021 to November2022 were selected as the research objects,and basic information such as gender,age,diet taste and lifestyle were collected.Patients’ symptoms,tongue and pulse syndromic manifestations,gastroscopy report and pathological diagnosis report were collected.TCM diagnosis and syndrome differentiation were carried out according to TCM syndrome waiting and diagnosis criteria.2.Data collation and statistics: The collected data were recorded into Excle for summary and collation,and SPSS26.0 statistical software was used to analyze the relationship between TCM syndrome,gastroscopy image and gastric mucosa histopathology of patients with CAG.Results :1.Basic information of patients with chronic atrophic gastritis: The average age of 240 patients with CAG was 56.99±10.28 years old,and the ratio of male to female was 1.31:1,with 55-66 years old accounting for the most;There were 18 kinds of gastroscopic images in 240 CAG patients,and the top 10 kinds of gastroscopic images were ranked by frequency:There were 127 cases of mucous plaque congestion(52.6%),126 cases of mucous granular nodules(52.5%),123 cases of mucous swelling(51.2%),113 cases of mucous leukoplakia(47.1%),103 cases of mucous membrane thin(vascular exposure)(42.9%),101 cases of bile reflux(42.9%),and plicae flat and thin In 100 cases(41.7%),82cases(34.2%)were plicae swollen and thick,77 cases(32.1%)were gastric juice white and sticky,and 63 cases(26.3%)were mucosal erythema.2.TCM syndromic characteristics of chronic atrophic gastritis are: syndrome of heat stagnation of liver and stomach(21.7%%)>syndrome of dampness-heat of spleen deficiency(21.3%)>syndrome of weakness of spleen and stomach(cold)>syndrome of liver and stomach qi stagnation(15.4%)>syndrome of deficiency of stomach and Yin(13.8%)>syndrome of spleen deficiency and stasis(7.9%).The age of patients with syndrome of deficiency of stomach and Yin and syndrome of spleen and stomach weakness(cold)were older than those with syndrome of spleen deficiency and damp-heat,and the difference was statistically significant(P<0.05).3.Relationship between TCM syndrome of chronic atrophic gastritis and gastroscopy image:(1)Relationship with the morphology of gastric mucosa erosion: gastric mucosa depression and erosion were more common in the syndrome of deficiency of stomach Yin,and the difference was statistically significant compared with the syndrome of heat stagnation of liver and stomach(P<0.05).The syndrome of spleen deficiency and damp-heat was mainly characterized by gastric mucosal uplift and erosion,and the difference was statistically significant compared with the syndrome of spleen and stomach weakness(cold)(P<0.05).(2)The syndrome of spleen deficiency and dampness-heat and the syndrome of liver and stomach stagnation of heat are mostly characterized by swollen and large gastric mucosal folds;the syndrome of deficiency of stomach Yin and the syndrome of spleen and stomach weakness(cold)are mostly characterized by flat and thin gastric mucosal folds;the syndrome of liver and stomach stagnation of heat is statistically significant compared with the syndrome of spleen deficiency and dampness-heat,the syndrome of deficiency of stomach and stomach weakness(cold)(P<0.05).(3)The relationship between the color and color of gastric mucosa: spleen deficiency and damp-heat syndrome and liver-stomach heat stagnation syndrome are more common in the stomach mucosa with mottle-like hyperemia;liver-stomach qi stagnation syndrome and spleen-stomach weakness syndrome(cold)are more common in the stomach mucosa white phase;the difference between spleen deficiency and damp-heat syndrome and liver-stomach stagnation syndrome and liver-stomach qi stagnation syndrome is statistically significant(P<0.05).(4)The relationship between the liver and stomach and the shape and color of gastric fluid: the syndrome of stagnation heat of liver and stomach was mainly characterized by the dark yellow and viscous gastric fluid,and the difference was statistically significant compared with the other 5 groups(P<0.05).The liver and stomach qi stagnation syndrome was more common with yellowish and thin gastric fluid,and the difference was statistically significant compared with spleen deficiency and damp-heat syndrome(P<0.05).Spleen deficiency damp-heat syndrome was mainly characterized by white turbidness and thick gastric fluid,which had statistical significance compared with liver-stomach qi stagnation syndrome,liver-stomach heat stagnation syndrome,deficiency of stomach Yin syndrome,weakness of spleen and stomach(cold)syndrome(P<0.05).The syndrome of deficiency of stomach Yin and weakness of spleen and stomach(cold)were more common with white permeation of gastric fluid,which had statistical significance compared with the syndrome of heat stagnation of liver and stomach and the syndrome of dampness-heat of spleen deficiency(P<0.05).(5)Relationship with other gastroscopy images: spleen deficiency and stasis syndrome was more common with old blood stains in gastric mucosa,and the difference was statistically significant compared with other syndrome groups(P<0.05).The syndrome of spleen deficiency and damp-heat was mainly characterized by gastric mucosa erythema,and the difference was statistically significant compared with the syndrome of liver-stomach qi stagnation and liver-stomach heat stagnation(P < 0.05).The syndrome of heat stagnation in liver and stomach was more common with gastric mucosa granule nodules,and the difference was statistically significant with the ratio of liver and stomach qi stagnation(P < 0.05).The syndrome of spleen deficiency and dampness-heat was gastric mucosal swelling,which had statistical significance compared with the other 5 groups(P <0.05).The syndrome of liver and stomach depression and heat was gastric mucosal swelling,which had statistical significance compared with the syndrome of spleen and stomach weakness(cold)(P <0.05).The syndrome of spleen deficiency and stasis was mainly characterized by flat and thin gastric mucosa(exposed blood vessels),which had statistical significance compared with the syndrome of heat stagnation of liver and stomach and the syndrome of spleen deficiency and dampness-heat(P < 0.05).The syndrome of stomach deficiency and spleen and stomach weakness(cold)mainly featured flat and thin gastric mucosa(exposed blood vessels),which had statistical significance compared with the syndrome of heat stagnation of liver and stomach(P < 0.05).4.Relationship between TCM syndrome of chronic atrophic gastritis and Hp: The positive rate of Hp in spleen deficiency damp-heat syndrome was higher than that in other5 groups,and the difference was statistically significant(P <0.05).5.Relationship between TCM syndrome of chronic atrophic gastritis and pathological tissue of gastric mucosa:(1)Relationship with the degree of atrophy of gastric mucosa: the degree of atrophy of gastric mucosa in syndrome of spleen deficiency and blood stasis is more serious,and the difference is statistically significant compared with syndrome of liver and stomach qi stagnation,syndrome of spleen deficiency and dampness-heat,syndrome of spleen and stomach weakness(cold)(P<0.05).(2)Relationship with the degree of intestinal metaplasia: the degree of intestinal metaplasia of gastric mucosa in the syndrome of spleen deficiency and stasis was more severe,and the difference was statistically significant compared with the syndrome of liver-stomach qi stagnation,liver-stomach heat stagnation,spleen deficiency and damp-heat,and spleen and stomach weakness(cold)(P < 0.05).The degree of intestinal metaplasia in the syndrome of deficiency of stomach and stomach was more serious,and the difference was statistically significant compared with the syndrome of liver-stomach qi stagnation,liver-stomach heat stagnation and spleen deficiency damp-heat(P < 0.05).(3)Relationship with the degree of active inflammation: The degree of active inflammation was more serious,and the difference was statistically significant compared with the syndrome of liver-stomach qi stagnation,liver-stomach heat stagnation,deficiency of stomach Yin and weakness of spleen and stomach(cold)(P< 0.05).(4)Relationship with the degree of chronic inflammation: spleen deficiency damp-heat syndrome had a higher degree of chronic inflammation,and the difference was statistically significant compared with the syndrome of deficiency of stomach and Yin and the syndrome of spleen and stomach weakness(cold)(P< 0.05).(5)The relationship between the hyperplasia of lymphatic follicles and the pathological tissue of gastric mucosa: the hyperplasia of lymphatic follicles was more obvious in spleen deficiency and dampness heat syndrome,and the difference was statistically significant compared with that in liver and stomach stagnation heat syndrome(P < 0.05).Research conclusions:1.Chronic atrophic gastritis mainly presents 6 syndrome types,and their distribution characteristics are as follows: syndrome of heat stagnation of liver and stomach >syndrome of dampness-heat of spleen deficiency > syndrome of weakness of spleen and stomach(cold)> syndrome of qi stagnation of liver and stomach > syndrome of deficiency of stomach and Yin > syndrome of spleen deficiency and stasis.2.Relationship between TCM syndrome of chronic atrophic gastritis and gastroscopic image: the gastric mucosa folds are swollen and thick,and the mucosa is speckle-like congestion;the syndrome of liver and stomach stagnation is considered if the gastric fluid is dark yellow and thick,and the mucosal granules are nodule;the syndrome of spleen deficiency and damp-heat is considered if the gastric fluid is elevated and erosive,the gastric fluid is white and sticky,the mucosal erythema,and the mucosal swelling is considered.The gastric mucosa folds are thin and sparse,the gastric mucosa is thin(blood vessels are exposed),and the gastric fluid is white and rare.If the gastric mucosa is white,the syndrome of weakness of the spleen and stomach(cold)is considered;if the gastric mucosa is depressed and erosive,the syndrome of deficiency of stomach Yin is considered.Gastric mucosa white accompanied by thin yellow gastric fluid considering the syndrome of liver and stomach qi stagnation;Old blood stains of gastric mucosa accompanied by thin mucosa(blood vessel exposure)were considered as spleen deficiency and stasis syndrome.3.Chronic atrophic gastritis with spleen deficiency dampness-heat syndrome is closely related to Hp infection.4.Relationship between TCM syndrome and histopathology of chronic atrophic gastritis: the degree of intestinal metaplasia and active inflammation of gastric mucosa in liver-stomach heat stagnation syndrome were less.The degree of gastric mucosa atrophy,intestinal metaplasia,active inflammation and chronic inflammation were severe in spleen deficiency and dampness-heat syndrome,and lymphatic follicular hyperplasia was obvious.The degree of gastric mucosa atrophy,intestinal metaplasia,active inflammation and chronic inflammation in the syndrome of spleen and stomach weakness(cold)were slighter.The atrophy degree of gastric mucosa,intestinal metaplasia degree of gastric mucosa and active inflammation degree of hepato-gastric qi stagnation syndrome were less.In the syndrome of deficiency of stomach Yin,the degree of intestinal metaplasia,active inflammation and chronic inflammation of gastric mucosa were relatively severe.The degree of gastric mucosa atrophy and intestinal metaplasia in spleen deficiency and stasis syndrome was serious. |
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