早期胃癌的中医证候特点与胃镜征象的相关性研究

Study on the correlation between traditional Chinese medicine syndromes and gastroscopic signs of early gastric cancer

关键词:  早期胃癌  中医证候  胃镜

Key words:  early gastric cancer  traditional Chinese medicine syndrome  gastroscope

摘要:

[目的] 探讨早期胃癌（EGC）的中医证候特点及其与胃镜征象之间的关系，为EGC的微观辨证提供新的客观化依据。[方法] 选取2022年5月—2023年12月就诊于北京中医药大学东方医院及中国医学科学院肿瘤医院住院部、内镜中心的EGC患者173例，收集患者基本个人信息、中医四诊信息、胃镜检查结果及病理诊断结果。归纳整理数据，使用SPSS 27.0统计软件分析EGC患者中医证候特点及其与胃镜征象的相关性。[结果] EGC患者的中医证候与性别之间差异具有统计学意义（P<0.05），女性以肝气犯胃证多见，男性以湿热瘀滞证多见；关于中医证候与胃黏膜表现的关系：各证候间胃黏膜溃疡、隆起、粗糙、僵硬、伴陈旧性血迹、覆盖黄厚苔、伴黄浊黏液比较，差异有统计学意义（P<0.01），均以湿热瘀滞证为多见；各证候间胃黏膜糜烂、未见覆盖苔、伴白清稀液比较，差异有统计学意义（P<0.05），均以脾胃虚弱（寒）证多见；各证候间胃黏膜凹陷比较，差异有统计学意义（P<0.05），以胃热伤阴证多见；各证候间胃黏膜颗粒结节、覆盖薄黄苔比较，差异有统计学意义（P<0.05），均以肝气犯胃证多见；各证候间胃黏膜覆盖白厚苔、伴白浊黏液比较，差异有统计学意义（P<0.01），均以痰湿凝结证多见。[结论] EGC的中医证候与胃镜征象联系紧密。阴阳失衡、气血不畅是发病主因，不同证型病理过程不同，胃镜表现也各异，男女证型有别，胃镜表现也不同，该研究为EGC临床诊治提供新思路和方法。

Abstract:

[Objective] To explore the characteristics of traditional Chinese medicine（TCM） syndrome of early gastric cancer and its relationship with gastroscopy signs，and to provide a new objective basis for TCM micro-syndrome differentiation and diagnosis and treatment. [Methods] A total of 173 patients with early gastric cancer who were admitted to the inpatient department and endoscopy center of Oriental Hospital of Beijing University of Chinese Medicine and Cancer Hospital of Chinese Academy of Sciences from May 2022 to December 2023 were selected. The basic personal information，information of four TCM diagnoses，gastroscopy results and pathological diagnosis results of the patients were collected. SPSS 27.0 statistical software was used to analyze the characteristics of TCM syndrome and its correlation with gastroscopy signs in patients with early gastric cancer. [Results] There was statistical difference between the TCM syndrome and gender of EGC patients（P<0.05）. The syndrome of liver qi occupying stomach was more common in women，and the syndrome of dampness-heat stasis was more common in men. The relationship between TCM syndromes and gastric mucosal manifestations：gastric mucosal ulcer，bulge，rough，stiff，accompanied by old blood，covered with yellow thick moss，accompanied with yellow mucous were significantly different among the syndromes（P<0.01），and the syndrome of damp-heat stasis was most common. Gastric mucosal erosion，no covering of moss，and Baiqing dilute liquid were statistically different in each syndrome（P<0.05），and the syndrome of spleen and stomach weakness（cold） was most common. Gastric mucosa depression was statistically different among the syndroms（P<0.05），and the syndrome of stomach heat injuring yin was more common. There were statistically significant differences in granule nodules and thin yellow fur covering gastric mucosa in each syndrome（P<0.05），and the syndrome of liver qi invading stomach was most common. The gastric mucosa covered with white fur and white mucous were statistically different in each syndrome（P<0.001），and phlegm-dampness coagulation was the most common syndrome. [Conclusion] This study found that the TCM syndromes of early gastric cancer were closely related to the gastroscopic image. The imbalance of yin and yang and the obstruction of qi and blood are the main causes of gastric cancer. Different syndrome types correspond to different pathological processes and show different manifestations under gastroscopy. In terms of gender differences，women are prone to liver qi attack stomach syndrome，and men are mostly damp-heat stasis syndrome，which makes the gastroscopy performance of men and women have obvious differences. TCM syndrome types are divided into two categories，through the stratified study of the syndrome types，we can interpret the gastroscopy phenotype with the help of TCM theory.