本文關鍵詞：125例消化性潰瘍的中醫(yī)辨證分型與其胃鏡下表現及Hp感染的關系探討　出處：《大連醫(yī)科大學》2016年碩士論文　論文類型：學位論文

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【摘要】：目的:通過對消化性潰瘍中醫(yī)辨證分型與胃鏡下表現及Hp(Helicobacter pylori,幽門螺桿菌)感染等客觀指標間相互關系的研究,探究微觀辨證與宏觀辨證的關系,為消化性潰瘍中醫(yī)辨證分型更加客觀化、科學化提供依據。方法:收集大連醫(yī)科大學附屬第二醫(yī)院2015年3月-2016年1月門診消化內鏡室及消化內科的符合入選標準的病例資料,剔除符合排除標準的病例。參照2002年中華人民共和國衛(wèi)生部發(fā)布的《中藥新藥臨床研究指導原則》[1](試行)將剩余的125例病例進行中醫(yī)辨證分型,同時收集他們經OLYMPUS GIF-H260Z型胃鏡檢查所得胃鏡結果及快速尿素酶試驗或14C㧟尿素呼氣試驗所得Hp檢查結果。用SPSS 22.0統(tǒng)計軟件對所收集的數據進行分析,探究消化性潰瘍中醫(yī)各證型與胃鏡下表現、Hp感染的關系。結果:1、本次研究納入的125例消化性潰瘍患者各中醫(yī)證型的分布比例依次為:肝胃郁熱型脾胃虛弱(虛寒)型肝胃不和型胃陰不足型。2、各中醫(yī)證型間年齡分布的差異具有統(tǒng)計學意義(P0.01),其中脾胃虛弱(虛寒)型平均發(fā)病年齡較小,與其余3型相比,差異具有統(tǒng)計學意義(P0.05或P0.01),而胃陰不足型平均年齡明顯大于其余3型,與脾胃虛弱(虛寒)及肝胃郁熱2型相比,差異具有統(tǒng)計學意義(P0.05或P0.01)。消化性潰瘍總體患病率男性大于女性,性別在各中醫(yī)證型間的分布,差異無統(tǒng)計學意義(P0.05)。3、消化性潰瘍鏡下部位分類的分布:十二指腸潰瘍胃潰瘍復合型潰瘍。消化性潰瘍部位分類在中醫(yī)各證型中的分布,差異無統(tǒng)計學意義(P0.05)。4、中醫(yī)各證型的鏡下分期分布,差異有統(tǒng)計學意義(P0.01)。其中胃陰不足型主要分布于瘢痕期,與其余主要分布于活動期的3型相比,差異具有統(tǒng)計學意義(P0.05或P0.01)。5、潰瘍病灶表現與中醫(yī)證型的關系:潰瘍病灶覆苔在各中醫(yī)證型中的分布,差異具有統(tǒng)計學意義(P0.05),其中胃陰不足型中潰瘍表面無苔情況較多,與其余3型相比,差異具有統(tǒng)計學意義(P0.05或P0.01)。而潰瘍面積及潰瘍單發(fā)、多發(fā)在各證型中的分布,差異無統(tǒng)計學意義(P0.05)。6、潰瘍周邊黏膜表現與中醫(yī)證型的關系:潰瘍周邊黏膜糜爛在胃陰不足型中較少見,與其余3型相比,差異具有統(tǒng)計學意義(P0.05或P0.01)。潰瘍周邊皺襞集中現象在胃陰不足型中所占比例較高,但與其余3型相比,差異無統(tǒng)計學意義(P0.05)。潰瘍周邊黏膜充血、水腫在各證型間的分布,差異無統(tǒng)計學意義(P0.05)。7、PU鏡下合并慢性淺表性胃炎、慢性萎縮性胃炎及腸胃反流在中醫(yī)各證型中的分布,差異均不具有統(tǒng)計學意義(P0.05)。8、胃陰不足型中Hp感染率較低,與脾胃虛弱(虛寒)型及肝胃郁熱型相比,差異具有統(tǒng)計學意義(P0.01)。結論:1、消化性潰瘍中醫(yī)證型分布:肝胃郁熱型脾胃虛弱(虛寒)型肝胃不和型胃陰不足型。消化性潰瘍鏡下部位分類的分布:十二指腸潰瘍胃潰瘍復合性潰瘍。2、年齡與消化性潰瘍中醫(yī)證型存在關系,性別與中醫(yī)辨證分型沒有關系。3、消化性潰瘍胃鏡下表現與中醫(yī)證型存在一定關系,其中胃陰不足型與其余各型間差異較明顯。4、Hp感染與消化性潰瘍中醫(yī)證型存在關系。
[Abstract]:Objective: through and Hp features of TCM Syndromes of peptic ulcer type and gastroscope (Helicobacter pylori, Helicobacter pylori infection) research on the relationship between objective indicators such as the relationship between microcosmic and macroscopic differentiation, for TCM syndrome of peptic ulcer type more objective and scientific basis. Methods: We collected data from the second hospital of Dalian Medical University from March 2015 to January, which met the inclusion criteria in the digestive endoscopy room and gastroenterology department of -2016 hospital, and excluded the cases that met the exclusion criteria. According to the 2002 People's Republic of China Ministry of Health issued the "Chinese medicine clinical research guiding principle" ([1] trial) 125 cases remaining TCM type, they also collected by OLYMPUS GIF-H260Z gastroscopy and rapid urease test results obtained by urea breath test or 14C? The Hp examination results. SPSS 22 statistical software was used to analyze the data collected, and to explore the relationship between the TCM Syndromes of peptic ulcer and the manifestations of gastroscope and Hp infection. Results: the distribution of 125 patients with peptic ulcer syndromes 1, this study included as follows: liver stomach disharmony (deficiency) deficiency of spleen and stomach incoordination between liver and stomach yin. There was statistically significant difference in age distribution, 2 different syndromes of traditional Chinese medicine (P0.01), the spleen and stomach (cold) the average age of onset is smaller, compared with the other 3 types, the difference was statistically significant (P0.05 or P0.01), and stomach yin deficiency type is obviously greater than that of the average age of more than 3, and the weakness of the spleen and stomach (cold) and liver stomach heat type 2 compared, the difference was statistically significant (P0.05 or P0.01). The overall prevalence rate of peptic ulcers was greater than that of women, and there was no significant difference in the distribution of sex between various TCM syndromes (P0.05). 3. The distribution of the classification of peptic ulcers: the compound ulcer of duodenal ulcer and gastric ulcer. The distribution of the parts of peptic ulcer in the TCM syndrome types was not statistically significant (P0.05). 4. The distribution of different types of TCM syndromes under the microscope was statistically significant (P0.01). The deficiency of gastric Yin was mainly distributed in the cicatricial period, and the difference was statistically significant (P0.05 or P0.01) compared with the other 3 types mainly distributed in the active stage. The relationship between the 5, ulcer lesions and TCM syndrome type distribution of ulcer lesions covered with moss in TCM syndrome types, the difference was statistically significant (P0.05), no ulcer surface moss more the stomach yin deficiency type, compared with the other 3 types, the difference was statistically significant (P0.05 or P0.01). The distribution of the area of ulcers and the single and multiple ulcers in each type of syndrome was not statistically significant (P0.05). 6, the relationship between the performance of ulcer peripheral mucosa and TCM syndromes: ulcer peripheral mucosal erosion is less frequent in the stomach yin deficiency type, compared with the other 3 types, the difference is statistically significant (P0.05 or P0.01). The concentration of the circumjacent fold of the ulcer was higher in the deficiency of the stomach yin, but there was no significant difference compared with the other 3 types (P0.05). The distribution of hyperemia and edema in the peripheral mucosa of the ulcer was not statistically significant (P0.05). 7, the distribution of chronic superficial gastritis, chronic atrophic gastritis and gastrointestinal regurgitation in TCM syndromes under PU microscope is not statistically significant (P0.05). 8 Hp infection and stomach yin deficiency type rate is low, and the weakness of the spleen and stomach (cold) compared and liver stomach disharmony, the difference was statistically significant (P0.01). Conclusion: 1, peptic ulcer syndromes: liver stomach disharmony (deficiency) deficiency of spleen and stomach incoordination between liver and stomach yin. The distribution of the sites under the mirror of peptic ulcer: the compound ulcer of the duodenal ulcer and gastric ulcer. 2. There is a relationship between age and TCM syndrome type of peptic ulcer, and there is no relationship between sex and TCM syndrome differentiation. 3. There is a certain relationship between the manifestation of peptic ulcer gastroscope and the TCM syndrome type, of which the difference between the deficiency of the stomach and the other types is obvious. 4, the relationship between Hp infection and TCM syndrome type of peptic ulcer.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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