The Relationship Between The Subtypes Of Functional Dyspepsia And TCM Differentiation And The Level Of GLP-1

Objective: According to the Rome Ⅲ criteria which is defined by themain symptoms in patients and related pathophysiology, functional dyspepsia(FD), a common clinical complex, can be classified into two subtypes:epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). Atpresent, the studies on FD are mainly focus on gastrointestinal dynamics,visceral hypersensitivity, Hp infection and psychological factors. TraditionalChinese medicine (TCM) identify FD into different syndrome types based ondifferentiation. There has little researches on the relationship between the twosubtypes of FD and TCM syndrome differentiation. Glucagon-like peptide-1(GLP-1) is an important incretin. The current study of GLP-1is limited to thehypoglycemic mechanism, which is little on the function of FD. The aim ofthis research is to study the relationship between different syndrome types andsubtypes of FD, meanwhile, to observe the change of GLP-1level in differentsubtypes of FD, to explore the effects on adjusting the level of GLP-1, and todiscuss the pathogenesis of FD and the role of TCM acted on the FD.Methods:1Eighty-three patients who went to Fourth Hospital of Hebei MedicalUniversity and were clinically diagnosed as FD, without organic diseases bylaboratory and imaging examinations, were enrolled. In all patients, the malecases were20and the female cases were63(M/F=1/3.15), and they aged25to70years old (44.77±13.32years old). All patients were divided into twogroups according to Rome Ⅲ criteria,25cases in EPS, and58cases in PDS.Patients’ clinical manifestation were recorded by making clinical questionary.2TCM syndrome differentiation of FD patients was classified by thesame experienced TCM doctor. 3The levels of GLP-1in different FD subtypes: Three milliliter bloodwere abstracted from elbow veins of all fasting patients, then collected indisposable test-tube and left in room temperature for two hours, and fromwhich the serum was separated and stored in EP at-70℃until analysis. Thefree GLP-1levels in serum were detected by Enzyme linked immunosolidassay (ELISA) method.4Following up: we followed up curative effect after medication of FDpatients by phones.5Statistical analysis: All analyses were performed using SPSS software(version13.0, SPSS, Chicago, IL). The nonparametric test was used to analyseGLP-1levels in bloods of FD patients of two subtypes. The χ~2test was used toanalyse the relationship between TCM differentiation and two subtypes of FD.A P-value <0.05was considered statistically significant, and all statistical testswere two sides.Results:1Comparison between two subtypes of FDFour types of TCM differentiation in FD patients were as follows:1.thehepatogastric discord syndrom,2.the dampness-heat in spleen and stomachsyndrom,3.the insufficiency of spleen-YANG syndrom,4.the deficiency ofstomach-YIN syndrome.Of83FD patients,35were the hepatogastric discord syndrome (42.17%),followed by the dampness-heat in spleen and stomach syndrome and23cases(27.71%), the other two syndromes were the insufficiency of spleen-YANGsyndrome in17cases (20.48%), and the deficiency of stomach-YIN syndrome,8cases (9.64%). The mainly syndrome differentiation of FD were thehepatogastric discord syndrome and the dampness-heat in spleen and stomachsyndrome, the insufficiency of spleen-YANG syndrome and the deficiency ofstomach-YIN syndrome were fewer.As mentioned above, there are two subtypes in FD: EPS and PDS. Theinsufficiency of spleen-YANG syndrom was the most in EPS, a total of12cases (48.00%), followed by the dampness-heat in spleen and stomach syndrome and the hepatogastric discord syndrome, the hepatogastric discordsyndrome was the most in PDS, a total of30cases (51.72%), followed by thedampness-heat in spleen and stomach syndrome and the insufficiency ofspleen-YANG syndrome.The number of the hepatogastric discord syndrome patients among EPSand PDS were5and30respectively, there was significant statistical differencebetween two groups (χ~2=7.210，P=0.007); the number of the insufficiency ofspleen-YANG syndrom patients among EPS and PDS were12and5respectively, there was significant statistical difference between two groups(χ~2=16.634，P=0.000); the number of the dampness-heat in spleen and stomachsyndrome patients among EPS and PDS were5and18respectively, there wasno significant difference between EPS and PDS (χ~2=1.062，P=0.303); thenumber of the deficiency of stomach-YIN syndrome patients among EPS andPDS were3and5respectively, there was no significant difference betweenEPS and PDS (P=0.692).The data demonstrated that the insufficiency of spleen-YANG syndromwas the main syndrome of EPS, and the hepatogastric discord syndrome wasthe main syndromes of PDS.2Comparison of GLP-1levels between two subtypes of FDThe levels of GLP-1in EPS and PDS were4.04±0.42pmol·L-1，3.62±0.35pmol·L-1respectively. For the levels of GLP-1, there was nosignificant difference between EPS and PDS (P=0.218).Conclusions:1The main syndrome differentiation of FD were the hepatogastricdiscord syndrome and the dampness-heat in spleen and stomach syndrome; asfor the subtypes of FD, the insufficiency of spleen-YANG syndrom was themain syndrome of EPS, and the hepatogastric discord syndrome was the mainsyndromes of PDS. There was a correlation between the subtypes of FD inmodern medicine and the differentiation in traditional medicine.2There was no significant difference between the GLP-1levels of twosubtypes of FD patients. The change of the GLP-1levels may not play an important role in the clinical manifestations of the two subtypes of FD.