Study On The Relationship Among Helicobacter Pylori Infection With Tongue Picture, Gastroscopic Signs Basing On The Microecology-Zhuodu Theory

Objective: To explore the correlation of tongue picture、gastric mucosal appearances with Helicobacter pylori infection of patients with gastric diseases basing on the Microecology-Zhuodu theory,and to provide information for clinical diagnosis and treatment to the patiens with upper gastrointestinal symptoms.Methods: 110 patients were selected with inclusion criteria,which were divided into Helicobacter pylori positive group and Helicobacter pylori negative group according to the ¹³C Urea Breath Test（UBT）.At the meantime,the detection kit for typing Hp antibody of typeⅠand typeⅡ,and rapid urease test（RUT）were also used along with the endoscopy.Tongue picture of every patient enrolled were captured by using high resolution digital camera.The dedicated collectors were used to collect exfoliated cells of the coating on the tongues of patients in two groups.Maturation index（MI）and maturation value（MV）of exfoliated cells of the coating on the tongues of patients were calculated.Finally,The database was established,and the data statistics were processed.Results:1 The infection rate of helicobacter pylori in 110 cases is about 46.63%.2 Among 107 cases,RUT detection rate was 39.25%,the sensitivity was 83.67%,the specificity was 98.28%,the positive likelihood ratio is 48.64,the negative likelihood ratio is 0.17,consistence percentage was 91.59%;The detection rate of antibody parting was 69.09%;the sensitivity was 96.08%,the specificity was 54.24%,the positive likelihood ratio was 2.10,the negative likelihood ratio was 0.07,the consistence percentage was 73.64%.3 The distribution of tongue color,accounting for 58.82% of light red tongue,was statistical significant in Helicobacter pylori positive group（χ²=11.9191,P=0.008<0.05）.There was no significant in tongue shape（old or tender tongue,teeth-printed tongue,spotted tongue,fissured tongue）（P>0.05）.There was significant in distribution of color of coating on the tongue,（63.64% of yellow one,χ²=14.3943,P=0.000<0.05）.No significance was found in the distribution of coating nature（thin and thick）.However,the distribution of greasy coating was significant more than the others（χ²=14.3943,P=0.013<0.05）.The distribution of Helicobacter pylori positive group in coated tongue（P=0.000<0.05）as follows: yellow greasy fur > yellowish fur > whitish fur > white greasy fur,including the yellow greasy fur of 27 cases（55.10%）.4 In the study of tongue coating exfoliated cells morphology,the quantity of middle level cells of tongue coating smear in Hp positive group was higher than the one in Hp negative group（P=0.0181<0.05）,However,neither the number of the surface cells,or the MV of tongue coating smear in Hp positive group was less than the one in Hp negative（P=0.0181<0.05）.5 There were no significant in the distribution of color,edema,erosion,ulcers,polyps,haemorrhage of gastric mucosa between the two groups（P>0.05）,However,the rough（granular rough only）gastric mucosa（χ²=20.984,P=0.000<0.05）and hyperemic spots（χ²=4.991,P=0.025<0.05）with gastric mucosa showed high significance in Helicobacter pylori positive group.Conclusions:1 In 110 cases of patients,Hp infection rates was about 46.63%,which was lower than the national average of survey within 2001²004,which was related with the widespread uses of antibiotics and the improvement of the treatment level.2 Clinically,among the three methods commonly used in the detection of Helicobacter pylori（Hp）,¹³C-UBT is considered to be the gold standard for the diagnosis of Hp infection,with relatively high and balanced sensitivity and specificity.RUT detection is handy,rapid but invasive,therefore,combining with gastroscopy is needed.Moreover,results are easily affected by the number of biopsy tissues,sampling site,Hp amount,environmental conditions,etc,leading to inaccurate results.The detection of serum anti-Hp antibodies not only reflects the situation of Hp infection in the body（including stomach and oral cavity）in a period of time,but also can clarify the pathogenicity of Hp infection.After Hp eradication therapy,serum antibodies remain in the body for a period of time;therefore,effectively combining with ¹³C-UBT detection can accurately reflect the situation of Hp infection at the time,as well as the history of Hp infection and its treatment effect.3 Hp infection was related to three tongue indicators including pink tongue,yellow tongue fur and greasy tongue fur（P<0.05）;among which pink tongue is normal tongue color and has no clinical significance in the determination of Hp infection.While,Hp infection has a certain correlation with yellow and greasy tongue fur（P<0.05）.Therefore,yellow and greasy tongue fur in patients can be used as an assistant to determine Hp infection,providing a clinical reference for traditional Chinese medicine.4 Changes of maturation index（MI）and mature value（MV）in exfoliated cells of tongue fur are related to Hp infection,indicating that Hp infection affects the maturation of exfoliated cells of tongue coating,leading to increased proportion of cells on the middle and superficial layer and reduced MV.Therefore,it is suggested that MI and MV can be used as laboratory references for the determination of Hp infection.5 Hp infection is related to granular and coarse gastric mucosa and congestion spot（P<0.05）,suggesting these two indicators can be used to determine Hp infection,providing a clinical reference.6 There may be a certain symbiotic relationship between oral Hp infection and gastric Hp infection.Hp infection in the oral cavity is the underlying cause of Hp infection in the stomach.