| Objective: Studying the correlation between different Traditional Chinese Medicine(TCM)syndromes of chronic atrophic gastritis with intestinal hyperplasia and gastroscopic images and Systematic Immune-inflammation Index(SII)levels,to refine the TCM identification from a microscopic perspective.Observing the differences of SII levels in different TCM syndromes,to investigate the core pathological elements in the process of inflammation-cancer transformation.Methods: In this study,a total of 226 patients with chronic atrophic gastritis with intestinal hyperplasia who conformed to the inclusion and exclusion criteria were selected from the Department of Traditional Chinese Medicine and the Department of Gastroenterology from October 2021 to November 2022.Employing investigating and recording the clinical data of patients,the correlations between TCM syndromes and gastroscopic images and SII were analyzed.Results:1.Analysis of general data: A total of 226 patients aged 62(55～66)were included,including 160 male(70.8%)and 66 female(29.2%),with a male to female ratio of about 2.8:1.There was no statistical difference in the age of patients by gender(P=0.847>0.05).Of the 226 patients included,138(61.1%)had a history of previous Hp infection,and 124(54.9%)had a history of smoking.There was no statistical difference in the distribution of smoking history between the different groups of Hp infection histories(P=0.085>0.05).Of the 226 patients,133(58.8%)had mild intestinal metaplasia and 93(41.2%)had moderate to severe intestinal metaplasia.The SII was indicated as 392.46(280.48～538.92).The SII levels were statistically different in the two subgroups with the mild and moderatesevere histopathologic degree of intestinal metaplasia(P<0.001).2.Correlation analysis of TCM syndromes:(1)The distribution of the TCM syndromes was as follows: Spleen and Stomach Weakness 66(29.2%)>Liver and Stomach Discordance 60(26.5%)> Spleen and Stomach Dampness and Heat 45(19.9%)> Gastric Blood Stasis 41(18.1%)> Stomach Yin Deficiency14(6.2%).(2)Correlation between TCM syndromes and clinical general information: There was no significant difference in the distribution of gender and age among the TCM syndrome groups(P=0.567>0.05;P=0.997>0.05).SII levels were statistically different in each TCM syndrome(P<0.001).After a two-by-two comparison,the SII levels were found to be statistically different in the Gastric Blood Stasis compared to the Weak Spleen and Stomach(P=0.006),Liver and Stomach Discordance(P=0.000),Spleen and Stomach Damp Heat(P=0.000)and Stomach Yin Deficiency(P=0.020).There was a statistical difference in SII levels for the Spleen and Stomach Weakness compared to the Liver and Stomach Discordance(P=0.000)and the Spleen and Stomach Damp Heat(P=0.003).There was no statistically significant difference in the pairwise comparison of SII values among other syndrome types(P>0.05).(3)Correlation between TCM syndromes and gastroscopic images.Gastroscopic images in 226 patients were as follows:red and white mucosa with mostly grayish mucosa 146(64.6%),red and white gastric mucosa with congestion and bleeding 99(43.8%),edematous gastric mucosa 96(42.5%),eroded gastric mucosa 87(38.5%),granular and nodular gastric mucosa 58(25.7%).Difference analysis showed that in five syndrome groups,there was a statistical difference in the red and white mucosa with mostly grayish mucosa,with Spleen and Stomach Weakness being the most common(P<0.001);there was statistical difference in the red and white gastric mucosa with congestion and bleeding(P<0.001),with Spleen and Stomach Dampness and Heat being the most common;there was a statistical difference in the mucosal erosion(P<0.001),with Spleen and Stomach Dampness and Heat being the most common;there was a statistical difference in the presentation of mucosal granular nodules,with Gastric Blood Stasis being the most common(P=0.031).There was no statistical difference in mucosal edema in the different syndromes(P=0.271>0.05).3.The diagnostic value of SII the for moderate-severe histopathologic degree of intestinal metaplasia and Gastric Blood Stasis syndrome was analyzed as follows: The ROC curve was plotted using the moderate-severe histopathologic degree as the end state,and the results showed that the AUC(95%CI): 0.73(0.66～0.79),sensitivity: 0.70,specificity: 0.65,and the cut-off value of SII : 394.72.The ROC curve was plotted using the syndrome of gastric blood stasis as the end state,and the results showed that the AUC(95%CI): 0.84(0.74～0.94),sensitivity: 0.83,specificity:0.92,and the cut-off value of SII : 562.79.Conclusions:1.The overall distribution of TCM symptoms is that Weak Spleen and Stomach,Liver and Stomach Disharmony are the most common,followed by Damp Heat in the Spleen and Stomach,Blood stasis in the Stomach,and Yin Deficiency in the stomach is less common.Gastroscopic manifestations of chronic atrophic gastritis with intestinal metaplasia in spleen and stomach damp-heat syndrome are red and white mucosa with congestion and bleeding,and mucosal erosion;gastroscopic manifestations in patients with spleen and stomach weakness show red and white mucosa with mostly grayish mucosa;gastroscopic findings in patients with blood stasis syndrome show granules and nodules in the gastric mucosa.2.The SII level is the highest in patients with blood stasis syndrome."Blood stasis" may be the core pathological element of TCM in the process of inflammation-cancer transformation.SII is of moderate diagnostic value in patients with blood stasis syndrome,and chronic atrophic gastritis with intestinal metaplasia could be diagnosed when SII is ≥ 562.79.3.SII level is the highest in patients with chronic atrophic gastritis with moderate to severe intestinal hyperplasia.SII is of moderate diagnostic value in patients with chronic atrophic gastritis with moderate to severe intestinal metaplasia.And SII ≥ 394.72 has diagnostic significance for chronic atrophic gastritis with moderate and severe intestinal metaplasia. |
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