| Background The incidence rate of ulcerative colitis in China is increasing year by year.The onset of ulcerative colitis seriously affects the quality of life of patients,and its course is generally longer,with a certain tendency towards cancer.At present,the diagnosis and evaluation of ulcerative colitis mainly rely on electronic colonoscopy,colonoscopy pathology,and large-scale physical examinations such as abdominal CT and MRI.These examinations have shortcomings such as invasiveness,subjectivity,and high cost.It is particularly important to explore objective,convenient,and economical laboratory evaluation indicators.At the same time,there is a bottleneck in the Western medicine treatment of ulcerative colitis,and the combination of Chinese and Western medicine treatment is currently the optimal solution.The key to treating UC with traditional Chinese medicine lies in syndrome differentiation.At present,a small number of scholars have explored the correlation between traditional Chinese medicine syndrome types and modern physical and chemical indicators,but there are still shortcomings such as a small sample size,inconsistent syndrome differentiation labeling,and lack of repeatability.Further research is needed in this field to elucidate the modern connotation of traditional Chinese medicine syndrome types in a deeper and broader way.Research objective To explore the potential evaluation indicators of ulcerative colitis,further explain the modern connotation of traditional Chinese medicine syndrome types of ulcerative colitis,and provide reference for the clinical diagnosis and treatment of ulcerative colitis.Research method Collect data from the information system of the Department of Gastroenterology Ward of Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from 2012 to 2022.According to the inclusion and exclusion criteria,a total of 305 patients with ulcerative colitis were included as a case group;Select physical examination patients who were hospitalized during the same period and did not show any abnormalities during gastroscopy examination as the control group for research.Score according to the modified Mayo standard,and then group the case groups according to the lesion range and severity according to the modified Truelove and Witts disease severity classification and Montreal classification;Finally,collect the four diagnostic information and classify the case group based on traditional Chinese medicine syndrome differentiation.By statistically analyzing the distribution characteristics of traditional Chinese medicine syndromes in ulcerative colitis,comparing the levels of various research indicators between the case group and the control group for statistical differences,as well as the differences between each subgroup of the case group and the correlation between each research indicator,a conclusion can be drawn.Research results1.General information 305 inpatients with ulcerative colitis in active stage were included in the case group of this study,including 155 male patients and 150 female patients.The gender ratio was relatively equal,with men slightly more than women;In terms of age stratification,the majority are young and middle-aged,accounting for approximately 64%.A total of 968 hospitalized patients were included in the control group,with male patients accounting for about 35%and female patients accounting for about 65%,with more females than males;Age stratification is relatively equal.2.The distribution of Western medicine diagnosis The 305 cases of UC group patients,with 16 cases having initial onset,accounting for 5.2%;There were 289 cases of chronic recurrence,accounting for 94.8%.81 cases of rectal type;144 cases of left hemicolon type;80 cases of extensive colon type.The left colon type is the most common,accounting for approximately 47.2%,followed by the extensive colon type and rectal type.There are 154 patients with mild severity,accounting for approximately 50.5%;Moderate to severe patients accounted for 49.5%.3.The distribution of traditional Chinese medicine syndrome types The 305 cases of UC patients included were divided into 7 syndrome types,including 85 cases of liver stagnation and spleen deficiency syndrome(27.9%),81 cases of large intestine dampness heat syndrome(26.6%),67 cases of spleen deficiency and dampness accumulation syndrome(22.0%),25 cases of mixed cold and heat syndrome(8.2%),20 cases of spleen and kidney yang deficiency syndrome(6.6%),16 cases of excessive heat toxin syndrome(5.2%),and 11 cases of yin and blood deficiency syndrome(3.6%).The distribution of various syndrome types is uneven(P<0.001),with liver depression and spleen deficiency,large intestine dampness heat,and spleen deficiency and dampness accumulation being the most common,with a total of 233 cases,accounting for about 76.4%.4.The correlation between BIL,CHE,SOD and UC BIL,CHE,SOD showed significant differences(P<0.01)between the case group and the control group,indicating a significant correlation between the above indicators and UC.Logistic binary regression analysis was conducted on each indicator,and the results showed that DBIL:B=-0.420,OR=0.657,P<0.01;TBIL:B=-0.163,OR=0.849,P<0.01;CHE:B=-0.001,OR=0.999,P<0.01;SOD:B=-0.26,OR=0.974,P<0.01.All indicators have a significant negative correlation with the diagnosis of UC,that is,the lower the level of each indicator,the higher the probability of disease.Draw ROC curves to describe the auxiliary diagnostic value of each indicator for UC,and the results show that the accuracy,sensitivity,specificity,and corresponding cutoff value of DBIL auxiliary diagnosis of UC are 73.0%,60.2%,77.3%,cutoff value is 3.275 μmol/L;The accuracy of TBIL assisted diagnosis of UC is 77.1%,sensitivity is 56.9%,specificity is 87.5%,cutoff value is 10.85 μ mol/L.The accuracy of CHE assisted diagnosis of UC is 75.0%,sensitivity is 55.7%,specificity is 88.6%,and corresponding cutoff value is 6477 U/L.The accuracy of SOD assisted diagnosis of UC is 69.5%,sensitivity is 68.4%,specificity is 68.4%,cutoff value is 183.05 U/L.The AUC of each indicator’s comprehensive prediction of UC is 0.898(P<0.01),which is higher than the individual prediction of each indicator,indicating that the comprehensive prediction of each indicator has higher auxiliary diagnostic value for UC.5.The distribution characteristics of TCM syndrome types of UC There are differences in the distribution of disease severity in patients with different syndrome types of UC(P<0.001).Further comparison between the two results showed that the P value of the syndrome of liver stagnation and spleen deficiency was less than 0.001 compared with the syndrome of damp heat in large intestine and the syndrome of heat toxin burning.Compared with the large intestine dampness heat syndrome,the spleen deficiency dampness accumulation syndrome has a P<0.001;Compared with the syndrome of spleen deficiency and dampness accumulation,P<0.01.Compared with the syndrome of spleen kidney yang deficiency and the syndrome of excessive heat toxin,P<0.05.There was no significant difference in comparison between the other groups.There is a correlation between the severity classification of UC and the classification of syndrome types.The severity of disease in the empirical group is greater than that in the combination of deficiency and excess syndrome group and greater than that in the deficiency syndrome group(Kendall’s tau-b 0.250,P<0.001).There are differences in the range of lesions among different types of UC patients(P<0.01).A pairwise comparison shows that compared with the syndrome of mixed cold and heat,P<0.05;Compared with the syndrome of liver depression and spleen deficiency,P<0.05;There was no significant difference in comparison between the other groups.There is a correlation between the lesion range of UC and the grouping of syndrome types,with the lesion range being greater in the empirical group than in the combination of deficiency and excess syndrome group than in the deficiency syndrome group(Kendall’s tau-b 0.134,P<0.01).There is a significant difference in the improved Mayo score level among patients with different traditional Chinese medicine syndrome types(P<0.001).The results of pairwise comparison show that the P-value of spleen kidney yang deficiency syndrome is less than 0.001 compared to large intestine dampness heat syndrome and heat toxin excess syndrome;Compared with the syndrome of dampness and heat in the large intestine,P<0.01;Compared with the syndrome of mixed cold and heat and the syndrome of excessive heat toxin,P<0.05;Compared with large intestine dampness heat syndrome and excessive heat toxin syndrome,the P-value of liver depression and spleen deficiency syndrome is less than 0.001.Compared with the damp heat syndrome of the large intestine and the excessive heat toxin syndrome,the P-value of the spleen and kidney yang deficiency syndrome is less than 0.001.There was no significant difference in the distribution of gender and age among patients with different traditional Chinese medicine syndrome types(P>0.05).6.The correlation between UC traditional Chinese medicine syndrome types and BIL,CHE,SOD The median of DBIL,TBIL,and CHE in the syndrome of excessive heat toxin is the highest among all syndrome types(DBIL 3.36,TBIL 13.25,CHE 8498.50);The median values of DBIL,TBIL,and CHE in spleen and kidney yang deficiency syndrome are the lowest among all syndrome types(DBIL 2.33,TBIL,CHE 5732.00).However,there was no statistically significant difference in the levels of various indicators among traditional Chinese medicine syndrome types(P>0.05).Conclusions1.There is a correlation between UC and the levels of BIL,CHE,and SOD.Lower levels of BIL,CHE,and SOD have certain auxiliary diagnostic value for UC,and the combined predictive analysis of the above indicators has higher auxiliary diagnostic value for UC.2.The distribution of UC syndrome types is correlated with the severity,range,and activity of the disease.3.There is a certain correlation between the distribution of UC syndrome types and the levels of BIL and CHE. |
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