| Objective:Tongue observation is an important method for judging the syndrome differentiation of precancerous lesions of chronic atrophic gastritis.It does not cause pain or discomfort to patients and is of critical significance in determining the prognosis of the condition.The purpose of this study is to reveal the relationship between traditional Chinese medicine(TCM)syndromes and syndrome elements of chronic atrophic gastritis(CAG)patients of different ethnicities in China and Mongolia with different CAG TCM syndromes and tongue flora of different pathological stages.It also aims to improve clinical diagnosis,including TCM diagnosis and treatment of precancerous lesions of CAG.It also offers a new thought process for the diagnosis and treatment of CAG while showing the scientific connotation of tongue coating changes and enriches the subject of tongue diagnosis in traditional Chinese medicine.This project is composed of theoretical research and clinical portions,as well as an experimental section.1 Theoretical ResearchThree reviews were written:the first describes modern medical research on precancerous lesions of CAG,with emphasis on comprehensively presenting the relevant information and trends in pathology,etiology,diagnosis,management,and treatment for better prevention and control;the second review summarizes the research progress concerning CAG and TCM etiology and pathogenesis,TCM syndrome differentiation and treatment,and TCM therapy;the third review summarizes TCM tongue diagnosis and tongue coating flora's correlation with the spleen and stomach,and focuses on the association between spleen and stomach conditions and tongue coating flora.2 Clinical ResearchMethods:100 CAG cases were collected in both China and Mongolia,for a total of 200 cases of CAG patients for use in this study.Beginning with general data and four diagnostic method information,statistical methods such as descriptive analysis,difference testing,and factor analysis were used to explore the distribution characteristics of TCM syndromes and syndrome elements of CAG in China and Mongolia.Results:1.There was no statistically significant difference between the gender distributions of CAG patients in China and Mongolia(P>0.05).2.The difference in age distribution between the two groups of patients was statistically significant(P<0.05).After correction by the Bonferroni method,it was found that the number of individuals in the 18-44 age range among Chinese patients was significantly higher than that of Mongolian patients.3.A statistically significant difference in BMI distribution between the two countries was apparent(P<0.05).Statistics showed that the number of CAG patients with weight outside of a normal range in Mongolia was relatively high,more than half of the total number of subjects in Mongolia.The BMI of Chinese CAG patients concentrated in the normal weight range.There were more obese subjects in Mongolia than in China,and there were more CAG patients of normal weight in China than in Mongolia,both differences being statistically significant.4.There was no statistically significant difference in the distribution of tobacco and alcohol history(P>0.05).5.There was a statistically significant difference in the distribution of H.pylori infection between the two countries(P<0.05).H.pylori infection in CAG patients was significantly higher in Mongolia than in China.6.There was a statistically significant difference in the distribution of absence of precipitating factors and presence of precipitating factors between the two countries(P<0.05).After Bonferroni correction,Mongolia had a greater number of CAG patients without obvious precipitating factors compared to China,and there was a greater number of Chinese patients for which diet,emotional state,climate,were precipitating factors compared to Mongolian patients.The difference was statistically significant.7.There was no statistical significance in the distribution of concomitant diagnosis under gastroendoscopy in both countries(P>0.05).8.Factor analysis of 200 CAG patients in China and Mongolia showed that CAG in Mongolian patients was located in the stomach,spleen,and liver,the nature of the condition included dampness,qi stagnation,heat,blood stasis,yang deficiency,qi deficiency and yin deficiency,the syndrome types included spleen and stomach deficiency syndrome,liver and stomach qi stagnation syndrome,spleen and stomach damp-heat syndrome,stomach yin deficiency syndrome,stomach Luo blood stasis syndrome,and liver and stomach stagnant heat syndrome.CAG in Chinese patients was located in the stomach,liver,and spleen,the nature of the condition included heat,qi stagnation,dampness,and qi deficiency,and syndrome types included liver and stomach qi stagnation syndrome,liver and stomach stagnant heat syndrome,spleen and stomach damp-heat syndrome,and spleen and stomach deficiency syndrome.9.For the different pathological stages(atrophy,intestinal metaplasia and dysplasia)in both countries,TCM syndrome distribution of the atrophy and intestinal metaplasia stages showed obvious statistically significant difference(P<0.05),while that of the pathological stage of dysplasia showed statistically significant difference(P<0.05).Conclusions:The main Chinese and Mongolian CAG syndrome types were spleen and stomach damp-heat syndrome,liver and stomach qi stagnation syndrome,stomach yin deficiency syndrome,liver and stomach stagnant heat syndrome,stomach Luo blood stasis syndrome,and spleen and stomach deficiency syndrome,although the Chinese CAG group did not show stomach yin deficiency syndrome or stomach Luo blood stasis syndrome,instead primarily exhibiting liver and stomach qi stagnation syndrome and liver and stomach stagnant heat syndrome,without significant manifestation of spleen and stomach damp-heat or spleen and stomach deficiency syndromes.3 Experimental ResearchMethods:The case control method was used on the basis of the previous research.16S rRNA gene high-throughput sequencing technology was applied based on the investigation of CAG syndromes and syndrome elements in China and Mongolia to perform sequencing analysis of the tongue coating flora of CAG patients with different pathological stages in both countries.In order to obtain data on the diversity of tongue coating flora,alpha diversity of each pathological stage was analyzed respectively using the Sobs,Ace,Chao,Simpson and Shannon indexes.Microbial composition of tongue coating flora of Chinese and Mongolian CAG patients with different pathological stages was also analyzed and compared according to phylum and genus level.Results:1.18 cases of atrophic gastritis in Mongolia and 17 cases of atrophic gastritis in China were compared to 6 healthy cases serving as the control group per country.Tongue flora was analyzed according to pathological stage and CAG syndrome.2.Statistical analysis of CAG syndrome and tongue coating flora distribution in China and Mongolia found that the Mongolian liver and stomach qi stagnation group(M_GWQZ),spleen and stomach damp-heat group(M_PWSR),spleen and stomach deficiency group(M_PWXR)and stomach yin deficiency group(M_WYBZ)had a greater abudance of Streptococcus and Rothia(P<0.05)than the Chinese liver and stomach qi stagnation group(C_GWQZ),liver and stomach stagnant heat group(C_GWYR)and spleen and stomach deficiency group(C_PWXR).Chinese liver and stomach qi stagnation group(C_GWQZ),liver and stomach stagnant heat group(C_GWYR)and spleen and stomach deficiency group(C_PWXR)had a greater abundance of Neisseria(P<0.05)than the Mongolian liver and stomach qi stagnation group(M_GWQZ),spleen and stomach damp-heat group(M_PWSR),spleen and stomach deficiency group(M_PWXR)and stomach yin deficiency group(M_WYBZ).3.The species level distribution of tongue coating microbes of CAG patients in both countries with different pathological stages showed that the atrophy and dysplasia stages in Mongolia were associated with a greater total number of species and number of endemic species compared to that of China,but the total number of species and number of endemic species in healthy individuals and individuals with metaplasia in China were higher than in Mongolia(P<0.001).4.The phylum level distribution of the tongue coating flora in different pathological stages of CAG in the two countries found that the abundance of Fusobacteria in the MN CONTRL group and MN_Dys group(P<0.05)was relatively lower than that in the CN CONTRL group and CN_Dys group,and the difference was statistically significant.The alpha diversity of the tongue coating flora of different pathological stages in both countries was analyzed with the help of the Sobs index,Shannon index,Simpson index,Ace index,and Chao index.The Sobs index,Ace index,and Chao index between the CN CONTRL group and MN CONTRL group were statistically different(P<0.05).5.The results of the genus level distribution of tongue coating flora in the dysplasia and healthy groups of the two countries showed that the abundance of Neisseria of the CN_Dys group(P<0.05)was significantly higher than that of the other three groups.The abundance of Leptotrichia(P<0.05)in the MN_Dys group and CN_Dys group was higher than that of the MN_CONTRL group and CN CONTRL group.Conclusions:By establishing a microbial characteristic atlas of the CAG tongue coating flora,it was found that the distribution of composition of the tongue coating flora in Chinese and Mongolian CAG patients with different syndrome and different pathological stages had statistical differences in abundance of Streptococcus,Rothia,Fusobacteria,Neisseria,and Leptotrichia.This study also established a foundation for future comparison of the relationship between tongue coating flora and CAG in China and Mongolia while opening up a new research path for the internationalization of TCM tongue diagnosis. |
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