| Background:Gastric cancer is a common malignant tumor of gastric mucosal epithelial cells,the effect of intervention in patients with early gastric cancer is relatively good.In a broad sense,chronic atrophic gastritis refers to a precancerous state of the stomach.Paying close attention to the precancerous state of gastric cancer-chronic atrophic gastritis has become the focus of secondary prevention of gastric cancer.The treatment of chronic atrophic gastritis is of great significance to control or even reverse gastric cancer.Objective:1.To analyze the correlation between TCM syndromes of chronic atrophic gastritis and related factors,gastroscopy and pathological lesion2.To explore the method of microscopic differentiation of symptoms and signs for chronic atrophic gastritis endoscopyMethodsIn this study,a clinical survey of patients with chronic atrophic gastritis was conducted in three hospitals:Xiyuan Hospital,Beijing Friendship Hospital,and Beijing Jishuitan Hospital.The questionnaire included basic information,clinical symptoms,endoscopic findings,pathological features,etc.The gastroscope evaluation form,pathology evaluation form and TCM Syndrome diagnosis form were filled in by the senior endoscopist,pathologist and TCM doctor.After the data were collected and analyzed,the distribution of TCM syndrome types of chronic atrophic gastritis was summarized,and the correlation with risk factors,mucosal manifestation under gastroscope and pathological lesion was analyzed.Results:1.Case inclusion?basic information(1)Basic information:This study included 346 cases,182(52.6%)males and 164(47.4%)females,186(53.76%)young adults aged 60-74,105(30.35%)middle-aged adults aged 45-59,and 30(8.67%)young adults ?44,there were 25 patients(7.23%)aged from 75 to 89 years old,74 patients(21.39%)with smoking history,272 patients(78.61%)without smoking history,and 69 patients(19.94%)with other diseases,there were 277 patients(80.06%)without other diseases.37 patients with Helicobacter pylori(10.69%)and 309 patients with Helicobacter pylori negative(89.31%).(2)Disease information:there were 189 patients with mild atrophic gastritis(54.62%),116 patients with moderate atrophic gastritis(33.53%),41 patients with severe glandular atrophy(11.85%),272 patients with simple gastric antrum atrophy(78.61%),36 patients with gastric body atrophy(10.41%)and 38 patients with total gastric atrophy(10.98%).There were 113 cases of mild glandular intestinal metaplasia(32.66%),126 cases of moderate glandular intestinal metaplasia(36.42%),47 cases of severe glandular intestinal metaplasia(13.58%),241 cases of simple gastric antrum intestinal metaplasia(69.65%),23 cases of intestinal metaplasia of gastric body(6.65%)and 22 cases of total gastric intestinal metaplasia(6.36%).There were 21 patients with uncertain hyperplasia(6.07%),54 patients with intraepithelial neoplasia(15.61%).(3)The distribution of TCM syndromes:68 cases of spleen-stomach weakness syndrome(19.65%),66 cases of spleen-stomach damp-heat syndrome(19.08%),64 cases of stomach collateral blood stasis syndrome(18.50%),59 cases of liver-stomach heat stagnation syndrome(17.05%),48 cases of stomach yin deficiency syndrome(13.87%)and 41 cases of liver-stomach qi stagnation syndrome(11.85%).2.Correlation between TCM SYNDROME AND RELATED FACTORS(1)Sex and age:There was no significant difference between sex and age distribution of TCM syndromes(all p>0.05).(2)Smoking:The distribution of TCM syndromes of smoking chronic atrophic gastritis were liver-stomach stagnation-heat Syndrome,spleen-stomach damp-heat syndrome,stomach collateral blood stasis syndrome,spleen-stomach Deficiency Syndrome,liver-stomach Qi stagnation syndrome and stomach-yin deficiency syndrome.Liver-stomach stagnation-heat Syndrome was the most(27.0%),the difference was statistically significant(p<0.05).The correlation analysis showed that Liver-stomach Stagnation-heat Syndrome was positively correlated with smoking(p<0.05,r>0).(3)Drinking:The distribution of TCM syndromes of chronic atrophic gastritis patients who drink alcohol is:liver-stomach stagnation-heat Syndrome,spleen-stomach damp-heat Syndrome,spleen-stomach Deficiency Syndrome,liver-stomach Qi Stagnation Syndrome,stomach-yin Deficiency Syndrome,stomach-collateral Blood Stasis Syndrome,the liver-stomach stagnation-heat Syndrome was the most common in the history of drinking(32.84%),and the stomach-collateral Blood Stasis Syndrome was the most common in the history of non-drinking,the difference was statistically significant(p<0.05),and the distribution of other TCM syndromes was the same(p<0.05,r>0),the liver-stomach stagnation-heat Syndrome was positively correlated with alcohol consumption(p<0.05,r>0),the stomach-collateral Blood Stasis Syndrome was negatively correlated with alcohol consumption(p<0.05,r<0).(4)Co-existing diseases:There was no statistical difference in the distribution of TCM syndromes among co-existing diseases(p>0.05).(5)Helicobacter pylori infection:HP Positive Chronic atrophic gastritis syndrome is distributed in the order of spleen-stomach damp-heat Syndrome,liver-stomach stagnation-heat Syndrome,spleen-stomach Deficiency Syndrome,stomach-yin Deficiency Syndrome,liver-stomach Qi stagnation syndrome and stomach collateral blood stasis syndrome,hP distribution of spleen-stomach damp-heat Syndrome was the most(32.43%),the difference was statistically significant(p<0.05).The correlation analysis showed that Damp-heat Syndrome of spleen and stomach was positively correlated with HP infection(p<0.05,r>0)3.Correlation between TCM Syndrome types and endoscopic manifestations(1)The color of Mucosa:The distribution of spleen-stomach damp-heat Syndrome and liver-stomach stagnation-heat Syndrome were more in the red color of Mucosa,and the distribution of spleen-stomach Weakness Syndrome and stomach-collateral blood stasis syndrome were more in the white color of Mucosa,the difference was statistically significant(p<0.05).There were negative correlation(p<0.05,r<0)between spleen-stomach damp-heat Syndrome,liver-stomach stagnation-heat Syndrome and mucous membrane color(p<0.05,r>0),and positive correlation(p<0.05,r>0)between spleen-stomach Deficiency Syndrome,stomach-collateral Blood Stasis Syndrome and mucous membrane color.(2)Mucosal erosion:In multiple mucosal erosion,damp-heat syndrome of the spleen and stomach was the most common(40%),while in non-mucosal erosion,the syndrome of blood stasis of the stomach collaterals was the most common(23.04%),and the difference was statistically significant(p<0.05),there was positive correlation between damp-heat Syndrome of spleen and stomach and mucosal erosion(p<0.05,r>0),negative correlation between deficiency of Stomach Yin Syndrome and blood stasis syndrome of stomach collaterals and mucosal erosion(p<0.05,r<0).(3)Vascular Penetration:The distribution of TCM syndromes of Mucosal vascular penetration were spleen-stomach deficiency,stomach-collateral stasis,damp-heat of spleen-stomach,deficiency of stomach-yin,stagnation of liver-qi and stomach-qi;The distribution of TCM syndromes without blood vessel penetration in Mucosa were liver-stomach stagnation-heat Syndrome,spleen-stomach damp-heat Syndrome,spleen-stomach deficiency syndrome,stomach collateral blood stasis syndrome,liver-stomach Qi stagnation syndrome and stomach YIN deficiency syndrome.The liver-stomach stagnation-heat Syndrome was the most in no vascular penetration(12.95%),the difference was statistically significant(p<0.05).(4)Mucosal folds:There were more normal mucosal folds with damp-heat syndrome of the spleen and stomach and stagnation of heat syndrome of the liver and stomach,and more thin mucosal folds with weakness of the spleen and stomach and blood stasis syndrome of the stomach collateral(p<0.05),there was a negative correlation(p<0.05,r<0)between liver-stomach stagnation-heat Syndrome and spleen-stomach damp-heat Syndrome and Mucosal PLICA,and a positive correlation(p<0.05,r>0)between spleen-stomach Deficiency Syndrome and stomach collateral stasis syndrome and Mucosal PLICA.(5)Mucosal bleeding:the distribution of TCM syndromes of local mucosal bleeding is in the order of spleen-stomach damp-heat Syndrome,liver-stomach stagnation-heat Syndrome,spleen-stomach Deficiency Syndrome,stomach-collateral Blood Stasis Syndrome,liver-stomach Qi stagnation syndrome and stomach-yin deficiency syndrome,the distribution of TCM syndromes in multiple sites of mucous membrane and diffuse hemorrhage were spleen-stomach damp-heat Syndrome,liver-stomach stagnation-heat Syndrome,spleen-stomach Deficiency Syndrome,liver-stomach Qi stagnation syndrome,stomach-yin deficiency syndrome and stomach-collateral blood stasis syndrome.There were significant differences(p<0.05)between the two groups in the occurrence of mucosal bleeding(16.81%)and in the occurrence of gastric yin deficiency(16.81%).The Syndrome of damp-heat in the spleen and stomach,stagnation of heat in the liver and stomach were positively correlated with mucosal hemorrhage(p<0.05,r>0).The syndrome of stagnation of heat in the liver and stomach,insufficiency of stomach Yin was negtively correlated with mucosal hemorrhage(p<0.05,r<0).(6)Mucous granule:There was no significant difference in the distribution of mucous granule in tcm syndrome(p>0.05).(7)Erythema Mucosa:There was no significant difference in the distribution of Erythema Mucosa among TCM syndromes(p>0.05)(8)Intestinal tubercle:There was no significant difference in the distribution of TCM syndromes in intestinal nodules(p>0.05).(9)Bile regurgitation:The most common TCM syndromes of Bile regurgitation were liver-stomach stagnation-heat syndrome(25.81%),followed by spleen-stomach Weakness Syndrome,spleen-stomach damp-heat Syndrome,stomach-collateral Blood Stasis Syndrome,liver-stomach Qi stagnation syndrome and stomach YIN deficiency syndrome,there was no significant difference(p>0.05).4.Correlation between TCM Syndrome types and pathological featuresAccording to the degree of reduction of inherent glandular atrophy,it can be divided into mild,moderate and severe atrophy,and according to the degree to which gastric mucosal epithelial cells are replaced by intestinal epithelial cells,they can be divided into mild,moderate and severe intestinal metaplasia.According to the site of inherent glandular atrophy/intestinal metaplasia,it can be divided into gastric antrum atrophy/intestinal metaplasia,gastric body atrophy/intestinal metaplasia,total gastric atrophy/intestinal metaplasia.According to the degree of abnormal cell structure and disordered differentiation,it can be divided into uncertain hyperplasia and intraepithelial neoplasia.The degree of mucosal active inflammation and chronic inflammation was divided into mild,moderate and severe.(1)Degree of Atrophy:The distribution of mild atrophic gastritis in TCM syndromes is in the order of stagnation of heat in the liver and stomach,blood stasis in the stomach and collterals,damp-heat in the spleen and stomach,deficiency of Yin in the stomach,weakness of the spleen and stomach,stagnation of Qi in the liver and stomach.The distribution of moderate atrophic gastritis in TCM syndromes is in the order of spleen-stomach Deficiency Syndrome,spleen-stomach damp-heat Syndrome,liver-stomach depression-heat Syndrome,stomach-collateral blood stasis syndrome,stomach-yin Deficiency Syndrome,liver-stomach Qi stagnation syndrome.The distribution of TCM syndromes in severe atrophic gastritis were stomach collateral blood stasis syndrome,spleen-stomach Deficiency Syndrome,spleen-stomach damp-heat Syndrome,stomach-yin Deficiency Syndrome,liver-stomach stagnation-heat Syndrome and liver-stomach Qi stagnation syndrome.There was no significant difference in the distribution of atrophy degree of TCM syndromes(p>0.05).(2)Atrophic sites:The distribution of TCM syndromes of simple atrophic gastric antrum is in the order of the syndrome of blood stasis in the stomach collateral,the syndrome of weakness of the spleen and stomach,the syndrome of damp-heat in the spleen and stomach,the syndrome of deficiency of Yin in the stomach,the syndrome of stagnation of heat in the liver and stomach,and the syndrome of stagnation of Qi in the liver and stomach.The distribution of TCM syndromes of gastric body atrophy is in the order of spleen-stomach Deficiency Syndrome,liver-stomach stagnation-heat Syndrome,spleen-stomach damp-heat Syndrome,stomach-collateral stasis-blood Syndrome,liver-stomach Qi stagnation syndrome and stomach-yin deficiency syndrome.The distribution of TCM syndromes of whole stomach atrophy is liver-stomach stagnation-heat Syndrome,spleen-stomach damp-heat Syndrome,liver-stomach Qi stagnation syndrome,spleen-stomach Deficiency Syndrome,stomach-yin Deficiency Syndrome and stomach-collateral blood stasis syndrome.The distribution of liver-stomach stagnation-heat Syndrome in total gastric atrophy was 36.84%(p<0.001).(3)Degree of Intestinal metaplasia:The distribution of TCM syndromes of mild intestinal metaplasia is followed by spleen-stomach damp-heat Syndrome,stomach-collateral blood stasis syndrome,liver-stomach stagnation syndrome,liver-stomach Qi stagnation syndrome,spleen-stomach deficiency syndrome and deficiency of stomach-yin Syndrome,the distribution of moderate intestinal syndrome is spleen-stomach weak syndrome,spleen-stomach damp-heat Syndrome,liver-stomach stagnation-heat Syndrome,stomach-yin Deficiency Syndrome,stomach-collateral Blood Stasis Syndrome and liver-stomach Qi stagnation syndrome,while the distribution of severe intestinal syndrome is similar.There was no significant difference in the distribution of intestinal metaplasia(p>0.05).(4)Intestinal metaplasia sites:The distribution of TCM syndromes of simple gastric antrum-intestinal transformation is in the order of spleen-stomach damp-heat Syndrome,spleen-stomach deficiency syndrome,stomach collateral blood stasis syndrome,liver-stomach stagnation syndrome,stomach-yin Deficiency Syndrome and liver-stomach Qi stagnation syndrome,the TCM syndromes of gastric body and whole stomach are equally distributed.There was no significant difference in the distribution of TCM syndromes in intestinal metaplasia(p>0.05).There was a positive correlation between spleen-stomach damp-heat Syndrome and intestinal metaplasia(p<0.05,r>0)(5)The degree of dysplasia:The distribution of TCM syndromes of intraepithelial neoplasia is followed by spleen-stomach damp-heat Syndrome,stomach-collateral Blood Stasis Syndrome,spleen-stomach deficiency syndrome,liver-stomach Stagnation Syndrome,liver-stomach Qi stagnation syndrome and stomach-yin deficiency syndrome.The spleen-stomach damp-heat Syndrome was the most common type of intraepithelial neoplasia(31.48%),the difference was statistically significant(p<0.05).There was a positive correlation between spleen-stomach damp-heat Syndrome and intraepithelial neoplasia(p<0.05,r>0).(6)Inflammation:The distribution of TCM Syndromes of mild inflammation of the Mucosa is in the order of the syndrome of blood stasis in the stomach collaterals,deficiency of the spleen and stomach,stagnation of Qi in the liver and stomach,damp-heat in the spleen and stomach,deficiency of Yin in the stomach,stagnation of heat in the liver and stomach.The distribution of TCM syndromes of moderate inflammation of Mucosa is in the order of damp-heat Syndrome of spleen and stomach,stagnation of heat syndrome of liver-stomach,deficiency of stomach-yin Syndrome,deficiency of spleen-stomach syndrome,blood stasis syndrome of stomach-collaterals,stagnation of Qi in liver-stomach syndrome.The distribution of TCM syndromes of severe inflammation of Mucosa is in turn spleen-stomach Deficiency Syndrome,spleen-stomach damp-heat Syndrome,liver-stomach stagnation syndrome,stomach-collateral Blood Stasis Syndrome,liver-stomach Qi stagnation syndrome and stomach-yin deficiency syndrome.There was no significant difference in the distribution of inflammation degree among the TCM syndrome types(p>0.05).Spleen-stomach damp-heat Syndrome was positively correlated with inflammation(p<0.05,r>0),and stomach-collateral Blood Stasis Syndrome was negatively correlated with inflammation(p<0.05,r<0).(7)Active inflammation:The distribution of TCM Syndromes of mild active inflammation of Mucosa is in the order of damp-heat Syndrome of spleen and stomach,blood stasis syndrome of stomach collateral,stagnation of heat syndrome of liver-stomach,deficiency of stomach-yin Syndrome,deficiency of spleen-stomach syndrome,stagnation of liver-qi and stomach-qi Syndrome,the Syndrome types of moderate active inflammation of mucous membrane in TCM were spleen-stomach deficiency,damp-heat of spleen-stomach,stagnation of Qi in liver-stomach,deficiency of stomach-yin,stagnation of heat in liver-stomach and stomach,blood stasis in stomach collateral.There was no significant difference in the distribution of active inflammation in tcm syndrome(p>0.05).There was a positive correlation between Spleen-stomach Damp-heat Syndrome and active inflammation(p<0.05,r>0).CONCLUSIONS:1.In the syndrome of TCM of CAG,the patients with Liver-stomach Stagnation-heat Syndrome were more common with drinking and smoking,and the patients with Spleen-stomach Damp-heat Syndrome were more common with HP infection.2.The microscopic syndrome differentiation methods of CAG endoscopy were as follows:erosion is common in liver and stomach qi stagnation syndrome under endoscope.The syndrome of stagnation of heat in liver and stomach is often seen with red mucosal color,opaque blood vessels,normal folds and mucosal bleeding under endoscope.In the syndrome of weakness of spleen and stomach,the mucosal color is white,the folds are small and low and flat under endoscope.Under endoscope,the damp-heat syndrome of spleen and stomach is characterized by redness of mucosal color,normal folds,erosion and bleeding.Most patients with stomach yin deficiency syndrome have no bleeding spot in mucous membrane under endoscope.Gastric collaterals blood stasis syndrome under endoscope,the mucosal color is white,the folds are reduced,and erosion is rarely seen.3.According to the syndrome differentiation of CAG,the syndrome of stagnation of heat in the liver and stomach was mainly seen in the whole stomach atrophy,the syndrome of weakness of the spleen and stomach was mainly seen in the atrophy of the stomach body and the moderate intestinal metaplasia,and the syndrome of damp-heat in the spleen and stomach was mainly seen in the whole stomach intestinal metaplasia,intraepithelial Neoplasia,severe inflammation and active inflammation The syndrome of blood stasis in the stomach collateral was mainly seen in Antrum atrophy and mild inflammation.This study obtains some reference basis for microscopic syndrome differentiation of endoscopic pathology,which provides a reference for clinical objective and accurate syndrome differentiation.The cases of chronic atrophic gastritis in this study come from a single area,so we should further expand the scope of the study to collect cases to make the study more effective. |
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