Correlation Study Between TCM Syndromes Of Chronic Atrophic Gastritis And Serum Homocysteine, Vitamin B₆, Vitamin B₁₂ And Folic Acid Levels

Objective:To observe the correlation between TCM syndromes of chronic atrophic gastritis(CAG)and serum homocysteine(Hcy),vitamin B6,vitamin B12 and folic acid levels,in order to screen and diagnose CAG and The theoretical basis for the objectification and standardization of CAG TCM syndrome types.METHODS:From February 2018 to February 2019,252 patients with CAG and 42 patients in the control group were included in the Department of Traditional Chinese Medicine,Gastroenterology Clinic and Ward of Putuo Hospital affiliated to Shanghai University of Traditional Chinese Medicine.Fill in the case report form;judge the TCM syndrome type;test serum Hcy,vitamin B6,vitamin B12,folic acid.Results:1)Relationship between serum index of control group and atrophy group:There were significant differences in serum Hcy,vitamin B6,vitamin B12 and folic acid levels between the control group and the atrophy group(p<0.05),indicating that serum Hcy and vitamins were compared in patients with chronic atrophic gastritis compared with chronic non-atrophic gastritis.B6,vitamin B12,and folic acid levels have changed.2)General situation:A.There was no significant difference in gender and age between patients with different degrees of atrophy(P>0.05).B.A history of previous gastric disease(p<0.001),green tea(p<0.001),and espresso(p<0.05)were associated with the development of CAG.Patients with a history of stomach disease and drinking coffee have an increased risk of CAG;patients who prefer green tea have a lower risk of CAG.The remaining demographic variables were not significantly associated with the onset of CAG.3)Distribution of TCM syndrome types:A.TCM syndrome type distribution:32.10%of spleen and stomach deficiency syndrome,25.80%of gastric collateral blood stasis syndrome,17.90%of stomach yin deficiency syndrome,14.30%of liver and stomach qi stagnation syndrome,9.90%of liver and stomach stagnation syndrome,5.60%of spleen and stomach dampness syndrome.B.TCM syndrome types of CAG patients with different degrees of atrophy:The main TCM syndromes of mild CAG group were 59.3%of spleen and stomach weakness syndrome,21.30%of liver and stomach qi stagnation syndrome,13.50%of liver and stomach stagnation syndrome,13.50%of stomach yin deficiency syndrome,and gastric collaterals.12.90%of blood stasis syndrome,7.70%of spleen and stomach damp-heat syndrome;the main TCM syndromes of moderate CAG group were 36.6%of spleen and stomach weakness syndrome,29.30%of stomach yin deficiency syndrome,23.20%of spleen and stomach dampness syndrome,4.90%of liver and stomach stagnation syndrome,liver and stomach qi stagnation 3.70%of the syndrome,2.40%of the spleen and stomach damp-heat syndrome;the main TCM syndromes of the severe CAG group were 80.00%of the gastric collateral blood stasis syndrome and 20.00%of the spleen-stomach weakness syndrome.4)Relationship between CAG and serum indicators:A.The degree of atrophy was significantly positively correlated with serum Hcy level(correlation coefficient:0.59,p<0.001).The serum Hcy level in the mild CAG group was significantly lower than that in the moderate CAG group(p<0.001)and the severe CAG group(p<0.001).).The degree of atrophy was significantly negatively correlated with vitamin B6(correlation coefficient:-0.455,p<0.001).The level of vitamin B6 in the mild CAG group was significantly higher than that in the moderate CAG group(p<0.001)and the severe CAG group(p<0.001)..The degree of atrophy was not significantly correlated with vitamin B12 and folic acid,but the vitamin B12 level in the mild CAG group was significantly higher than that in the moderate CAG group(p<0.001)and the severe CAG group(p<0.001).With the aggravation of atrophy,the serum Hcy level of CAG patients increased,and the serum vitamin B12,vitamin B6 and folic acid levels showed a downward trend.B.There were significant differences in serum Hcy,vitamin B6,vitamin B12 and folic acid levels between patients with different TCM syndromes(p<0.05).Serum Hcy level in patients with spleen and stomach deficiency syndrome,stomach qi deficiency syndrome and gastric collateral blood stasis syndrome is higher than other syndrome types;serum vitamin B6 level in patients with gastric yin deficiency syndrome and gastric collateral blood stasis syndrome is lower than other syndrome types;serum vitamin B12 in patients with spleen and stomach weakness syndrome The level is lower than other syndrome types;the serum folic acid level of patients with gastric collateral blood stasis syndrome is lower than other syndrome types.C.There were no significant differences in serum Hcy,vitamin B6 and vitamin B12 levels between different genders(p>0.05).There was a statistically significant difference in the sex of folic acid(p<0.05),which was lower in men than in women.There was no significant correlation between serum age and serum vitamin B6,folic acid and vitamin B12 levels(p>0.05),and positive correlation with serum Hcy level(p<0.05).That is,the older the serum,the higher the serum Hcy level.D.Influencing factors of serum index levels:Hcy:In addition to age,drinking history has a significant positive predictive effect on serum Hcy levels in CAG patients(p<0.05).Vitamin B6:Previous gastric history and hypertension had a significant negative predictive effect on vitamin B6 levels(p<0.05).Vitamin B12:Hot food has a positive predictive effect on vitamin B12(p<0.05).Folic acid:gender,cerebral infarction,and spicy stimulation had a negative predictive effect on serum folate levels(p<0.05).E.As the degree of atrophy increased,serum Hcy levels in CAG patients increased,serum vitamin B12,vitamin B6,and folic acid levels decreased significantly.Conclusion:The degree of atrophy in CAG patients is closely related to the distribution of TCM syndrome types.The occurrence of CAG is related to serum Hcy,vitamin B6,vitamin B12 and folic acid levels,and the degree of atrophy is positively correlated with serum Hcy level,and negatively correlated with serum vitamin B6,which can provide a basis for screening and preliminary diagnosis of CAG.Serum levels of Hcy,vitamin B6,vitamin B12 and folic acid were different among TCM syndrome types.Hcy and CAG spleen and stomach weakness syndrome,stomach yin deficiency syndrome and gastric collateral blood stasis syndrome are closely related,vitamin B6 and CAG stomach yin deficiency syndrome,gastric collateral blood stasis syndrome is closely related,vitamin B12 and CAG spleen and stomach weakness syndrome is closely related,folic acid and CAG stomach The blood stasis syndrome is closely related.It is inferred that the above indicators are related to the production of CAG deficiency(spleen and stomach and yin deficiency)and sputum,which can be used as a reference for CAG TCM syndrome differentiation.