Correlation Between Tongue Picture Of Chronic Atrophic Gastritis And Gastroscopic Diagnosis,pathology And Hp Infection

Objective:To observe and analyze the characteristics and distribution of tongue images in patients with chronic atrophic gastritis(CAG),and to study the assessment of atrophy/intestinal metaplasia(OLGA/OLGIM)associated with CAG tongue images and gastroscopic diagnosis and operable gastric cancer risk.Between the pathological stage and Helicobacter pylori(Hp)infection,in order to provide an objective basis for the clinical diagnosis of CAG with integrated traditional Chinese and Western medicine.Method:The patients in the Department of spleen and stomach of Ningde Hospital of traditional Chinese medicine from January 2021 to January 2022 were collected,and 205 CAG cases meeting the inclusion criteria were screened.The clinical information collection scale of CAG patients was designed to collect the general information,symptoms and other related information of patients.The patient information was observed and recorded successively,and the statistical data were processed by SPSS 26.0 software.The statistical methods such as test and Fisher exact test were used to analyze the distribution and correlation of tongue image,gastroscopic diagnosis,OLGA/OLGIM stage and Hp infection.Results:(1)General information of patients: A total of 205 cases were collected in this study,including 103 male cases and 102 female cases.The gender distribution of males and females was not statistically significant(P>0.05).Patients aged 59(39%)> 30-39 years(17.6%)>60-69 years(14.6%)> 18-29 years(5.4%).The results showed that there were significant differences in age distribution(P<0.05).(2)The distribution of TCM syndrome types in CAG: The distribution of TCM syndrome types in CAG patients from high to low is: 63 cases(30.7%)of spleen and stomach deficiency syndrome > 45 cases(22.0%)of liver and stomach disharmony syndrome > 42 cases of spleen and stomach damp-heat syndrome(20.5%)%)> 39 cases(19.0%)of stomach yin deficiency syndrome > 16 cases(7.8%)of stomach collaterals stasis syndrome.There were regular differences in the age of patients with different TCM syndrome types,with statistical significance(P<0.05).Among them,spleen and stomach damp-heat syndrome is mainly distributed in patients aged 18-49 years old,and stomach-yin deficiency syndrome and liver-stomach disharmony syndrome are mainly distributed in patients aged 50-59 years old.The majority of patients were in the 50-69 age group.(3)The distribution law of CAG tongue image: the distribution of tongue color from high to low is: 77 cases with pale red tongue(37.6%)> 61 cases with red tongue(29.8%)>35 cases with dark tongue(17.1%)> 20 cases with pale tongue(9.8%)%)>ecchymosis/purple tongue in 12 cases(5.9%);tongue coating distribution from high to low:72 cases(35.1%)with thin white coating> 48 cases(23.4%)with thin yellow coating> 42cases(20.5%)with yellow thick(greasy)coating %)> 29 cases(14.1%)with white thick(greasy)coating > 14 cases(6.8%)with peeling(less)coating;tongue shape distribution from high to low: 85 cases(40.5%)with fat/scarred tongue >40 cases of normal tongue(19.5%)>36 cases of cracked tongue(17.5%)>35 cases of pricked tongue(17.1%)>11 cases of thin tongue(5.4%).(4)Correlation between tongue image and gastroscopic diagnosis: in CAG patients diagnosed by gastroscopy,CAG with erosion(36.1%)> simple CAG(27.8%)> CAG with bile reflux(22.4%)> CAG with erosion and bile reflux(13.7%).There were regular differences in the distribution of tongue color,tongue coating,tongue shape and type of gastroscopic diagnosis,with statistical significance(P<0.05).In the distribution of tongue color: the red tongue is mainly common in simple CAG and CAG with bile reflux,and the red tongue is more common in CAG with erosion.Crimson tongue,ecchymosis/purple tongue are more common in CAG with erosion and bile reflux.In the distribution of tongue coating:simple CAG is dominated by thin white coating,while CAG with erosions is more common with thick(greasy)yellow coating and thin yellow coating.Thin white coating and thin yellow coating are more common in CAG with bile reflux;greasy coating and peeling(less)coating are more common in CAG with erosion and bile reflux.In terms of tongue distribution: simple CAG is more common with fat/scarred tongue,CAG with erosion,CAG with bile reflux is mainly fat/scarred tongue,the proportion of punctured tongue and cracked tongue is increased,CAG with erosion Cracked tongue is more common with bile reflux.(5)Correlation between tongue image and OLGA staging: there were significant differences in tongue color,tongue coating,tongue shape and OLGA staging(P<0.05).In the distribution of tongue color: the distribution of tongue color in stage I is mainly red tongue;in stage II,the distribution of tongue color is mainly red tongue and purple tongue.Stage III tongue color distribution: red tongue,ecchymosis/purple tongue predominant.In stage IV,the distribution of tongue color is mainly crimson tongue.In terms of the distribution of tongue coating: in stage I,thin white coating is the main distribution,followed by thin yellow coating;in stage II and III,yellow and thick(greasy)coating is the main distribution.Stage IV is dominated by flaking(less)moss.In the distribution of tongue shape: in stage I,the distribution of tongue shape is mainly fat/scarred tongue,followed by normal tongue;in stage II,the distribution of tongue shape is mostly fat/scarred tongue,cracked tongue,and the proportion of punctured tongue increases.In stage III,the distribution of tongue shape is mainly cracked tongue and punctured tongue;in stage IV,the distribution of tongue shape is mainly thin uvula,followed by cracked tongue.(6)Correlation between tongue image and OLGIM staging: There were significant differences in tongue color,tongue coating,tongue shape and OLGIM staging(P<0.05).In terms of tongue color distribution: stage 0 is dominated by light red tongue,while stage I is dominated by red tongue and light red tongue.Stage II is dominated by red tongue and red tongue.In stage III,crimson tongue,red tongue,ecchymosis/purple tongue are more common.There were only 11 cases of stage IV,with red tongue mainly followed by ecchymosis/purple tongue.In the distribution of tongue coating: stage 0 is dominated by thin white coating,while stage I is more common with thin yellow coating and thin white coating,and white thick(greasy)coating/yellow thick(greasy)coating also occupies a large proportion.In stage II,white thick(greasy)moss/yellow thick(greasy)moss and thin yellow moss are more common.In stages III and IV,yellow thick(greasy)fur and peeling(less)fur are more common.In terms of tongue shape distribution: in stage 0 and I,the fat/scarred tongue and normal tongue are the main ones;in stage II,the pricked tongue is dominant,followed by the fat/scarred tongue and the cracked tongue.Cracked tongue and thin uvula are more common in stage III and IV.Correlation between tongue image and Hp infection: Among the 205 CAG patients,118(57.6%)were Hp positive and 81(39.5%)were negative.There was no statistical significance in tongue color,tongue shape and distribution of Hp(P>0.05).There was statistical significance between the tongue coating and the distribution of Hp(P<0.05).The positive detection rate of Hp was highest in the yellow thick(greasy)coating(76.2%).Conclusion:(1)There is a correlation between CAG tongue appearance and gastroscopic diagnosis:tongue appearance is red/purple tongue,ecchymosis/purple tongue,yellow thick(greasy coating),and cracked tongue can reflect mucosal damage and gastric inflammation to a certain extent.Degree.(2)There is a correlation between CAG tongue appearance and OLGA staging: when the tongue appearance is light red/white tongue,thin coating,fat/scarred tongue,the degree of gastric mucosal atrophy is low,indicating a low risk of cancer.When the tongue appearance is ecchymosis/purple tongue,peeling(less)fur,and thin uvula,the gastric mucosa has a higher degree of atrophy,indicating a high risk of cancer.(3)There is a correlation between CAG tongue appearance and OLGIM staging: the tongue appearance is pale tongue,red tongue,thin coating,white thick(greasy)coating,fat/scarred tongue,the degree of gastric mucosal intestinal metaplasia is mild,Cancer risk is low.Tongue manifestations are crimson tongue,ecchymosis/purple tongue,yellow thick(greasy)coating,peeling(less)coating,and when the tongue is cracked,the degree of gastric mucosal intestinal metaplasia is more serious,indicating a higher risk of intestinal metaplasia and cancer.(4)There was no correlation between CAG tongue color and tongue shape distribution and Hp infection,but the positive rate of Hp was the highest in red tongue,and the lowest in ecchymosis/purple tongue.There is a correlation between tongue coating and Hp infection,and the detection rate of Hp positive in yellow thick(greasy)coating is the highest.