Study On The Correlation Of Gastroscopic And Pathological Grades With Constitution And Tongue Image In Chronic Atrophic Gastritis

Objective:This topic observes and analyzes the distribution characteristics of physical constitution and tongue image in chronic atrophic gastritis patients,and studies the correlation of gastroscopic,pathological changes and HP infection with body constitution and tongue image,so as to provide reference for diagnosis and treatment of chronic atrophic gastritis.Methods:According to inclusion and exclusion criteria,selected 220cases with chronic atrophic gastritis who admitted to the outpatient,inpatient of Liver,Spleen and Stomach Diseases department and gastroscopy room in The First Affiliated Hospital of Heilongjiang University of Chinese Medicine from October 2021 to February 2023,collected the patient’s general information(age,gender,season of onset,smoking history,drinking history,etc.).The Chinese medicine constitution classification and judgment was used to determine physical type.Combine with AI tongue analysis system and manual interpretation to determine the tongue diagnosis results,and the correlation between gastroscopic manifestations and pathological changes of chronic atrophic gastritis and constitution,tongue image was analyzed by Fisher precise test,Spearman analysis and other statistical methods.Results:1.In this study,the frequency of constitution types among chronic atrophic gastritis patients was:qi deficiency constitution(29.5%),qi stagnation type constitution(22.3%),Yin deficiency constitution(13.2%),damp-heat constitution(12.7%),Yang deficiency constitution(9.5%),phlegm-dampness constitution(5.9%),blood-stasis constitution(4.5%),peaceful constitution(2.3%),no special constitution.2.In this study,the tongue color distribution of those suffering from chronic atrophic gastritis was as follows:light red tongue(30.0%)(29)light white tongue(26.8%)(29)red tongue(20.0%)(29)dark red tongue(13.2%)(29)purple tongue(10.0%),the distribution of the form of tongue was toothed tongue(28.2%)(29)normal tongue(25.5%)(29)cracked tongue(14.1%)(29)fat tongue(13.6%)(29)punctured tongue(11.4%)(29)thin tongue(7.3%),the distribution of tongue coating was thinness white moss(37.3%)(29)greasy(thick)yellow moss(23.3%)(29)thinness yellow moss(15.9%)(29)greasy(thick)white moss(11.8%)(28)exfoliated(little)moss(11.8%).3.Correlation of gastroscopic findings and pathological changes with physical constitution:mucosal color,mucosal erosion,bile reflux,proliferative particles and vascular penetration were statistically significant in physical distribution(P(27)0.05),while the texture of mucosa and the presence or absence of mottled changes were not statistically significant in physical distribution difference(P(29)0.05).Additionally,the degree of gastric mucosa atrophy,intestinal metaplasia and dysplasia are all different in different constitutions(P(27)0.05).The mucosa color distribution of qi-deficiency,Yin-deficiency and damp-heat were different(P(27)0.05),qi deficiency was found in the white phase of mucosa,Yin deficiency and damp-heat were more common in the red phase of mucosa;presence of mucosal erosion in Yin deficiency,damp-heat constitution,qi depression constitution distribution were different(P(27)0.05),Yin deficiency constitution and damp-heat constitution were common in mucous membrane erosion;damp-heat constitution and non-damp-heat constitution was different in bile reflux(P(27)0.05);Yang deficiency and non-Yang deficiency was different in proliferative particles(P(27)0.05);Qi-deficiency quality,Yang-deficiency quality,damp-heat quality and air-stagnation quality had differences in the distribution of vascular permeability(P(27)0.05),and Qi-deficiency quality and Yang-deficiency quality were more commonly seen in patients with vascular permeability;Blood-stasis constitution was positively correlated with atrophy,intestinal metaplasia and dysplasia(r_s(29)0);Yin deficiency and Yang deficiency were positively correlated with atrophy and dysplasia(r_s(29)0);Qi stagnation was mostly not accompanied by mucosal erosion and vascular permeability,and it was negatively correlated with the degree of pathological changes(r_s(27)0).4.Correlation between gastroscopic findings and pathological changes with tongue image:there were statistically significant in the distribution of tongue color,tongue shape and tongue coating in mucosa color and mucosa erosion(P(27)0.05),bile reflux and proliferative particles had statistical significance in the distribution of tongue color and coating(P(27)0.05),with or without vascular penetration was statistically significant in tongue color(P(27)0.05),mucosal texture was statistically significant in the difference of tongue shape distribution(P(27)0.05),with or without piebald change was not statistically significant in tongue image distribution difference(P(29)0.05).Mucosal leukoplakia was more common in light white tongue,exfoliated(little)moss;mucous erosion was mainly characterized by red tongue,greasy(thick)yellow moss or exfoliated(little)moss;bile reflux was common in red tongue,greasy(thick)yellow moss,vascular penetration was common in purple tongue,hyperplastic particles was commom in purple tongue,thick white(greasy)or thick white(greasy)moss.Significant differences were observed between pathological grades of tongue color,tongue shape and tongue coating(P(27)0.05);dark red tongue,purple tongue,exfoliated(little)moss were all positively associated with atrophy,intestinal metaplasia and dysplasia(r_s(29)0);cracked tongue was also linked to atrophy and dysplasia(r_s(29)0);punctured tongue was positively correlated with intestinal metaplasia and dysplasia(r_s(29)0).5.Statisticant differences were obsered in the distribution of constitution and tongue image with or without HP infection(P(27)0.05),as well as in the distribution of damp-heat constitution and yellow(thick)moss.Both of which were significantly different(P(27)0.05).Conclusion:1.Some gastroscopic manifestations and pathological grades of CAG were correlated with constitution:Qi deficiency constitution was more commonly seen in mucous membrane white phase,vascular penetration;red phase of mucous membrane,mucosal erosion and bile reflux were common in dampness and heat;Yang deficiency constitution was more common in hyperplastic granules and vascular penetration;Yin deficiency constitution is more common in mucous membrane red phase,mucosal erosion.The pathological changes of gastric mucosa in patients with Qi depression were mild,with blood stasis constitution were more severe than those in other constitutional types,the degree of atrophy and dysplasia was higher in Yin deficiency and Yang deficiency constitution.2.Some gastroscopic manifestations and pathological grades of CAG were correlated with tongue appearance:mucous membrane white phase was more common in light white tongue,exfoliated(little)moss,the red phase of mucosa was more common in red tongue and cracked tongue;the smooth mucosa texture was mainly fat tongue,the rough mucosa texture is mainly punctured tongue,and the uneven mucosa was often seen toothed tongue;mucous erosion was mainly characterized by red tongue,greasy(thick)white moss or exfoliated(little)moss;bile reflux with red tongue,yellow greasy(thick)moss more common;vascular penetration was common in purple tongue;hyperplasia granules to purple tongue,white greasy(thick)moss or greasy(thick)white moss more common;the pathological changes of gastric mucosa were higher when the tongue showed dark red tongue or purple tongue,exfoliated(little)moss,punctured tongue and cracked tongue may indicate a higher degree of dysplasia.3.HP infection was correlated with constitution and tongue image,the HP infection rate was higher in patients with damp-heat constitution,yellow greasy(thick)moss.