胃食管反流病中醫(yī)證型分布規(guī)律及食管測(cè)壓參數(shù)的相關(guān)性研究
發(fā)布時(shí)間：2018-10-25 17:18
【摘要】：目的:探討胃食管反流病(GERD)中醫(yī)證型分布規(guī)律及其影響因素,并基于高分辨率食管測(cè)壓技術(shù)(HRM)研究各證型及其動(dòng)力參數(shù)的相關(guān)性。方法:根據(jù)GERD西醫(yī)診斷標(biāo)準(zhǔn),納入GERD患者114例,采集納入患者信息,包括性別、年齡、身高、體重、幽門螺桿菌(HP)感染情況,并由副主任及以上職稱醫(yī)師根據(jù)中醫(yī)診斷標(biāo)準(zhǔn)進(jìn)行辨證分型,共分為寒熱錯(cuò)雜證、肝胃郁熱證、肝胃不和證、痰濕內(nèi)阻證、中虛氣逆證5組,并行高分辨率食管測(cè)壓,記錄食管上括約肌(UES)、食管下括約肌(LES)、食管體部的相關(guān)動(dòng)力參數(shù),分析不同中醫(yī)證型及其動(dòng)力參數(shù)的相關(guān)性。結(jié)果:1.中醫(yī)證型分布規(guī)律及影響因素114例GERD患者中寒熱錯(cuò)雜證組39例(占34.2%),肝胃郁熱證組27例(占23.7%),肝胃不和證組21例(占18.4%),痰濕內(nèi)阻證組16例(占14.0%),中虛氣逆證組11例(占9.6%),證型分布與西醫(yī)分型構(gòu)成無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。年齡方面,肝胃不和證組及肝胃郁熱證組男性發(fā)病率高于女性,其余三型男性低于女性,各組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。中虛氣逆證平均發(fā)病年齡(60.45±9.99)歲明顯高于其余四型(P0.05),各組年齡段分布存在差異(P0.05)。各組在體重指數(shù)、HP感染率均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2.食管動(dòng)力參數(shù)研究(1)UES動(dòng)力參數(shù):在UES靜息壓方面,痰濕內(nèi)阻證組要低于肝胃郁熱證組及中虛氣逆證組(P0.05);各組間在UES長(zhǎng)度、UES殘余壓方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(2)LES動(dòng)力參數(shù):在LES靜息壓方面,中虛氣逆證組、寒熱錯(cuò)雜證組明顯低于其他3組,且與肝胃郁熱證組及痰濕內(nèi)阻證組有統(tǒng)計(jì)學(xué)差異(P0.05);各組間在LES長(zhǎng)度、4s綜合松弛壓、LES低壓占比方面均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(3)食管體部動(dòng)力參數(shù):在遠(yuǎn)端收縮積分(DCI)方面,肝胃郁熱證組高于中虛氣逆證組及寒熱錯(cuò)雜證組(P0.05)。在蠕動(dòng)中斷方面,中虛氣逆證組高于寒熱錯(cuò)雜證組(P0.05)。在收縮前沿速度(CFV)、遠(yuǎn)端潛伏期(DL)方面均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(4)無(wú)效收縮:在收縮力度方面,痰濕內(nèi)阻證組高于其他四組(P0.05)。在無(wú)效收縮占比方面,痰濕內(nèi)阻證組低于其他四組(P0.05)。(5)在濕咽成功率方面,痰濕內(nèi)阻證組高于寒熱錯(cuò)雜證組、肝胃不和證組及肝胃郁熱證組(P0.05),同時(shí),中虛氣逆證組低于寒熱錯(cuò)雜證組、肝胃郁熱證組及痰濕內(nèi)阻證組(P0.05)。結(jié)論:GERD中醫(yī)證型中以寒熱錯(cuò)雜證最為常見(jiàn),其次依次為肝胃郁熱證、肝胃不和證、痰濕內(nèi)阻證、中虛氣逆證。GERD患者不同證型與年齡、UES靜息壓、LES靜息壓、DCI、無(wú)效收縮占比、食管收縮力度、濕咽成功率有一定相關(guān)性。
[Abstract]:Objective: to investigate the distribution of TCM syndromes of gastroesophageal reflux disease (GERD) and its influencing factors, and to study the correlation between these syndromes and their dynamic parameters based on high resolution esophageal manometry (HRM). Methods: according to the diagnostic criteria of western medicine for GERD, 114 patients with GERD were included in the study. The information including sex, age, height, weight, Helicobacter pylori (HP) infection was collected. According to the diagnostic criteria of TCM, the doctors with deputy director and above were divided into five groups: cold and heat disorder syndrome, liver and stomach stagnation syndrome, liver and stomach disharmony syndrome, phlegm dampness internal obstruction syndrome, middle deficiency qi inverse syndrome, and high resolution esophageal manometry. The dynamic parameters of the upper esophageal sphincter (UES),) lower esophageal sphincter (LES),) esophagus were recorded and the correlation of different TCM syndromes and their dynamic parameters were analyzed. The result is 1: 1. The distribution pattern of TCM syndromes and its influencing factors were 39 cases (34.2%) in the cold and heat disorder syndrome group, 27 cases (23.7%) in the liver and stomach stagnation syndrome group, 21 cases (18.4%) in the liver and stomach disharmony syndrome group, 16 cases (14.0%) in the phlegm dampness and internal obstruction syndrome group, and 11 cases in the middle deficiency and qi inverse syndrome group. There was no statistical difference between the distribution of syndromes and the composition of western medicine typing (P0.05). In terms of age, the incidence of liver and stomach disharmony syndrome and stagnation of heat of liver and stomach in male group was higher than that in female group, and the other three types of males were lower than female. There was no statistical difference among the three groups (P0.05). The average age of onset of the syndrome was (60.45 鹵9.99) years old, which was significantly higher than that of the other four types (P0.05), and the age distribution of each group was different (P0.05). There was no significant difference in body mass index (BMI) and HP infection rate among the groups (P0.05). Study on esophageal dynamic parameters (1) UES dynamic parameters: in UES resting pressure, The phlegm dampness internal obstruction syndrome group was lower than the liver and stomach stagnation heat syndrome group and the middle deficiency qi inverse syndrome group (P0.05); there was no significant difference in UES length and UES residual pressure between the groups (P0.05). (2) LES dynamic parameters: in LES resting pressure group, middle deficiency Qi inverse syndrome group, The cold and heat disorder syndrome group was significantly lower than the other three groups, There was no significant difference in LES length, 4 s comprehensive relaxation pressure and LES hypobaric ratio between the groups (P0.05). (3), and in the distal contraction integral (DCI), there was no significant difference between the three groups (P0.05), and there was no significant difference between the two groups in the length of LES, the comprehensive relaxation pressure of 4 s, and the ratio of low pressure to low pressure of LES (P0.05). (3). The liver and stomach stagnation syndrome group was higher than the middle deficiency qi inverse syndrome group and the cold heat disorder syndrome group (P0.05). In the peristaltic interruption, the deficiency of qi in the syndrome group was higher than that in the cold and heat disorder syndrome group (P0.05). There was no significant difference in the (DL) of the distal latency of (CFV), (P0.05). (4). In the contractile intensity, the phlegm dampness resistance syndrome group was higher than the other four groups (P0.05). In the ratio of invalid contraction, phlegm dampness internal obstruction syndrome group was lower than other four groups (P0.05). (5) in wet pharynx success rate, phlegm dampness internal obstruction syndrome group was higher than cold and heat disorder syndrome group, liver and stomach disharmony syndrome group and liver stomach stagnation heat syndrome group (P0.05), at the same time, The central deficiency of qi inverses syndrome group was lower than that of cold and heat disorder syndrome group, liver and stomach stagnation syndrome group and phlegm dampness internal obstruction syndrome group (P0.05). Conclusion: the most common syndromes of GERD are cold and heat disorder, followed by liver and stomach stagnation, disharmony of liver and stomach, internal obstruction of phlegm and dampness, and inverses of middle deficiency and qi. Different types and ages of GERD patients, UES resting pressure, LES resting pressure, and invalid contraction of DCI, are the most common syndrome types. Esophageal contraction intensity, wet pharynx success rate has certain correlation.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259
[Abstract]:Objective: to investigate the distribution of TCM syndromes of gastroesophageal reflux disease (GERD) and its influencing factors, and to study the correlation between these syndromes and their dynamic parameters based on high resolution esophageal manometry (HRM). Methods: according to the diagnostic criteria of western medicine for GERD, 114 patients with GERD were included in the study. The information including sex, age, height, weight, Helicobacter pylori (HP) infection was collected. According to the diagnostic criteria of TCM, the doctors with deputy director and above were divided into five groups: cold and heat disorder syndrome, liver and stomach stagnation syndrome, liver and stomach disharmony syndrome, phlegm dampness internal obstruction syndrome, middle deficiency qi inverse syndrome, and high resolution esophageal manometry. The dynamic parameters of the upper esophageal sphincter (UES),) lower esophageal sphincter (LES),) esophagus were recorded and the correlation of different TCM syndromes and their dynamic parameters were analyzed. The result is 1: 1. The distribution pattern of TCM syndromes and its influencing factors were 39 cases (34.2%) in the cold and heat disorder syndrome group, 27 cases (23.7%) in the liver and stomach stagnation syndrome group, 21 cases (18.4%) in the liver and stomach disharmony syndrome group, 16 cases (14.0%) in the phlegm dampness and internal obstruction syndrome group, and 11 cases in the middle deficiency and qi inverse syndrome group. There was no statistical difference between the distribution of syndromes and the composition of western medicine typing (P0.05). In terms of age, the incidence of liver and stomach disharmony syndrome and stagnation of heat of liver and stomach in male group was higher than that in female group, and the other three types of males were lower than female. There was no statistical difference among the three groups (P0.05). The average age of onset of the syndrome was (60.45 鹵9.99) years old, which was significantly higher than that of the other four types (P0.05), and the age distribution of each group was different (P0.05). There was no significant difference in body mass index (BMI) and HP infection rate among the groups (P0.05). Study on esophageal dynamic parameters (1) UES dynamic parameters: in UES resting pressure, The phlegm dampness internal obstruction syndrome group was lower than the liver and stomach stagnation heat syndrome group and the middle deficiency qi inverse syndrome group (P0.05); there was no significant difference in UES length and UES residual pressure between the groups (P0.05). (2) LES dynamic parameters: in LES resting pressure group, middle deficiency Qi inverse syndrome group, The cold and heat disorder syndrome group was significantly lower than the other three groups, There was no significant difference in LES length, 4 s comprehensive relaxation pressure and LES hypobaric ratio between the groups (P0.05). (3), and in the distal contraction integral (DCI), there was no significant difference between the three groups (P0.05), and there was no significant difference between the two groups in the length of LES, the comprehensive relaxation pressure of 4 s, and the ratio of low pressure to low pressure of LES (P0.05). (3). The liver and stomach stagnation syndrome group was higher than the middle deficiency qi inverse syndrome group and the cold heat disorder syndrome group (P0.05). In the peristaltic interruption, the deficiency of qi in the syndrome group was higher than that in the cold and heat disorder syndrome group (P0.05). There was no significant difference in the (DL) of the distal latency of (CFV), (P0.05). (4). In the contractile intensity, the phlegm dampness resistance syndrome group was higher than the other four groups (P0.05). In the ratio of invalid contraction, phlegm dampness internal obstruction syndrome group was lower than other four groups (P0.05). (5) in wet pharynx success rate, phlegm dampness internal obstruction syndrome group was higher than cold and heat disorder syndrome group, liver and stomach disharmony syndrome group and liver stomach stagnation heat syndrome group (P0.05), at the same time, The central deficiency of qi inverses syndrome group was lower than that of cold and heat disorder syndrome group, liver and stomach stagnation syndrome group and phlegm dampness internal obstruction syndrome group (P0.05). Conclusion: the most common syndromes of GERD are cold and heat disorder, followed by liver and stomach stagnation, disharmony of liver and stomach, internal obstruction of phlegm and dampness, and inverses of middle deficiency and qi. Different types and ages of GERD patients, UES resting pressure, LES resting pressure, and invalid contraction of DCI, are the most common syndrome types. Esophageal contraction intensity, wet pharynx success rate has certain correlation.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259
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