胆汁反流性胃炎中医证候分布规律分析

胆汁反流性胃炎中医证候分布规律分析

目的探討胆汁反流性胃炎中医证候分布情况。方法通过统一的观察量表采集来自2014年1月～2016年1月就诊于北京朝阳医院、北京市通州区中西医结合医院、北京中医药大学第三附属医院的门诊102例胆汁反流性胃炎患者临床资料，并对一般资料、中医主要症状和症候分布、中医症候与内镜下胃粘膜表现的关系进行分析。结果①胆汁反流性胃炎女性居多，发病年龄以51～60岁年龄段为主，病程分布以1～3年居多。②BRG的发病与饮食不节、情绪不畅有一定相关性。③临床症状以胃胀、口苦、心烦易怒、口干、反酸、呃逆、胃痛为主。④常见中医证候以胆热犯胃和肝胃不和。⑤中医证候与内镜下胃粘膜表现比较，差异具有统计学意义（P＜0.05）。粘膜充血、水肿多见于肝胃不和证，其次为胆热犯胃证，粘膜水肿、糜烂多见于胆热犯胃证，其次为脾胃湿热证。粘膜出血多见于胃络瘀血证、肝胃不和证。结论胆汁反流性胃炎病位在胆胃，多以胆热犯胃、肝胃不和为主；中医证候与内镜下胃粘膜表现具有相关性。故在中医药治疗应注重清热化痰、利胆和胃、疏肝和胃；胆汁反流性胃炎患者的胃黏膜改变与中医证候之间存在密切联系，在临床治疗中运用中医分型有助于辨证施治。

Abstract：Objective To investigate the distribution of TCM syndromes in bile reflux gastritis.Methods A total of 102 cases of bile reflux gastritis were collected from January 2014 to January 2016 in the outpatient department of Beijing Chaoyang hospital，Tongzhou district hospital of Integrated traditional Chinese and western medicine，and the third affiliated hospital of Beijing university of traditional Chinese medicine.The clinical data of the patients were analyzed，and the relationship between general data，distribution of major symptoms and symptoms of traditional Chinese medicine，and symptoms of TCM and gastric mucosa under endoscopy was analyzed.Results ①Most bile reflux gastritis women，the age of onset is mainly 51 to 60 years of age，disease course distribution is mostly 1 to 3 years.②the onset of BRG is related to eating and drinking，and there is a certain correlation between emotional unobstruction.③The clinical symptoms were stomach distension，bitter mouth，upset and irritable，dry mouth，acid regurgitation，hiccup and stomach pain.

④The main syndromes of TCM were gallbladder fever invading stomach and liver stomach disharmony.⑤There was a statistically significant difference between the TCM syndrome and endoscopic gastric mucosal performance（P＜0.05）.Mucosal hyperemia and edema were more common in liver-stomach disharmony syndrome，followed by gallbladder heat invasion of stomach syndrome，mucosal edema，erosion more seen in gallbladder heat into stomach syndrome，followed by spleen and stomach damp-heat syndrome.Mucosal bleeding is more common in the gastric collaterals blood stasis syndrome，liver and stomach disharmony syndrome. Conclusion Bile reflux gastritis is located in gall stomach，most of which are gall fever invading the stomach and disharmony between liver and stomach，and there is a correlation between TCM syndromes and gastric mucosal manifestations under endoscope.Therefore，Chinese medicine treatment should pay attention to clearing heat and resolving phlegm，promoting gallbladder and stomach，soothing liver and

stomach；there is close relation between gastric mucosal changes and TCM syndrome in patients with bile reflux gastritis，and the application of TCM classification in clinical treatment is helpful to syndrome differentiation and treatment.Key words：Bile reflux gastritis；TCM syndromes；Clinical epidemiological investigation

胆汁返流性胃炎（bile reflux gastritis，BRG）是指过多的十二指肠内容物反流入胃，造成胃粘膜充血、水肿、糜烂等炎性改变[1]，是消化系统疾病中的一种常见病。该病主要表现为上腹胀痛不适、口苦、嗳气、泛酸、恶心、呕吐胆汁等症状。治疗上多应用抑酸、促胃动力、保护胃粘膜等药物，但效果欠佳，停药后容易复发。本研究对102例胆汁反流性胃炎患者临床资料进行分析，对胆汁反流性胃炎的病因病机及中医证候分布规律等方面的相关性进行分析，旨在为临床提供客观依据。

1资料与方法

1.1一般资料所有病例均来自2014年1月～2016年1月就诊于北京朝阳医院、北京市通州区中西医结合医院、北京中医药大学第三附属医院的门诊胆汁反流性胃炎患者，此次纳入的研究病例共102例。

1.2诊断标准

1.2.1西医诊断标准参照中华医学会消化病分会2013年美国胃肠病学院制定的《胃食管反流病诊断和处理指南》[2]及中华医学会消化病学分会制定的《中国慢性胃炎共识意见》（2017 年，上海）[3]。

1.2.2中医证候诊断标准参照2009年中华中医药学会脾胃病分会《胃食管反流病中医诊疗共识意见》和2012年《慢性胃炎中西医结合诊疗共识意见》的中医证候诊断标准，制定了BRG中医诊断标准[4，5]。①肝胃不和证：胃脘胀痛或痛连两胁，每因情志因素作痛，嗳气频繁，脉弦滑数。②胆热犯胃证：口苦咽干，胃脘痞满灼痛，烦躁易怒，嘈杂易饥，脉弦滑。③脾胃虚弱（包括虚寒）证：胃脘隐痛，胃痛喜按喜暖，便溏腹泻，脉沉细。④脾胃湿热证：胃脘痞满或隐痛，常欲呕恶，口苦、口中异味，渴不欲饮，纳呆不欲饮食，舌质红、边尖深红，苔黄厚或腻。⑤胃阴不足证：胃脘灼热疼痛，胃脘隐痛口干舌燥，舌红少津或有裂纹。⑥胃络瘀血证：胃脘痛有定处，拒按，舌质黯红或紫黯，或有瘀斑。

⑦寒热错杂证：胃脘痞满疼痛，口干口苦，畏寒肢冷，口疮便溏。

1.3纳入标准与排除标准纳入标准：①符合原发性胆汁反流性胃炎西医诊断标准；②年龄18～75岁；③受试者知情，自愿签署知情同意书，有一定阅读能力。排除标准：①有胃肠道手术史、肝胆手术史；②伴有心肝肾等主要脏器严重病变者，造血系统疾病以及肿瘤患者；③有上消化道活动性出血者；④有消化系统器质性疾病者；⑤孕妇及哺乳期妇女；⑥有神经系统及精神疾病病史；⑦年龄75岁；⑧经腹部彩超证实有胆结石者。

1.4方法临床证候调查表的制定：根据统一制定的观察量表收集患者的姓