反流性食管炎中医证型与内镜下表现及胃肠激素的关系研究

摘要

Objective To explore the correlation of modern medical examination indexes with the traditional Chinese medical syndrome types of reflux esophagitis ( RE) , thus to supply evidence for the standardization of syndrome differentiation. Methods Seventy-six RE patients who met the inclusion criteria were enrolled into the study. And then we investigated the correlation of traditional Chinese medical syndrome types with endoscopicmucosal performance grading, plasma Ghrelin content, esophageal mucosal substance P ( SP) and vasoactive intestinal peptide (VIP) . Results (1) Syndrome patterns of RE showed certain correlation with the endoscopic mucosal performance (P<0.01) . Endoscopic mucosal performance grade 0-Ⅲ corresponded to the syndromes of gallbladder heat attaching stomach, liver-stomach disharmony/phlegm-qi blocking middle energizer, hepatogastric stagnant heat, middle energizer deficiency with reversed flow of qi, respectively. ( 2) The plasma Ghrelin content of RE patients with syndrome of phlegm-qi blocking middle energizer was lower than that of the patients with other syndrome patterns, and the difference was significant compared with the syndromes of hepatogastric sta gnant heat, liver-stomach disharmony, and gallbladder heat attaching stomach ( P<0.05 or P<0.01) . ( 3 ) The expression level of SP in the esophageal mucosa was the highest in the syndrome of hepatogastric stagnant heat, and was the lowest in the syndrome of phlegm-qi blocking middle energizer; expression level of VIP in the esophageal mucosa was the highest in the syndrome of middle energizer deficiency with reversed flow of qi, and was the lowest in the syndrome of hepatogastric stagnant heat ( P<0.05 or P<0.01) . Conclusion Traditional Chinese medical syndrome types of RE have correlation with endoscopic mucosal performance and immunohistochemical detection results for gastrointestinal hormones, which will be beneficial to the estimation of the development and severity of RE.%【目的】研究反流性食管炎(reflux esophagitis， RE)中医证型与现代医学辅助检查指标间的关联，探求客观检测指标与中医证型的联系，为中医辨证客观化寻找证据。【方法】收集符合反流性食管炎诊断标准的76例患者，观察中医证型与内镜分级、血浆Ghrelin浓度、食管黏膜下P物质(substance P， SP)及血管活性肠肽(vasoactive intestinal peptide， VIP)的关系。【结果】（1）反流性食管炎中医证型与内镜下黏膜改变具有一定相关性，差异有统计学意义（P＜0.01）。内镜下0～芋级依次对应为胆热犯胃证、肝胃不和证与痰气中阻证、肝胃郁热证、中虚气逆证。（2）痰气中阻证型患者血浆Ghrelin浓度低于其他证型，其中与肝胃郁热证、肝胃不和证、胆热犯胃证组比较，差异有统计学意义（P＜0.05或P＜0.01）。（3）食管黏膜组织P物质表达量以肝胃郁热证最多，痰气中阻证最少；食管黏膜组织VIP表达量以中虚气逆证最多，肝胃郁热证最少（P＜0.05或P＜0.01）。【结论】反流性食管炎中医证型与内镜下表现、胃肠激素免疫组织化学等客观指标有关，临床有助于从证型判断病情轻重及评估发病机制。