摘要
通过研究胆汁返流和慢性胃炎证型间的关系，探讨胆汁返流各指标在中医分型、 证治中的应用价值并阐述各证型可能的发病机理。方法：将５９例慢性胃炎病人（胃镜下可见胆汁返 流者４２例．无返流者１７例）分为肝胃不和型（Ｕ型ｎ＝１９），东热夹杂型（Ｒ型，ｎ＝１５）．脾胃虚寒 型（Ｈ型，ｎ＝１９）和胃阴不足型（Ⅰ型，ｎ＝６）。１０名健康志愿者作为正常对照组（Ｃ组，ｎ＝１０）。检 测胃液胆酸（ＧＣ，μｇ／ｍｌ，ＲＩＡ法）、ｐＨ值、病理积分（ＲＦＩ，“１５分”法）和组织学ＨＰ。结果：Ｕ型病人 胃液 ＧＣ、ＰＨ和 ＲＦＩ明显高于其他各证型及 Ｃ组（ Ｐ ＜均０．０１ ），后者间 ＧＣ以及 ＰＨ无显著性差 异，但 ＲＦＩ以 Ｈ型的胃炎程度比 Ｒ型的重（ Ｐ ＜０． ０５），与 Ⅰ型间无显著性差异。幽门螺杆菌（ＨＰ） 感染与证型有关，以 Ｕ型的感染率最低，而 Ｒ型的感染率最高，明显高于其他各证型（ Ｐ ＜０． ０５～ ０． ０１）。以 ＧＣ＞５８ μｇ／ｍｌ，ｐＨ＞３． ０和ＲＦＩ＞９判断为病理性胆汁返流，则见Ｕ型的返流率明显高于 其他各证型（ Ｐ均＜０． ０１）。胆汁返流性胃炎以实证为主（占７０． ４％），其中又以 Ｕ型（５５ ６％）明显 高于Ｒ型（１４．８％）；
Aim: In this study, the clinical value of the parameters of bile reflux in the distinguisement of different Chinese medical types in chronic gastritis,and explored the possible mechanisms of the occurence of excessive and deficiency syndrome in spleen--stomach were investigated. Methods: 59 patients with chronic gastritis were divided into four groups as follows: 19 patients with incoordination the liver and the spleen (type U), 15 patients with simultaneous occurrence of cold and heat syndromes (type R ), 19 patients with insufficiency of the spleen-yang (type H ) and 6 patients with deficiency of the spleen--yin (type I ). 10 healthy voleenters served as contrals (group C ). Subjects were measured concentration of bile salts (GC, g/ml )and pH in gastric fluid, histological scores of gastric mucosa (RFI )and infection of HP. Results: Type U showed a significant higher AC,pH and RFI than the other types and the controls (P <0. 01 ). Parameters of GC and pH observed no statistic difference among groups of R,H,I and C. RFI were higher in type H than in type R (P <0. 05 ),but showed no significant importance when comparing to type I. Higher rate of infection of HP were found in type Rvs other types and controls, (P <0. 05~0. 01 ). When criteria of GC>58 g/ml,pH 3. 0 and RFI>9 were used to diagnose pathologic bile reflux,rate of abnormal reflux were remarkedly higher in type U than in any other types and controls (P <0. 01 ). Bile reflux gastritis was strongly associated with excessive syndrome,of which, incoordination between the liver and the spleen was its main type,while non-reflux gastritis showed similar occurences between excessive and deficiency syndromes, of which, simultaneous occurrence of cold and heat syndrome was a determinant. Conclusions: Each parameters of bile reflux were strongly associated with type U .suggesting that excessive bile salts, hypochlorhydria and severe damage to gastric mucosa were of pathophysiologic importance in the genesis of incoordination between the liver and the spleen. Infection of HP was a main factor for the production of simultaneous ocrrence of cold and heat syndrome. All parameters of bile reflux contribute to the distinguisement of different Chinese medical types and their subsequent therapy.
关键词
慢性
胃炎
胆汁返流
中医辨证
Bile reflux,Chronic gastritis,Defferentiation of symptoms and signs , Incoordination between the liver and the spleen,Simultaneous occurrence of cold and heat syndrome, Insufficiency of the spleen--yang,Dificiency of the spleen-yin
