反流性食管炎中医证型与酸反流、心理因素关系的研究

目的研究反流性食管炎(RE)中医辨证分型与酸反流各项指标及心理因素的关系。方法对109例反流性食管炎患者进行中医辨证分型和神经症状评分,选用24 h食管pH值监测的多项酸反流指标,运用多种统计学分析方法,研究各主要证型与食管酸反流多项指标的差异,并分析中医证型与神经症状评分的关系。结果筛选出的主要证型有肝胃不和、肝胃郁热、中虚气逆、胃热气逆、痰气郁阻5型。总pH<4的时间百分率、总反流次数在肝胃不和、肝胃郁热、胃热气逆型中显著高于中虚气逆、痰气郁阻型。DeMeester积分在肝胃不和、肝胃郁热、胃热气逆型中显著高于中虚气逆型。立位时pH<4的时间百分率在肝胃郁热型中显著高于中虚气逆型。卧位时pH<4的时间百分率在胃热气逆型中显著高于中虚气逆型。神经症评分在肝胃不和、肝胃郁热型中显著高于中虚气逆、胃热气逆型。结论RE的中医辨证分型与某些酸暴露参数之间存在明显关系;肝主疏泄功能失常在反流性食管炎发病中是十分重要的一环。

Study of relationship between TCM syndrome types of reflux esophagitis with acid reflux and psychological factor

Objective It is to approach the relationship between TCM syndrome types of reflux esophagitis(RE) with acid reflux and psychological factor.Methods 109 patients of RE were classified according to their syndrome differentiation and their nerve symptoms were graded,some acid reflux indexes of 24 hour-esophageal pH monitoring were selected,and the relationship between the types with acid reflux indexes and the nerve symptom grades were analyzed.Results The main types selected from 109 patients with RE were incoordination between liver and stomach(type Ⅰ),stagnant heat of liver and stomach(typeⅡ),adverse rising of weakness of spleen and stomach(type Ⅲ),adverse rising of stomach-heat(type Ⅳ),stagnation of phlegm and qi(type Ⅴ).The total fraction time of pH<4(%) and the total number of acid reflux episodes in type Ⅰ,Ⅱand Ⅳ were higher than that in typeⅢ and Ⅴ(P<0.05).The DeMeester′s score in types Ⅰ,Ⅱand Ⅳ were greater than that in type Ⅲ(P<0.05).The upright fraction time of pH<4(%) in type Ⅱ was higher than that in type Ⅲ(P<0.01).The supine fraction time of pH<4(%) in type Ⅳ was higher than that in type Ⅲ(P<0.05).The nerve symptom grades in types Ⅰ and Ⅱwere higher than that in type Ⅲ and Ⅳ(P<0.01).Conclusion There is some relationship between the TCM syndrome types of RE with esophageal acid exposure;The stagnation of liver plays an important role in the pathogenesis of RE.