【作者】 张杰；

【导师】 顾勤；

【作者基本信息】 南京中医药大学 ， 中医内科学（专业学位）， 2020， 硕士

【摘要】 目的:研究慢性萎缩性胃炎患者的体质特点及与中医证候类型、焦虑抑郁状态的关系,为临床诊治本病提供理论依据。方法:收集符合本研究诊断及纳入标准的CAG患者,填写CAG调查问卷、中医体质分类判定表、证候调查表、焦虑及抑郁自评量表。记录调查结果,运用SPSS25.0软件对录入的数据进行统计分析。结果:(1)收集的173例患者中,女性发病人数略高于男性,男女比例为1:1.19。年龄范围为28-82岁,平均年龄为56.62±10.34岁,发病人数以50-59岁年龄段多见,年龄分层以中年人多见。有明显发病诱因者占84.39%,吸烟者占27.17%,饮酒者占20.23%,有饮食偏好者占86.13%,饮食不规律中进食快占26.59%,从业人员中,59.30%的人反映工作强度及压力较大。(2)调查的CAG患者中,气虚质35例(20.23%),人数最多,阴虚质28例(16.18%),气郁质25例(14.45%),阳虚质及湿热质各23例(13.29%),痰湿质18例(10.40%),平和质10例(5.78%),血瘀质9例(5.20%),特禀质2例(1.16%)。其中偏颇体质与平和质比较有显著差异(P<0.01)。虚性与实性体质比较无差异(P>).05)。(3)CAG患者不同性别的体质分布有差异(P<0.05),男性常见气虚质、痰湿质、湿热质,女性常见阴虚质、气虚质、气郁质;不同年龄层的体质分布无差异(P>0.05)。(4)有无HP感染的患者体质分布存在差异(P<0.05)。按照从高到低的顺序对HP阴性体质出现频次进行排序,依次为气虚质、阴虚质、气郁质、痰湿质、阳虚质、湿热质、平和质、血瘀质、特禀质;同样对HP阳性体质出现频次进行排序,依次为湿热质、阳虚质、气郁质=气虚质、阴虚质=血瘀质、平和质=痰湿质、特禀质。(5)173例患者中各证候分布规律为脾胃虚弱证58例(33.53%)、脾胃湿热证31例(17.92%)、肝胃气滞证27例(15.61%)、胃阴不足证23例(13.29%)、肝胃郁热证20例(11.56%)、胃络瘀血证14例(8.09%)。不同体质的中医证候分布存在差异(P<0.05)。气虚质多见脾胃虚弱证(60.0%),阳虚质多见脾胃虚弱证(52.2%),阴虚质多见胃阴不足证(42.9%),湿热质多见脾胃湿热证(60.9%),气郁质多见肝胃气滞证(44.0%)。(6)本研究中有159人填写SAS、SDS调查表,无焦虑抑郁者67人,焦虑者33人,抑郁者27人,存在焦虑抑郁者32人。CAG患者不同体质的焦虑状态差异有显著统计学意义(P<0.01),不同体质的抑郁状态差异有显著统计学意义(P<0.01),气郁质、湿热质患者易出现焦虑状态,气郁质、痰湿质患者易出现抑郁状态。结论:(1)CAG患者以气虚质、阴虚质、气郁质、阳虚质、湿热质为常见体质类型。(2)CAG患者体质分布与性别有关,男性以气虚质、痰湿质、湿热质多见,女性以阴虚质、气虚质、气郁质多见。(3)有无HP感染的患者体质分布存在差异,HP 阳性患者多见湿热质。(4)CAG患者各证候出现频数由高到低依次为脾胃虚弱证、脾胃湿热证、肝胃气滞证、胃阴不足证、肝胃郁热证、胃络瘀血证。(5)CAG患者体质分布与证候类型之间具有联系,气虚质、阳虚质多见脾胃虚弱证,阴虚质多见胃阴不足证,湿热质多见脾胃湿热证,气郁质多见肝胃气滞证。(6)CAG患者的体质分布与焦虑状态、抑郁状态存在关联性,气郁质、湿热质患者易出现焦虑状态;气郁质、痰湿质患者易出现抑郁状态。更多还原

【Abstract】 Objective:To study the physical characteristics of patients with chronic atrophic gastritis and the relationship with the types of TCM syndromes,anxiety and depression status,and provide theoretical basis for clinical diagnosis and treatment of this disease.Methods:Collect CAG patients who meet the diagnosis and inclusion criteria of this study,and fill out the CAG questionnaire,TCM constitution classification judgment form,syndrome questionnaire,and anxiety and depression self-assessment scale.Record the survey results and use SPSS25.0 software to perform statistical analysis on the entered data.Results:(1)Of the 173 patients collected,the number of females was slightly higher than that of males,and the ratio of males to females was 1:1.19.The age range is 28-82 years old,the average age is 56.62±10.34 years old,the number of onsets is more common in the 50-59 age group,and the age stratification is more common in middle-aged people.84.39%had obvious causes of onset,27.17%were smokers,20.23%were drinkers,86.13%had dietary preferences,26.59%were eating fast during irregular diets,and 59.30%of the employees reflected work intensity And pressure.(2)Among the CAG patients surveyed,there were 35 cases(20.23%)of qi deficiency constitution,the largest number,28 cases of Yin deficiency constitution(16.18%),25 cases of qi depression constitution(14.45%),23 cases of Yang deficiency constitution and damp heat constitution(13.29%)),18 cases of phlegm and dampness constitution(10.40%),10 cases of peaceful constitution(5.78%),9 cases of blood stasis constitution(5.20%),2 cases of special constitution.(1.16%).Among them,there is a significant difference between the biased constitution and the peace constitution(P<0.01).There is no difference between virtual and physical constitution(P>0.05).(3)In CAG patients,the difference in physical distribution between different genders is statistically significant(P<0.05).qi deficiency,phlegm and dampness,damp heat constitution are common in men,and Yin deficiency,qi deficiency,qi depression constitution are common in women.There is no difference in the physical distribution of different age groups(P>0.05).(4)There are differences in the physical distribution of patients with or without HP infection(P<0,05).Sort the frequency of HP-negative physique from high to low,including qi deficiency,Yin deficiency,qi depression,phlegm and dampness,Yang deficiency,damp-heat,peaceful,blood stasis and special constitution;Also sort the frequency of HP positive physique,followed by damp heat,yang deficiency,qi depression=qi deficiency,Yin deficiency=blood stasis,peace=phlegm and dampness,special constitution.(5)Among the 173 patients,the distribution pattern of each syndrome type was 58 cases of spleen and stomach weakness syndrome(33.53%),31 cases of spleen and stomach dampness syndrome(17.92%),27 cases of liver and stomach qi stagnation syndrome(15.61%),and 23 cases of stomach yin deficiency syndrome(13.29%),20 cases of liver-stomach stagnation-heat syndrome(11.56%),14 cases of stomach-collateral stasis syndrome(8.09%).There are differences in the distribution of TCM syndromes of different constitutions(P<0.05).Qi deficiency constitution is more common in spleen and stomach weakness syndromes(60.0%),Yang deficiency constitution is more common in spleen and stomach weakness syndromes(52.2%),Yin deficiency constitution is more common in spleen and stomach deficiency syndromes(42.9%),and damp heat constitution is more common in spleen and stomach dampness heat syndromes(60.9%),qi depression constitution is more common in liver and stomach stagnation syndrome(44.0%).(6)In this study,159 people filled out the SAS and SDS questionnaires.There were 67 people without anxiety and depression,33 people with anxiety,27 people with depression,and 32 people with anxiety and depression.The difference in anxiety status of CAG patients with different constitutions was statistically significant(P<0.01),and the difference in depression status of different constitutions was statistically significant(P<0.01).Patients with qi depression and damp heat are prone to anxiety,and patients with qi depression and phlegm and dampness are prone to depression.Conclusion:(1)The common physical types of CAG patients are qi deficiency constitution,Yin deficiency constitution,qi depression constitution,Yang deficiency constitution and damp heat constitution.(2)The physical distribution of CAG patients is related to gender.Men are more common in Qi deficiency constitution,phlegm and dampness constitution,and damp heat constitution.Women are more common in Yin deficiency constitution,qi deficiency constitution and qi depression constitution.(3)There is a difference in the constitution distribution of patients with and without HP infection,and HP-positive patients are more common in damp-heat constitution.(4)The frequency of various syndrome types of CAG patients from high to low is as follows:spleen and stomach weakness syndrome,spleen and stomach dampness and heat syndrome,liver and stomach qi stagnation syndrome,stomach yin deficiency syndrome,liver and stomach stagnation syndrome,stomach stasis syndrome.(5)There is a relationship between the physical distribution of CAG patients and the type of syndrome.Qi deficiency constitution and Yang deficiency constitution are more common in spleen and stomach weakness syndrome,Yin deficiency constitution is more common in stomach and yin deficiency syndrome,damp heat constitution is more common in spleen and stomach damp heat syndrome,and qi depression constitution is more common in liver and stomach.Qi depression constitution is more common in liver and stomach stagnation syndrome.(6)The physical distribution of patients with CAG is associated with anxiety and depression.Patients with qi depression and damp heat are prone to anxiety;patients with qi depression and phlegm and dampness are prone to depression.更多还原