CAJ | 학술논문

目的：研究非萎缩性胃炎（ CSG）到萎缩性胃炎（ CAG）的中医证候演变。方法对400例慢性胃炎患者的中医证候进行分析，采用χ2检验比较从CSG到CAG的中医证候演变。结果慢性胃炎有9个病性要素：气虚、气滞、湿、热、阴虚、阳虚、瘀血、食积、寒；8个基本证型：类肝胃不和证、类肝胃郁热证、类脾寒胃热证、类湿热蕴结证、类脾胃虚弱证（气虚、阳虚）、类瘀阻胃络证、类饮食停滞证、类胃阴不足证。经χ2检验，CSG与气虚、气滞、热、阳虚、瘀血、食积、寒相关性较高，而CAG则与阴虚和湿相关性较高，尤其与阴虚关系密切；9个病性要素与幽门螺杆菌（ Hp ）阳性的CSG的相关性依次为：食积＞热＞阴虚，食积＞气滞＞阴虚，食积＞寒＞阴虚，食积＞湿，瘀血＞湿，气虚＞阴虚，阳虚＞阴虚，瘀血＞阴虚；Hp阳性的CAG则刚好相反。经χ2检验，类胃阴不足证与CAG相关性较高，CSG则与除类湿热蕴结证之外的其余6个基本证型相关性较高；8个基本证型与Hp阳性的CSG的相关性依次为：类饮食停滞证＞类肝胃郁热证＞类胃阴不足证，类饮食停滞证＞类脾胃虚弱证＞类胃阴不足证，类饮食停滞证＞类湿热蕴结证，类瘀阻胃络证＞类湿热蕴结证，类肝胃不和证＞类胃阴不足证，类瘀阻胃络证＞类胃阴不足证；Hp阳性CAG则刚好相反。结论饮食积滞，是慢性胃炎最早出现的中医证候，其后渐次出现湿、热、瘀血等。正虚贯穿慢性胃炎发病的整个过程，CSG阶段以邪实为主，或是虚实夹杂，至CAG阶段，则以正虚为主。
목적：연구비위축성위염（ CSG）도위축성위염（ CAG）적중의증후연변。방법대400례만성위염환자적중의증후진행분석，채용χ2검험비교종CSG도CAG적중의증후연변。결과만성위염유9개병성요소：기허、기체、습、열、음허、양허、어혈、식적、한；8개기본증형：류간위불화증、류간위욱열증、류비한위열증、류습열온결증、류비위허약증（기허、양허）、류어조위락증、류음식정체증、류위음불족증。경χ2검험，CSG여기허、기체、열、양허、어혈、식적、한상관성교고，이CAG칙여음허화습상관성교고，우기여음허관계밀절；9개병성요소여유문라간균（ Hp ）양성적CSG적상관성의차위：식적＞열＞음허，식적＞기체＞음허，식적＞한＞음허，식적＞습，어혈＞습，기허＞음허，양허＞음허，어혈＞음허；Hp양성적CAG칙강호상반。경χ2검험，류위음불족증여CAG상관성교고，CSG칙여제류습열온결증지외적기여6개기본증형상관성교고；8개기본증형여Hp양성적CSG적상관성의차위：류음식정체증＞류간위욱열증＞류위음불족증，류음식정체증＞류비위허약증＞류위음불족증，류음식정체증＞류습열온결증，류어조위락증＞류습열온결증，류간위불화증＞류위음불족증，류어조위락증＞류위음불족증；Hp양성CAG칙강호상반。결론음식적체，시만성위염최조출현적중의증후，기후점차출현습、열、어혈등。정허관천만성위염발병적정개과정，CSG계단이사실위주，혹시허실협잡，지CAG계단，칙이정허위주。
Objective To examine the evolution of TCM patterns from Non-atrophic gastritis ( CSG) to atrophic gastritis ( CAG) .Methods We analyzed TCM patterns in 400 cases of chronic gastritis.χ2 test was used to compare the evolution of TCM patterns from CSG to CAG.Results There were nine essential pattern elements for chronic gastritis, namely, Qi deficiency, Qi stagnation, dampness, heat, Yin deficiency, Yang deficiency, blood stasis, food accumulation, and cold.Eight basic pattern categories for chronic gastritis were liver-stomach disharmony, liver-stomach constraint heat, spleen cold and stomach heat, retention of heat in the interior, spleen-stomach weakness ( including Qi deficiency and yang deficiency) , phlegm obstructing the stomach collaterals, food accumulation, and stomach-Yin deficiency, respectively.Chi-square test showed that CSG was closely related to Qi deficiency, Qi stagnation, heat, Yang deficiency, blood stasis, food accumulation and coldness while CAG was related to dampness, particularly to Yin deficiency.The correlation between nine essential pattern elements and Hp-positive CSG were:food accumulation >Heat >Yin deficiency;food accumulation >Qi stagnation>Yin deficiency; indigestion >coldness >Yin deficiency; food accumulation >dampness; blood stasis >dampness;Qi deficiency >Yin deficiency;Yang deficiency>Yin deficiency;blood stasis >Yin deficiency.Hp-positive CAG was just the opposite.Chi-square test also showed that stomach-Yin deficiency pattern was related to CAG and that CSG was related to other six basic pattern types except the pattern of heat retention in the interior.The correlation between the eight basic pattern categories and Hp-positive CSG were:food accumulation >liver-stomach constraint heat >stomach-Yin deficiency; food accumulation >pattern of spleen-stomach weakness >stomach-Yin deficiency; food accumulation >accumulation of damp-heat; stasis obstructing stomach collateral >pattern of heat retention in the interior;liver-stomach disharmony >stomach-Yin deficiency; stasis obstructing stomach collaterals >stomach-Yin deficiency.Hp-positive CAG was just the opposite.Conclusion Food accumulation is the earliest TCM pattern in chronic gastritis, thereafter dampness, heat, and blood stasis.Pattern of heat retention in the interior and deficiency of Healthy Qi is present throughout the development of chronic gastritis.In CSG stage, excess of pathogenic factors is often dominant.Sometimes, deficiency and excess patterns may coexist.In CAG stage, deficiency of Healthy Qi is dominant.