基于食管癌高发区人群筛查探索反流性食管炎及Barrett食管的舌象转化规律  

The Change Characteristics of Tongue Manifestation of Reflux Esophagitis and Barrett′s Esophagus based on an Esophageal Carcinoma Screening Study in High-risk Areas of China

作　　者：于然[1] 娄彦妮[2] 梁婉娴 宋国慧 李军 刘猛[2] 贾立群[2] YU Ran;LOU Yanni;LIANG Wanxian;SONG Guohui;LI Jun;LIU Meng;JIA Liqun(Beijing University of Chinese Medicine,Beijing,100029;China-Japan Friendship Hospital;Ci County Cancer Hospital,Heibei Province;Yanting County Tumor Hospital,Sichuan Province)

机构地区：[1]北京中医药大学,北京市100029 [2]中日友好医院 [3]河北省磁县肿瘤医院 [4]四川省盐亭县肿瘤医院

出　　处：《中医杂志》2021年第9期782-788,共7页Journal of Traditional Chinese Medicine

基　　金：囯家中医药管理局重大疑难疾病中西医临床协作项目。

摘　　要：目的分析食管癌前病变反流性食管炎(RE)及Barrett食管的舌象转化规律。方法基于食管癌高发区人群筛查,通过倾向性评分匹配方法以1∶2分别匹配轻度、中重度反流性食管炎及Barrett食管人群,匹配因素包括人群一般特征、生活习惯及相关疾病,采用多因素Logistic回归及倾向性评分匹配方法(PSM)匹配后舌象特征分布规律及食管炎癌转化过程中舌象特征变化规律。结果经过一般特征、生活习惯、相关疾病PSM匹配,组间各变量间均衡可比(|d|>0.25),匹配后组间各变量之间基本均衡,PS进一步校正通过多因素Logistic回归分析,轻度RE与灰黑苔[OR=1.540(1.120,2.119)]、绛舌[OR=1.529(1.028,2.275)]、暗红舌[OR=1.291(1.128,1.479)]、紫舌[OR=1.532(1.237,1.896)]明显相关;中重度RE与紫舌[OR=1.681(1.068,2.648)]及灰黑苔[OR=4.719(1.858,11.987)]明显相关;Barrett食管与紫舌[OR=3.447(1.206,9.853)]相关。结论紫舌是RE向Barrett食管转变的危险舌象。Objective To analyze the change characteristics of tongue manifestation as the precancerous disease of the esophagus progresses of reflux esophagitis(RE) and Barrett′s esophagus. Methods Based on the screening of esophageal carcinoma in high-risk areas, the propensity score matching(PSM) method was used to match the mild RE group to the moderate-severe RE and Barrett′s esophagus group at a ratio of 1 ∶2 by general population characteristics, lifestyle and related diseases. Multivariate logistic regression in combination with PSM method were used to analyze the distribution law of tongue manifestation after adjustment and the change characteristics of tongue manifestation from RE to Barrett′s esophagus. Result A balanced exposure groups at baseline was achieved by adjusting general population characteristics, lifestyle and related diseases through PSM(|d| > 0.25). After further adjustment by PSM, multivariate logistic regression analysis showed that mild RE was significantly associated with gray and black coating(OR=1.540, 95% confidence interval(CI) 1.120 to 2.119), crimson tongue(OR=1.529, 95%CI 1.028 to 2.275), dusky red tongue(OR=1.291, 95%CI 1.128 to 1.479), and purple tongue(OR=1.532, 95%CI 1.237 to 1.896);moderate-severe RE was significantly related with tongue stasis(OR=1.681, 95%CI 1.068 to 2.648) and gray and black tongue(OR=4.719, 95%CI 1.858 to 11.987);Barrett′s esophagus was associated with purple tongue(OR=3.447, 95%CI 1.206 to 9.853). Conclusion Tongue stasis is a risk factor for the transformation from RE to Barrett′s esophagus.

关 键 词：食管癌 反流性食管炎 BARRETT食管 紫舌 血瘀证 倾向性评分匹配 

分 类 号：R735.1[医药卫生—肿瘤]