【目的】 探究胃息肉中医证型与内镜特征、病理类型的相关性。【方法】 选择广州中医药大学东莞医院总院脾胃病科收 治的胃息肉住院患者1 746例，收集患者的各项临床资料，包括性别、年龄、中医四诊资料以及胃息肉的病理类型、好发部 位、数量、大小等，分析胃息肉患者的中医证型分布规律及其与内镜特征、病理类型的相关性。【结果】（1）性别方面，1 746例 患者中，女性 1 107例（63.40%），男性 639例（36.60%），男女之比为 1∶1.73；年龄方面，发病率与年龄呈正相关（P＜0.01）， 年龄越大，发病率越高，中老年人是胃息肉的好发人群，≥ 40岁者占比高达87.40%。（2）中医证型方面，胃息肉患者的中医 证型以脾胃气虚证最多[418例（23.94%）]，其他按分布频次从高到低依次为寒湿阻滞证 394例（22.57%）、脾胃湿热证 353例 （20.22%）、气滞痰阻证 311 例（17.81%）和痰瘀互结证 70 例（15.46%）。（3）不同性别中医证型分布比较，差异有统计学意义 （P＜0.01），其中脾胃气虚证、寒湿阻滞证、气滞痰阻证、痰瘀互结证女性多于男性，而脾胃湿热证男性多于女性；不同年 龄段中医证型分布比较，差异有统计学意义（P＜0.01），其中＜30岁患者多见脾胃气虚证，30～39岁和40～49岁患者多见脾 胃湿热证，50～59岁患者多见气滞痰阻证，≥ 60岁患者多见寒湿阻滞证。（4）病理类型方面，胃息肉患者的主要病理类型为 胃底腺息肉1 327例（76.00%），其他依次为增生性息肉266例（15.23%）、炎性息肉146例（8.36%）、腺瘤性息肉7例（0.40%）； 不同病理类型中医证型分布比较，差异有统计学意义（P＜0.01），其中胃底腺息肉以脾胃气虚证为主，增生性息肉以气滞痰 阻证为主，炎性息肉以寒湿阻滞证为主，腺瘤性息肉以痰瘀互结证为主。（5）胃息肉数量方面，以多发性息肉为主[1 120例 （64.15%）]，单发性息肉较少[626例（35.85%）]；不同胃息肉数量的中医证型分布比较，差异有统计学意义（P＜0.05），其中 多发性息肉以脾胃气虚证的占比最高（25.45%），单发性息肉以脾胃湿热证的占比最高（24.28%）。（6）好发部位及大小方面， 胃息肉好发于胃体、胃底等部位，直径常 ≤ 0.5 cm；但不同发病部位及胃息肉大小之间的中医证型分布比较，差异均无统计 学意义（P＞0.05）。【结论】 胃息肉患者的中医证型与性别、年龄、病理类型和数量具有相关性；发病率与年龄呈正相关，中 老年是胃息肉的好发人群；女性明显高于男性，脾胃湿热证男性多于女性，其余证型均以女性多见；胃底腺息肉以脾胃气 虚证为主，增生性息肉以气滞痰阻证为主，炎性息肉以寒湿阻滞证为主，腺瘤性息肉以痰瘀互结证为主。

Objective To explore the correlation of traditional Chinese medicine（TCM）syndrome types with endoscopic features and pathological types of gastric polyps. Methods A total of 1 746 patients with gastric polyps admitted to the Department of Spleen and Stomach Diseases， Dongguan Hospital of Guangzhou University of Chinese Medicine were enrolled. The clinical data of the patients were collected， including gender， age，information obtained by four diagnostic methods of TCM，and pathological types and predilection sites of gastric polyps as well as their number and size. The distribution of TCM syndromes in the patients with gastric polyps and their correlation with endoscopic features and pathological types of the polyps were analyzed. Results（1）Of the 1 746 patients，1 107（63.40%）were female and 639（36.60%）were male，with the male to female ratio being 1∶ 1.73. The incidence of gastric polyps was positively correlated with the age（P＜0.01）：the older the age，the higher the incidence rate. The middle-aged and elderly people were the predilection population for gastric polyps， and the patients aged over 40 years old accounted for 87.40%.（2）The TCM syndrome types of patients with gastric polyps were predominated by spleen-stomach qi deficiency syndrome（418 cases，23.94%），and then came colddamp obstruction syndrome（394 cases，22.57%），damp-heat in the spleen and stomach syndrome（353 cases， 20.22%），qi stagnation and phlegm obstruction syndrome（311 cases，17.81%）and phlegm blended with blood stasis syndrome（70 cases，15.46%）.（3）There was a statistically significant difference in the distribution of TCM syndromes between the genders（P＜0.01）： spleen-stomach qi deficiency syndrome， cold-damp obstruction syndrome，qi stagnation and phlegm obstruction syndrome and phlegm blended with blood stasis syndrome were more common in the female，while damp-heat in the spleen and stomach syndrome was more common in the male. The distribution of TCM syndromes varied in different age groups（P＜0.01）：patients aged over 30 years old were more likely to suffer spleen-stomach qi deficiency syndrome，patients aged 30-39 and 40-49 years old were more likely to suffer damp-heat in the spleen and stomach syndrome，patients aged 50-59 years old were more likely to suffer qi stagnation and phlegm obstruction syndrome，and patients aged 60 years old or above were more likely to suffer cold-damp obstruction syndrome.（4）The pathological types of gastric polyps were predominated by fundus gland polyps（1 327 cases，76.00%），followed by hyperplastic polyps（266 cases，15.23 %），inflammatory polyps（146 cases， 8.36%）， and adenomatous polyps（7 cases， 0.40%）. There was a statistically significant difference in the distribution of TCM syndromes among various pathological types（P＜0.01）：fundus gland polyps were common in the patients with spleen-stomach qi deficiency syndrome，hyperplastic polyps were common in the patients with qi stagnation and phlegm obstruction syndrome，inflammatory polyps were common in the patients with cold-damp obstruction syndrome，and adenomatous polyps were common in the patients with phlegm blended with blood stasis syndrome.（5）Gastric polyps were characterized by multiple polyps（1 120 cases，64.15%）， single polyp was rare（626 cases， 35.85%）. The distribution of TCM syndromes varied in the patients with different number of polyps（P＜0.05）： patients with multiple polyps were predominated by spleen-stomach qi deficiency syndrome（25.45%）， patients with single polyp were predominated by damp-heat in the spleen and stomach syndrome（24.28%）.（6）Gastric polyps frequently appeared in the gastric body and gastric fundus，with the diameter being or less than 0.5 cm. And the differences of the distribution of TCM syndromes in the patients with various favored sites and polyp size were not statistically significant（P＞0.05）. Conclusion TCM syndrome types of patients with gastric polyps are correlated with gender and age of the patients and with the pathological types and number of gastric polyps. The incidence is positively correlated with the age， and middle-aged and elderly people are the predilection population of gastric polyps. The female incidence is significantly higher than that of the male，and damp-heat in the spleen and stomach syndrome is more common in the male while the rest of syndrome types are more common in the female. The patients with gastric fundus gland polyps usually suffer spleenstomach qi deficiency syndrome， patients with hyperplastic polyps usually suffer qi stagnation and phlegm obstruction syndrome， patients with inflammatory polyps usually suffer cold-damp obstruction syndrome， and patients with adenomatous polyps usually suffer phlegm blended with blood stasis syndrome.

R259.739

国家中医药管理局“刘石坚全国名老中医药专家传承工作室”建设项目（国中医药人教函[2019]41号）；王文辉东莞市名中医药 专家传承工作室建设项目（编号：5000164）