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| 新型冠状病毒肺炎患者中医证候756例分析 |
| 孟宪泽,万旭英,李军昌,巩小丽,梁玉清,高颂凯,徐纪平,吕坤聚,岳小强 |
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(1. 湖北省妇幼保健院光谷院区中医诊疗专家组, 武汉 430073;
2. 解放军海军971医院中医科, 青岛 266071;
3. 海军军医大学(第二军医大学)东方肝胆外科医院中西医结合科, 上海 200438;
4. 空军军医大学第一附属医院中医科, 西安 710016;
5. 解放军 96604部队医院中医科, 兰州 730030;
6. 南部战区空军医院中医科, 广东 510600;
7. 湖北省妇幼保健院光谷院区医务部, 武汉 430073;
8. 湖北省妇幼保健院光谷院区感染七科, 武汉 430073;
9. 解放军海军971医院呼吸科, 青岛 266071;
10. 海军军医大学(第二军医大学)长征医院中医科, 上海 200003
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨新型冠状病毒肺炎（COVID-19）的中医辨治规律，为指导中医临床提供参考。方法 采取横断面调查方法，对756例湖北省妇幼保健院光谷院区在院COVID-19患者进行中医四诊信息收集和中医辨证，分析其证候特点，并与患者性别、年龄、病程、病情分型等进行相关分析。结果 756例患者中，寒湿郁肺证101例（13.4%），湿热蕴肺证239例（31.6%），疫毒闭肺证18例（2.4%），肺脾气虚证195例（25.8%），气阴两虚证203例（26.9%）；其中位病程依次为寒湿郁肺证（21 d） < 湿热蕴肺证（22 d） < 疫毒闭肺证（27 d） < 脾肺气虚证（33 d） < 气阴两虚证（36 d）。证候分布在不同性别间差异无统计学意义（P>0.05）；>65岁患者中湿热蕴肺证的比例低于≤ 65岁患者［22.4%（69/308）vs 37.9%（170/448）］，肺脾气虚证［30.2%（93/308）vs 22.8%（102/448）］和气阴两虚证［34.1%（105/308）vs 21.9%（98/448）］则正好相反（P<0.01）。证候分布与COVID-19病情分型和病程有关（P=0.01，P<0.01），寒湿郁肺证在病情轻者（轻型+普通型）［14.1%（86/612）］中相对多见，疫毒闭肺证在病情较重者（重型+危重型）［6.2%（9/144）］中相对多见；寒湿郁肺证在疾病早期［26.2%（28/107）］常见，湿热蕴肺证在早期［43.9%（47/107）］、中期［42.0%（116/276）］均较常见，肺脾气虚证和气阴两虚证在中期、后期占比较高［中期21.7%（60/276）、18.1%（50/276），后期31.1%（116/373）、38.1%（142/373）］。结论 COVID-19患者证候偏热偏实，随病程进展因实致虚，其证候与患者年龄、病情分型和病程有关。 |
| 关键词: 新型冠状病毒肺炎 中医 证候 辨证论治 |
| DOI：10.16781/j.0258-879x.2020.04.0395 |
| 投稿时间：2020-03-26修订日期：2020-04-10 |
| 基金项目:湖北省妇幼保健院光谷院区科研项目（2020-FYGG-036）. |
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| Analysis on traditional Chinese medicine syndromes of 756 cases with coronavirus disease 2019 |
| MENG Xian-ze,WAN Xu-ying,LI Jun-chang,GONG Xiao-li,LIANG Yu-qing,GAO Song-kai,XU Ji-ping,Lü Kun-ju,YUE Xiao-qiang |
(1. Expert Team of Traditional Chinese Medicine, Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province, Wuhan 430073, Hubei, China;
2. Department of Traditional Chinese Medicine, No. 971 Hospital of the PLA Navy, Qingdao 266071, Shandong, China;
3. Department of Integrative Medicine, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University), Shanghai 200438, China;
4. Department of Traditional Chinese Medicine, the First Affiliated Hospital of Air Force Medical University, Xi'an 710016, Shaanxi, China;
5. Department of Traditional Chinese Medicine, No. 96604 Troop Hospital of PLA, Lanzhou 730030, Gansu, China;
6. Department of Traditional Chinese Medicine, Air Force Hospital of Southern Theater Command of PLA, Guangdong 510600, Guangzhou, China;
7. Department of Medical Service, Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province, Wuhan 430073, Hubei, China;
8. Department of Infectious Diseases (Ⅶ), Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province, Wuhan 430073, Hubei, China;
9. Department of Respiratory, No. 971 Hospital of the PLA Navy, Qingdao 266071, Shandong, China;
10. Department of Traditional Chinese Medicine, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai 200003, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the rule of traditional Chinese medicine (TCM) syndromes of coronavirus disease 2019 (COVID-19) patients, providing guidance for clinical practice. Methods The information and syndrome of 756 cases with COVID-19 in Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province were collected by cross sectional survey, the TCM syndrome differentiation was given by TCM experts, the syndrome characteristics were analyzed, and the relationships between syndromes and gender, age, course and severity of disease were analyzed. Results Among the 756 cases, 101 cases (13.4%) were diagnosed as cold-dampness accumulating lung syndrome, 239 cases (31.6%) were diagnosed as dampness-heat obstructing lung syndrome, 18 cases (2.4%) were diagnosed as epidemic toxin blocking lung syndrome, 195 cases (25.8%) were diagnosed as deficiency of lung and spleen Qi, 203 cases (26.9%) were diagnosed as deficiency of both Qi and Yin. The order of the median course of the TCM syndromes was: cold-dampness accumulating lung syndrome (21 d) < dampness-heat obstructing lung syndrome (22 d) < epidemic toxin blocking lung syndrome (27 d) < both lung and spleen Qi deficiency syndrome (33 d) < both Qi and Yin deficiency syndrome (36 d). There was no significant difference in syndrome distribution among different genders (P>0.05). The distribution of dampness-heat obstructing lung syndrome in patients over 65 years old was significantly lower than that in patients aged 65 and under (22.4%［69/308］ vs 37.9%［170/448］), while the syndrome of deficiency of lung and spleen Qi (30.2%［93/308］ vs 22.8%［102/448］) and the syndrome of both Qi and Yin deficiency (34.1% ［105/308］ vs 21.9%［98/448］) were just the opposite. The distribution of the syndromes was correlated with the severity and the course of COVID-19 (P=0.01, P<0.01). The syndrome of cold-dampness accumulating lung was relatively common in the general cases (14.1%［86/612］), while the syndrome of epidemic toxin blocking lung was more common in the severe and critical cases (6.2%［9/144］). The syndrome of cold-dampness accumulating lung was most common in the early stage (26.2%［28/107］) of COVID-19. Dampness-heat obstructing lung syndrome was common in both the early (43.9%［47/107］) and the middle stages (42.0%［116/276］). The syndrome of both lung and spleen Qi deficiency and the syndrome of both Qi and Yin deficiency were more common in the middle (21.7%［60/276］, 18.1%［50/276］) and late stages (31.1%［116/373］, 38.1%［142/373］). Conclusion The syndromes of COVID-19 are mostly hot and excessive in its early stage and getting into deficiency with the progress of the disease. And the syndromes are closely related to the age, severity and course of COVID-19 patients. |
| Key words: coronavirus disease 2019 traditional Chinese medicine syndrome syndrome differentiation and treatment |
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