基于证素辨证及前瞻性研究的甲型、乙型流感发病初期关键病机探讨

Exploration on the critical pathogenesis of influenza A and B in early stage based on syndrome factors differentiation and prospective study

目的结合现代基因诊断技术确定致病病毒,以循证医学理念为指导,采用临床流行病学研究方法,客观研究流感(时行感冒)的中医证素特点,探讨流感(时行感冒)发病初期的关键病机。方法采用前瞻性、多中心的方法,收集2009—2012年每年11月至次年2月的甲型流感患者资料330例(甲流组)、乙型流感患者资料86例(乙流组),填写临床观察记录表,按照《证候证素量表》录入数据库,应用SPSS17.0统计软件比较分析甲流组与乙流组的证素及其异同,探讨二者发病的不同关键病机。结果甲流组、乙流组2组年龄、性别差异无统计学意义(P>0.05);证素"肺、寒、湿"在甲流组和乙流组中差异均有统计学意义(P<0.01)。结论甲流初期病邪以风、热之邪常见,病机特点为风热毒邪夹湿袭表,初始易夹时令寒邪,卫气同病。乙流初期病邪亦以风、热之邪常见,病机特点为风热毒邪袭表,肺卫同病。

Objective By combining modem genetic diagnostic techniques to determine the causative virus, following the guidance of evidence-based medicine concept, using clinical epidemiological methods, so as to analyze the TCM characteristics of syndrome factors on influenza and explore the critical pathogenesis of influenza in early stage. Methods With a prospective, multi-center method used, 330 influenza A （ Group A） and 86 influenza B （ Group B） cases were selected from November to February next year of 2009 to 2012. Then the clinical observation record form was filled in, the data were entered into database according to Syrtdrome-Syndrome Factors Scale to compare the similarities and differences on syndrome factors between Group A and B with statistical software SPSS 17.0, and to further analyze the repspective critical pathogenesis. Results There was no significant difference on age, gender between Group A and B （P 〉 0. 05 ）. For syndrome factors ＇ lung, cold, damp＇ , there was significant difference between Group A and B （P 〈 0. 01 ）. Conclusion The common pathogenic evil in early stage of influenza A is wind and hot evils, the pathogenesis characteristics are wind-heat toxin evil assailing the exterior with damp evil which could easily involve seasonal cold evil at initial stage, leading to a disease involving weifen and qifen. In early stage of influenza B, the common pathogenic evil is also wind and hot evils. The pathogenesis characteristics are wind-heat toxin evil assailing the exterior, leading to a disease involving lung and weifen.