北京地区2016—2017年冬春季流感样病例中医病证特征观察与分析

Observation and analysis of characteristics of TCM syndromes of influenza-like cases in Beijing in winter and spring of 2016/2017

目的对2016—2017年冬春季北京地区流感样病例的中医病证特征进行观察和分析。方法采用横断面调查方法研究2016.11—2017.2首都医科大学附属北京朝阳医院、北京中医药大学东方医院、首都医科大学附属北京潞河医院、首都医科大学附属北京友谊医院、北京中医药大学东直门医院发热门诊收治的1 224例流感样病例,通过分析流行病学、临床表现及实验室检查结果,总结北京地区2016—2017年冬春季流感样病例的中医病证特征。结果 1 224例(97.5%)流感样病例初起发热,Tmax(38.5±0.7)℃,以咳嗽、咽痛等症为主。就诊时以发热、咳嗽为主,兼见肌痛、流涕、咽痛等症。中医证候以风热证为主,为440例(35.9%);风寒证与寒包火证次之,分别为335例(27.4%)、300例(24.5%)。流感确诊病例740例(60.5%),其中甲型流感732例(59.8%),甲型流感病原构成以季节性H3N2(54.1%)为主,余亚型占比极低。中性粒细胞百分比略有升高,与以往变化不大。结论北京地区2016—2017年冬春季流感样病例符合中医学"风温病"范畴,临床表现为卫气同病。

Objective To observe and analyze the characteristics of TCM syndromes of influenza-like cases in Beijing from the end of2016 to early 2017. Methods A cross-sectional survey method was used to study 1 224 influenza-like cases received by Chaoyang Hospital affiliated to the Capital Medical University and another 4 hospitals from Nov. 2016 to Feb. 2017,and through analysis based on epidemiology,the clinical manifestations and laboratory test results,TCM syndrome characteristics of influenza-like cases in the Beijing area in winter and spring 2016/2017 were summarized. Results Of 1 224 influenza-like cases,there were fever（ 97. 5%）,Tmax（ 38. 5 ± 0. 7） ℃ at the beginning with cough and sore throat as the main symptoms. On the visit to the clinic,there were fever,cough accompanied by body ache,running nose and sore throat. TCM syndromes were mainly characterized by wind and heat syndrome in 440 cases（ 35. 9%）,then wind cold syndrome and cold covering fire respectively in 335 cases（ 27. 4%） and 300 cases（ 24. 5%）.There were 740 confirmed flu cases（ 60. 5%） including 732 cases of swine flu（ 59. 8%）,seasonal H3 N2 swine flu（ 54. 1%） was the major part among influenza pathogen A,but subtypes were extremely low. The percentage of neutrophils was slightly higher,and there was not much change compared with that in the past. Conclusion The winter and spring flu-like cases in Beijing from 2016 to 2017 were in line with the category of ＂wind febrile disease＂in Chinese medicine accompanied with the clinical symptoms of simultaneous disorder of Defensive qi and qi.