基于隐结构结合系统聚类的新型冠状病毒肺炎中医常见证候特征研究

Study on traditional Chinese medicine common syndrome characteristic of coronavirus disease 2019 based on latent structure combined with system clustering analysis

目的探讨新型冠状病毒肺炎(简称新冠肺炎)中医常见证候分布及特征,为临床辨证提供依据。方法检索2020年2月24日前公开发表的新冠肺炎中医诊疗方案及证候相关文献,建立数据库。采用Lantern 5.0和SPSS 20.0软件,运用隐结构法和系统聚类分析,结合证候及其相关症状的频次及构成比,分析新冠肺炎中医常见证候及症状特征。结果纳入诊疗方案及相关文献42篇,包括212条证候记录。基于频数>10次的53个症状建立隐结构模型,得到隐变量;结合医学专业知识,对隐变量进行综合聚类,最终得到14个隐变量,综合聚类为7个证候,包括邪热犯肺证、内闭外脱证、湿热蕴肺证、气阴两虚证、疫毒闭肺证、寒湿郁肺证、肺脾气虚证。对频数>10次的53个症状进行因子分析,得到14个公因子;提取每个因子中因子载荷系数≥0.3的症状进行系统聚类,得到6个有意义的症状组合,并根据每个症状组合推断出6个潜在证候,分别为疫毒闭肺证、邪热犯肺证、气阴两虚证、内闭外脱证、寒湿郁肺证、湿热蕴肺证。对证候频数的描述显示,纳入文献涉及证候25个,其中构成比≥5%的证候有内闭外脱证(14.62%)、疫毒闭肺证(13.68%)、湿热蕴肺证(12.74%)、肺脾气虚证(10.85%)、寒湿郁肺证(8.50%)、气阴两虚证(8.50%)、邪热犯肺证(8.02%)、湿遏肺卫证(5.66%);涉及症状87个,累计频次2 838次,包括苔腻(5.25%)、发热(4.83%)、舌红(4.37%)、脉数(3.74%)、乏力(3.46%)等。根据以上结果总结出新冠肺炎常见证候及其主要症状分别为:①邪热犯肺证:发热、咳嗽、咽干、头痛、周身酸楚、大便秘结等;②寒湿郁肺证:恶寒、周身酸楚、呕恶、脘腹胀满、便溏等;③湿热蕴肺证:咳嗽、痰黏难咯、纳呆、渴不欲饮、大便秘结等;④疫毒闭肺证:发热、咳嗽、痰黄、喘促、憋气、口唇青紫等;⑤内闭外脱证:神昏、烦躁、憋气、汗出肢冷、口唇青紫等;⑥气阴两虚证:干咳、自汗、乏力、口干渴、手足心热、便溏等;⑦肺脾气虚证:咳嗽、喘息、自汗、乏力、呕恶、便溏等。结论新冠肺炎中医常见证候有邪热犯肺证、寒湿郁肺证、湿热蕴肺证、疫毒闭肺证、内闭外脱证、气阴两虚证及肺脾气虚证等,为临床辨证提供参考。

Objective To investigate traditional Chinese medicine(TCM)common syndrome characteristic of coronavirus disease 2019(COVID-19),thus providing evidence for clinical differentiation.Methods The COVID-19 TCM treatment plan and syndrome related literature published before February 24,2020 was searched and a database was established.TCM common syndrome characteristics of COVID-19 were analyzed by the method of latent structure and system clustering combined with frequency and constituent ratio,which were conducted by Lantern 5.0 and SPSS 20.0.Results Forty-two literatures about treatment plans,and 212 syndromes records were enrolled.Latent structure model was established based on 53 symptoms with frequency over 10,and 14 latent variables and 7 syndromes were concluded by comprehensive clustering,including syndrome of pathogenic heat invading lung,internal block and outward desertion,syndrome of dampness heat accumulating lung,syndrome of Qi and Yin deficiency,syndrome of epidemic virus closing lung,syndrome of cold dampness closing lung and syndrome of Qi deficiency of lung and spleen.Factor analysis was conducted for 53 symptoms,which were reported more than 10 times,and 14 common factors were obtained.Symptoms with load coefficient over 0.3 were clustered and 6 syndromes were obtained,including syndrome of epidemic virus closing lung,syndrome of pathogenic heat invading lung,syndrome of Qi and Yin deficiency,internal block and outward desertion,syndrome of cold dampness closing lung,and syndrome of dampness heat accumulating lung.The literatures included 25 syndromes,and the syndromes with constituent ratio over 5%were internal block and outward desertion(14.62%),syndrome of epidemic virus closing lung(13.68%),syndrome of dampness heat accumulating lung(12.74%),syndrome of Qi deficiency of lung(10.85%),spleen and syndrome of cold dampness closing lung(8.50%),syndrome of Qi and Yin deficiency(8.50%),syndrome of pathogenic heat invading lung(8.02%)and syndrome of dampness repressing defensive Qi of lung(5.66%).Eighty-seven symptoms whose cumulative frequency was 2838 were referred,including greasy fur(5.25%),fever(4.83%),red tongue(4.37%),rapid pulse(3.74%)and fatigue(3.46%).According to the results above,the common syndromes and their symptoms of COVID-19 were:①syndrome of pathogenic heat invading lung:fever,cough,throat-drying,headache,all of the body distressed and constipation,etc.;②syndrome of cold dampness closing lung:aversion to cold,all of the body distressed,nausea and vomiting,abdominal distention and loose stool,etc.;③syndrome of dampness heat accumulating lung:cough,sticky phlegm,anorexia,thirst without desire to drink and constipation,etc.;④syndrome of epidemic virus closing lung:fever,cough,yellow phlegm,wheezing,suffocation and purple lips,etc.;⑤internal block and outward desertion:coma,feel fidgety,suffocation,sweating and feel cold and purple lips,etc.;⑥syndrome of Qi and Yin deficiency:dry cough,sweating,fatigue,thirsty,feverish feeling in palms and soles and loose stool,etc.;⑦syndrome of Qi deficiency of lung and spleen:cough,wheezing,sweating,fatigue,nausea and vomiting,and loose stool,et al.Conclusions The common syndromes of COVID-19 were syndrome of pathogenic heat invading lung,syndrome of cold dampness closing lung,syndrome of dampness heat accumulating lung,syndrome of epidemic virus closing lung,internal block and outward desertion,syndrome of Qi and Yin deficiency and syndrome of Qi deficiency of lung and spleen.This study could provide reference for clinical differentiation.