35例新型冠状病毒肺炎证候特征及微观辨证相关性研究

A Correlational Research on the Syndromes and Micro-differentiation of Covid-19 in 35 Cases

目的分析35例新型冠状病毒肺炎患者临床证候、理法方药及实验室检查,探讨新型冠状病毒肺炎的证候特征及微观辨证之间相关性。方法采集35例新型冠状病毒肺炎患者症状、舌象、证型、方药、实验室检查及治疗效果,进行数据分析及统计学处理。结果 35例新型冠状病毒肺炎患者以轻症多见,中医辨证分型分布特征为"寒湿束表,热郁津伤证"20例、"风寒袭表,气虚湿滞证"6例、"热毒袭肺证"7例、"热毒壅肺证"2例。实验室检查,各证型之间淋巴细胞计数比较,差异有统计学意义(P<0.05),热毒壅肺证患者淋巴细胞计数低于寒湿束表、热郁津伤证患者(P<0.05)。各证型在白细胞计数、血沉、C反应蛋白方面无差异性(P>0.05),但血沉和C反应蛋白普遍升高。23例T淋巴细胞分析统计结果表明,各证型之间在总T淋巴细胞(CD3+)方面有差异性(P<0.05),在T辅助淋巴细胞(CD3+、CD4+)及T抑制淋巴细胞(CD3+、CD8+)方面无差异性(P>0.05);寒湿束表、热郁津伤证患者的总T淋巴细胞(CD3+)明显高于风寒袭表、气虚湿滞证及热毒壅肺证患者(P<0.05),差异具有统计学意义。疗效评定方面,主要症状明显好转时间为(4.85±3.40)天,平均住院日为(17.74±4.92)天,临床治愈率94.29%。结论新型冠状病毒肺炎中医基本病机为"湿""寒""热""毒""瘀",用方以藿香正气散、甘露消毒丹、银翘散、麻杏甘石汤使用频率较高,治疗新冠肺炎,坚持中西医并重,结合微观辨证,临床疗效确切。

Objective To explore the correlation between the syndromes and the micro-differentiation of Covid-19 by analyzing its clinical syndromes, therapy and prescription as well as laboratory examinationin in 35 cases. Method 35 cases with Covid-19 are collected to examine their symptoms, tongue manifestation, syndromes, prescriptions, laboratory test and curative effect, then the data analysis and statistical process are made. Result Among 35 cases, a majority of patients show mild symptoms. 20 cases are characterized by "the cold-dampness restraining the exterior and hot stasis harming the fluid" syndromes, 6 cases with "the wind-coldness invading the exterior and the damp-stasis caused by qi deficiency" syndromes, 7 cases with "the hot toxin invading the lung" syndromes, and 2 cases with hot toxin obstructing the lung" syndromes. After the laboratory test, the comparison of lymphocyte count among different syndromes shows statistically significant difference(P< 0.05). The lymphocyte count of patients with "the hot toxin obstructing the lung" syndromes are lower than those with "the cold-dampness restraining the exterior and hot stasis harming the fluid" syndromes(P<0.05). There was no difference in white blood cell count, erythrocyte sedimentation rate, and c-reactive protein(P>0.05), but erythrocyte sedimentation rate and c-reactive protein were generally increased among different syndromes. The statistical results of T lymphocyte analysis in 23 cases show that total T lymphocyte(CD3+) was different among different syndromes(P< 0.05). However, there is no difference in T-helper lymphocytes(CD3+, CD4+) and T-inhibitory lymphocytes(CD3+, CD8+)(P> 0.05). The total T lymphocytes(CD3+) of patients with "the cold-dampness restraining the exterior and hot stasis harming the fluid" syndromes are significantly higher than those with "the wind-coldness invading the exterior and the damp-stasis caused by qi deficiency" syndromes(P<0.05), and the difference is statistically significant. In terms of the evaluation of curative effect, the main symptom improvement time was(4.85±3.40) days, the average hospital stay was(17.74±4.92) days, and the clinical cure rate was 94.29%. Conclusion The basic pathogenesis of Covid-19 inclues the dampness, coldness, heat, toxin and stasis, therefore prescriptions like Huoxiang Zhengqi Powder, Ganlu Xiaodu Pill, Yinqiao Powder, Maxing Ganshi Decoction are used frequently. In all, the treatment of Covid-19 is highly effective if the Western and Chinese Medicine are attached equal importance, combining with the micro-differentiation.