新型冠状病毒肺炎患者舌象特征与临床分型的关系

The Relationship Between the Characteristics of Tongue Manifestation and Clinical Classification in Patients with Coronavirus Disease 2019

目的观察139例新型冠状病毒肺炎患者的舌象特征,并探讨其与临床分型的关系。方法应用中医传统望舌方法,采集139例新型冠状病毒肺炎住院患者的舌诊资料,包括舌色、舌形、苔色、苔质。比较不同临床分型(轻型、普通型、重型、危重型)患者舌质、舌苔特征。结果139例新型冠状病毒肺炎患者舌色主要为淡暗舌40例(28.78%)、红舌36例(25.90%)、淡红舌33例(23.74%);正常舌形85例(61.15%)、齿痕舌41例(29.50%)、裂纹舌13例(9.35%)。134例患者进行了舌苔分析,其中腻苔79例(58.96%)、薄苔33例(24.63%)、厚苔22例(16.42%);润苔115例(85.82%)、干苔19例(14.18%);黄苔94例(70.15%)、白苔40例(29.85%)。不同临床分型患者舌色、舌形、舌苔厚薄程度、舌苔润燥程度、舌苔颜色分布差异均具有统计学意义(P<0.05或P<0.01)。与普通型比较,危重型患者红舌、暗红舌更多见(P=0.004),重型(P<0.001)、危重型(P=0.002)患者裂纹舌更多见,危重型患者厚苔较多见(P<0.001),黄苔在重型(P=0.001)、危重型(P=0.012)患者中占比更高;与普通型、重型比较,危重型患者干苔更多见(均P<0.001)。结论新型冠状病毒肺炎患者病情严重时可出现红舌、暗红舌、裂纹舌和黄苔、干苔、厚苔,提示随着病情加重,疫邪存在化热、化燥表现,同时伤及气阴。

Objective To observe the tongue manifestation of 139 patients with coronavirus disease 2019(COVID-19),and to explore its relationship with the clinical classification.Methods Using the traditional method of tongue inspection in traditional Chinese medicine(TCM),the tongue examination data of 139 inpatients with COVID-19 were collected,including tongue color,tongue shape,tongue coating color,and tongue coating quality.The characteristics of tongue quality and tongue coating of patients of mild,common,severe,and critical type were compared.Results In the 139 patients,there were 40 cases(28.78%)with dark tongue,36 cases(25.90%)with red tongue,33 cases(23.74%)with light red tongue.There were 85 cases(61.15%)with normal tongue shape,41 cases(29.50%)with tooth mark tongue,13 cases(9.35%)with cracked tongue.Tongue coating analysis was performed on 134 patients,including 79 cases(58.96%)with greasy coating,33 cases(24.63%)with thin tongue coating,22 cases(16.42%)with thick tongue coating,115 cases(85.82%)with moist tongue coating,and 19 cases(14.18%)with dry tongue coating;94 cases(70.15%)with yellow tongue coating,40 cases(29.85%)with white tongue coating.There were statistically significant differences in tongue color,tongue shape,tongue coating thickness,degree of tongue coating moisturizing or dry,and tongue coating color distribution in patients of different clinical types(P<0.05 or P<0.01).Compared with the common type,red tongue and dark red tongue were more common in the critical patients(P=0.004),severe(P<0.001)and critical(P=0.002)patients are common to have cracked tongue,and thicker tongue coating was more common in critical patients.There were more thick tongue coating in critical patients(P<0.001)and more yellow tongue coating in severe patients(P=0.001).Critical patients(P=0.012)accounted for a higher proportion;compared with ordinary and severe patients.Dry tongue coating was more common in critical patients(all P<0.001).Conclusion Patients with COVID-19 may have red tongue,dark red tongue,cracked tongue,yellow coating,dry coating,and thick coating.As the condition is more serious,the epidemic pathogen may have the manifestations of heat and dryness transformation,and at the same time hurt the qi and yin.