重型和危重型新型冠状病毒肺炎患者中医体质与证候类型及临床特征相关性分析

Analysis of the Correlation between TCM Constitution and Syndrome Types and Clinical Characteristics in Severe and Critical Type Corona Virus Disease 2019 Patients

目的分析重型和危重型新型冠状病毒肺炎患者中医体质分布、证候类型以及临床特点,为疾病的总体辨证论治提供依据。方法选择108例重型和危重型新型冠状病毒肺炎患者为研究对象,根据《中医体质量表与判定》判别患者9种体质类型,计算患者体质转化分数,从而辨识体质;通过四诊资料判断中医证型;比较不同体质白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LY)、嗜酸性粒细胞计数(EC)、C反应蛋白(CRP)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、血尿素氮(BUN)、乳酸脱氢酶(LDH)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-Dimer)等指标差异。结果重型和危重型患者偏颇体质以痰湿质(22.2%)、平和质(18.5%)、湿热质(17.5%)、气虚质(14.8%)为主,男性患者偏颇体质以痰湿质(16.7%)为主,女性以气虚质(8.3%)为主。不同性别间体质差异有统计学意义(P<0.05),痰湿质、湿热质患者嗜酸性粒细胞水平低于平和质(P<0.05),痰湿质患者D-二聚体水平高于平和质(P<0.05)。重型患者中医证型以湿热壅肺证(25.92%)和疫毒闭肺证(58.33%)为主,疾病发展至危重期常出现内闭外脱证(10.19%)和阴竭阳脱证(5.56%)。结论重型和危重型新型冠状病毒肺炎患者中医体质以痰湿质、平和质、湿热质、气虚质为主;疫毒闭肺证、湿热壅肺证、内闭外脱证、阴竭阳脱证为常见证型。

Objective To analyze the distribution of Chinese medicine(CM)constitutions,syndrome types,and clinical characteristics of patients with corona virus disease 2019(COVID-19),it provides the basis for the overall syndrome differentiation and treatment of the disease. Methods 108 patients with severe and critical type COVID-19 were selected as subjects,according to Chinese Medicine Constitution Scale and Judgment,nine constitution types of patients were identified. The constitution transformation score of the patients was calculated. According to the four diagnostic datas,the TCM syndrome types were judged. The differences of leukocyte count,white blood cell(WBC),neutrophil(NEUT),lymphocyte(LY),eosnophils(EC),C-reactive protein(CRP),procalcitonin(PCT),aminotransferase(ALT),blood urea nitrogen(BUN),lactate dehydrogenase(LDH),prothrombin time(PT),activated partial thrombin activity time(APTT),D-dimer and other indicators were compared. Results The biased constitutions of severe and critical patients were dominated by phlegm-dampness(22.2%),gentleness(18.5%),dampness-heat(17.5%)and Qi deficiency(14.8%). Male patients were dominated by phlegm-dampness(16.7%),while that of female patients was dominated by Qi deficiency(8.3%). There were statistically significant differences in constitution between different genders(P<0.05). The level of eosinophils in patients with phlegm-dampness type and dampness-heat type was lower than that of gentleness type(P<0.05),and the level of D-dimer in patients with phlegm-dampness type was higher than that of gentleness type(P<0.05). The TCM syndromes of severe patients were dominated by dampness-heat obstructing lung syndrome(25.92%)and epidemic virus closing lung syndrome(58.33%). When the disease developed to critical stage,the syndrome of inner closing and outer detachment(10.19%)and Yin and Yang detachment(5.56%)were often found. Conclusion TCM constitutions of severe and critical COVID-19 patients were dominated by phlegm-dampness,gentleness,dampness-heat and Qi deficiency. The syndromes of epidemic virus closing lung,dampness-heat obstructing lung,internal closing and external detachment,and Yin exhausting Yang detachment are the common witness types.