新型冠状病毒肺炎240例患者中医药治疗用药特点分析

Analysis of Traditional Chinese Medicine prescriptions in 240 cases of COVID-19

目的分析上海地区新型冠状病毒肺炎(新冠肺炎)各分型中药处方用药特点。方法回顾性连续纳入2020年1月20日至4月20日复旦大学附属上海市公共卫生临床中心收治的240例新冠肺炎确诊患者,分析其入院的首次中药处方信息。240例患者中,轻型19例,普通型199例,重型16例,危重型6例。采用中医传承辅助平台(V2.5)分析新冠肺炎患者中药处方中药物的使用频率、性味归经、组合规律及核心组合。结果240张中药处方共涉及194味中药。各型新冠肺炎处方中,四气均以“寒”为主,轻型、普通型、重型、危重型使用频率分别为46.02%(104/226)、46.31%(1230/2656)、37.06%(146/394)、39.24%(31/79);其五味以“苦”味为主,轻型、普通型、重型、危重型使用频率分别为36.53%(122/332)、37.33%(1445/3857)、35.96%(205/564)、33.62%(39/113);各分型处方“苦”“寒”中药以黄芩使用频率最高。所用药物涉及归经主要为肺、胃、脾经为主。轻型及普通型药物组合出现频率最高的2组中药为均为“黄芩、甘草”“陈皮、甘草”。轻型患者处方共197个药物组合模式,125条中药关联规则,涉及13味中药;普通型共92个药物组合模式,38条中药关联规则,涉及19味中药;重型处方共62个药物组合模式,46条中药关联规则,涉及17味中药;危重型处方共80个药物组合模式,10条中药关联规则,包含涉及12味中药。结论各型新冠肺炎用药以“苦”“寒”为主,可从用药角度进一步验证上海地区新型冠状病毒肺炎以“湿热”病邪为主。新冠肺炎各分型中药配伍思路有所不同。结合中医理论及方剂,将分型用药关联规则进行分析,可对临床医师学习新冠肺炎中医分型用药提供借鉴。

Objective To analyze Traditional Chinese Medicine(TCM)prescriptions in COVID-19 patients in Shanghai area.Methods Two hundred and forty patients were enrolled in the study,including 19 mild cases,199 moderate cases,16 severe case and 6 critical cases.The COVID-19 formula in Shanghai area was extracted and input in TCM Inheritance platform.Data association method such as software association rules,improved mutual information method,complex system entropy clustering,unsupervised entropy hierarchical clustering were used to analyze the frequency,herb flavor and meridian,combination rule and core combination of different types of Chinese herbs in the treatment of COVID-19 in Shanghai area.Results According to the frequency analysis of 240 prescriptions of Chinese medicine,194 herbs were found.The COVID-19 formula herbs were all"cold",the frequency of use in mild,moderate,severe and critical cases was[46.02%(104/226),46.31%(1230/2656),37.06%(146/394),39.24%(31/79)].The flavor was mainly"bitter"and the frequency of use in 4 types of disease were[36.53%(122/332),37.33%(1445/3857),35.96%(205/564),33.62%(39/113)].Scutellaria was the most frequently used TCM of"bitter and cold".The drugs used were mainly lung,stomach and spleen meridians.By comparing the formulas between mild and moderate cases,herb combinations with the highest frequency were all"scutellaria glycyrrhiza"and"tangerine glycyrrhiza".The formulas for 19 mild cases were collected,and 197 drug combinations were counted,and 125 Chinese medicine association rules,including 13 Chinese herbs.The formulas were extracted in 199 moderate cases of COVID-19,a total of 92 drug combinations and 38 Chinese medicine association rules were collected,including 19 Chinese herbs.In 16 severe cases,a total of 62 drug combination models and 46 Chinese medicine association rules were collected,including 17 Chinese herbs.For the 6 critical cases,80 Chinese medicine prescriptions were combined,and 10 Chinese medicine association rules,including 12 Chinese herbs.Conclusions The herbal prescriptions of COVID-19 in Shanghai are characterized by clearing away heat and resolving dampness.By analyzing prescription rules with complex system entropy clustering,association compatibility ideas of different types of traditional Chinese medicine are found to be different among four types of COVID-19 cases.Analyzing the connection rules in formulas,by using the theory of TCM and pharmacology of traditional Chinese medical formula in different COVID-19 patients may be helpful for general practitioners.