基于潜在类别分析对不同年龄组患者新冠肺炎病因病机证候研究

Research on Traditional Chinese Medicine Etiology, Pathogenesis and Syndrome for Two Age Groups of COVID-19 Cases based on Latent Class Analysis

目的基于潜在类别模型的分析结果,探讨不同年龄组新冠肺炎普通型确认患者的主要病因病机和证候差异。方法对605例普通型新冠肺炎四诊数据按照老龄组和非老龄组采用多样本潜在类别分析,计算两个年龄组各类的类别概率和患者症状的条件概率。根据条件概率提取主要症状和两个年龄组各类别的共同症状和特异症状,进而分析两个年龄组各类患者的病因病机及证候。结果根据模型分析结果,感染新冠肺炎病毒后,老龄群体常见症状为神疲乏力、咳嗽、纳呆、发热、腻苔和咯痰,主要证型为"湿热伤肺、脾肾两虚"(51.6%);非老龄组则以发热、咳嗽、神疲乏力和咯痰为常见,主要证型为"热痰(湿)伤肺,脾虚不运"(40.0%)。结论老龄群体感染新冠肺炎后,首先出现气虚证,病性为气虚、痰湿和热毒,病位在肺、脾、肾。而非老龄群体则以发热为主症,病性以热毒、痰湿为主,伴有气虚,病位在肺、脾。

Objective To explore the differences of traditional Chinese medicine(TCM) etiology,pathogenesis,and syndromes between different age groups of confirmed ordinary COVID-19 cases based on the result of Multiple Samples Latent Class Analysis(MS-LCA).Methods Firstly,605 ordinary COVID-19 cases were divided into two groups,i.e.,cases 60 years and older were included in the aged group and other cases in the non-aged group.An MS-LCA model was established according to the two groups to cluster those cases into different categories.Secondly,26 cardinal symptoms were extracted from the 43 given clinical symptoms based on the conditional probabilities,which were obtained in the MS-LCA result,of symptoms that occurred in each categorical cases within each age group,and the common symptoms of each age group were also extracted based on the conditional probabilities of those 26 symptoms.Finally,the TCM etiology,pathogenesis,and syndrome were analyzed based on each group’s common symptoms and their probabilities.Results The main symptoms in the aged group were fatigue,cough,poor appetite,fever,greasy tongue coat and expectoration,and the main syndrome was damp-heat damaging the lung and deficiency in both spleen and kidney(accounting for 51.6% in this group);the main symptoms in the non-aged group were fever,cough,fatigue and expectoration,and the main syndrome was heat-toxin(dampness) damaging the lung and failure of splenic transportation(40.0% in this group).Conclusion After inflected by the COVID-19 virus,aged people tend to have qi deficiency syndrome,which is caused by qi deficiency,phlegm dampness and heat toxin,located in the lung,spleen and kidney.The non-aged people tend to have fever syndrome,which is caused by heat toxin,phlegm dampness,accompanied with qi deficiency,located in the lung and spleen.