新型冠状病毒肺炎普通型患者舌象特征与实验室指标的关系

Correlation between Tongue Manifestations and Laboratory Indicators in Moderate Cases of Coronavirus Disease 2019

目的探讨新型冠状病毒肺炎(简称"新冠肺炎")患者舌象特征与实验室指标的关系。方法收集2020年2月14日至2月28日在华中科技大学同济医学院附属协和医院肿瘤中心住院的76例临床确诊新冠肺炎普通型患者的舌象资料和实验室指标。舌象主要包括舌色、舌形、苔色、苔质。舌色分为淡红舌、淡白舌、红舌、绛舌、青紫舌;舌形根据舌体形态分为正常舌、胖大舌(包括齿痕舌)、瘦薄舌,根据是否存在裂纹分为无裂纹舌、裂纹舌;苔质根据厚薄程度分为薄苔、厚苔,根据润燥程度分为润苔、燥苔;苔色分为白苔、黄苔、灰苔、黑苔。实验室指标包括血常规、C反应蛋白(CRP)、血浆纤维蛋白原(FIB)、D-二聚体(DD)、白细胞介素2(IL-2)、白细胞介素4(IL-4)、白细胞介素6(IL-6)、白细胞介素10(IL-10)、肿瘤坏死因子(TNF)、γ干扰素(IFN-γ)、总胆红素(TBiL)、直接胆红素(DBiL)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、肌酐(Cr)、尿素氮(BUN)、乳酸脱氢酶(LDH)。分析不同舌象与实验室指标的关系。结果纳入的76例新冠肺炎普通型患者中淡红舌38例,红舌38例;正常舌38例,胖大舌26例,瘦薄舌12例;无裂纹舌54例,裂纹舌22例;薄苔42例,厚苔34例;润苔45例,燥苔31例;白苔39例,黄苔37例。燥苔患者年龄比润苔患者升高(P=0.049)。红舌、裂纹舌、厚苔、燥苔、黄苔患者CRP分别较淡红舌、无裂纹舌、薄苔、润苔、白苔患者升高(P<0.05或P<0.01)。不同舌体形态患者IL-6水平存在差异(P=0.029),其中瘦薄舌患者IL-6较胖大舌患者升高明显(P=0.009)。红舌患者IL-10低于淡红舌患者,厚苔患者IL-10、IL-2、IL-4、IFN-γ低于薄苔患者,燥苔患者IL-10低于润苔患者,黄苔患者IL-10、IFN-γ低于白苔患者(P<0.05或P<0.01)。裂纹舌患者DD、Cr、LDH高于无裂纹舌患者(P<0.05或P<0.01)。结论不同舌象特征新冠肺炎普通型患者实验室指标存在差异,红舌、厚苔、燥苔、黄苔患者CRP升高,而IL-10下降,瘦薄舌患者IL-6升高,裂纹舌患者心肾功能损害更为严重。

Objective To explore the correlation between tongue manifestations and laboratory indicators in moderate cases of coronavirus disease 2019(COVID-19).Methods The tongue manifestations and laboratory indicators of 76 patients confirmed as moderate type of COVID-19 who were hospitalized in the cancer center of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 14th to February 28th,2020 were collected.Tongue manifestations included tongue color and shape,tongue coating color and texture.Tongue color was divided into light red,light white,red,crimson and cyan purple;tongue shape included normal,enlarged(including teeth-marked tongue)and thin shape,and could be divided into non-cracked and cracked shape according to whether there was crack of tongue;regarding the coating texture,there was thin or thick,and moist or dry coating according to the thickness and mositure degree of the texture;the coating color was divided into white,yellow,gray and black.The laboratory indicators included blood routine examination,C-reactive protein(CRP),plasma fibrinogen(FIB),D-dimer(DD),interleukin 2(IL-2),interleukin 4(IL-4),interleukin 6(IL-6),interleukin 10(IL-10),tumor necrosis factor(TNF),interferon-γ(IFN-γ),total bilirubin(TBiL),direct bilirubin(DBiL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),creatinine(Cr),urea nitrogen(BUN),and lactate dehydrogenase(LDH).The correlation between tongue manifestations and laboratory indicators was analyzed.Results Among the 76 patients with moderate type of COVID-19,38 cases had light red tongue and 38 cases had red tongue;there were 38 cases of normal-shaped tongue,26 cases of enlarged tongue and 12 cases of thin tongue;the number of non-cracked and cracked tongue was 54 and 22,respectively;there were 42 cases of thin coating and 34 cases of thick coating,as well as 45 cases of moist coating and 31 cases of dry coating.White coating was found in 39 cases and yellow coating in 37 cases.The age of the dry coating group was higher than that of the moist coating group(P=0.049).The CRP level was significantly higher in red tongue group than in light red group,in cracked tongue group than in non-cracked tongue group,in thick coating group than in thin coating group,in dry coating group than in moist coating group,as well as in yellow coating group than in white coating group(P<0.05 or P<0.01).There were significant differences in the IL-6 level between different tongue shapes(P=0.029),and patients with thin tongue had higher level of IL-6 than those with enlarged tongue(P=0.009).Significantly lower level of IL-10 was found in patients with red tongue than those with light red tongue;the IL-10,IL-2,IL-4,and IFN-γlevels of the thick coating group were lower than those of the thin coating group;the patients with dry coating had decreased level of IL-10 than those with moist coating,and the IL-10 and IFN-γlevels were lower in the yellow coating patients compared to white coating patients(P<0.05 or P<0.01).The DD,Cr and LDH levels were significantly higher in the cracked tongue patients than the non-cracked tongue patients(P<0.05 or P<0.01).Conclusion The laboratory indicators varied among different tongue manifestations in patients with moderate type of COVID-19.The CRP level increases in patients with red tongue,thick,dry and yellow coating,while the IL-10 level decreases;increased IL-6 level is correlated with thin tongue,and the damage of cardiac and renal function is more severe in patients with cracked tongue.