上海地区新型冠状病毒奥密克戎变异株感染轻症患者中医证候特征研究

Characteristics of Traditional Chinese Medicine Syndromes in Mild COVID-19 Cases of Omicron Variant in Shanghai

目的分析上海地区新型冠状病毒奥密克戎变异株感染轻症患者的中医证候特征。方法纳入2022年4月6日至5月6日在上海市城市足迹馆方舱医院和长宁区绥宁路方舱医院收治的新型冠状病毒肺炎(新冠肺炎)奥密克戎变异株感染轻症患者2739例,应用问卷星二维码进行调查,收集资料条目包括基本资料、合并基础疾病、临床症状、舌象、脉象。将资料汇总建立信息数据库,选取其中频率>2%的症状采用主成分分析法提取因子,通过因子分析提取公因子,综合各公因子的病位、病性、病邪证候要素情况,归纳为若干个中医证型,总结新冠肺炎奥密克戎变异株感染轻症患者中医证候特征。结果2739例患者排名前三位的症状分别是咳嗽(1990例,72.65%)、咽痛(899例,32.82%)、鼻塞(732例,26.72%);共收集到脉象信息者2074例,其中排名前三位的脉象分别是细脉(733例,35.34%)、沉脉(347例,16.73%)、浮脉(320例,15.43%);共收集到舌色及舌苔信息者246例,其中前三位的舌色分别是舌淡红(164例,66.67%)、舌红(33例,13.41%)、舌尖红(28例,11.38%),前三位的舌苔分别是薄白苔(98例,39.84%)、薄黄苔(76例,30.89%)、黄腻苔(52例,21.14%)。以各个症状变量作为因子,提取初始特征值大于1的因子共5个,累积贡献率达到53.8%;归纳为5个中医证型,风热犯肺占44.80%,脾肺气虚占24.42%,湿热蕴肺占12.63%,风热兼气虚占11.14%,湿热兼气虚占7.01%。选取排名前三位的合并基础疾病进行不同中医证候观察,结果显示,合并高血压病、糖尿病、冠心病患者5个证型分布差异有统计学意义(P<0.01)。结论上海地区新冠肺炎奥密克戎变异株感染轻症患者病位在肺、脾,病因为风热、湿热兼有气虚,中医证型以风热犯肺、脾肺气虚为主。

Objective To analyze the characteristics of traditional Chinese medicine(TCM)syndromes in mild coronavirus disease 2019(COVID-19)cases with Omikron variant in Shanghai.Methods Wenjuanxing was used to collect data of 2739 mild COVID-19 cases with Omikron variant in the Pavilion of Footprint cabin hospital and Changning District Suining cabin Hospital from April 6 th to May 6 th,2022.The collected data included basic information,underlying diseases,clinical symptoms,tongue manifestations and pulse manifestations,on which an information database was established.Symptoms with a frequency greater than 2%were selected as factors using principal component analysis,and the common factors were obtained through factor analysis.The elements related to the disease location,disease nature and pathogenic syndromes of the common factors were summarized into multiple TCM syndromes,so as to obtain the characteristics of TCM syndromes in mild COVID-19 cases of Omikron variant.Results The top three symptoms of 2739 patients were cough(1990 cases,72.65%),sore throat(899 cases,32.82%),and nasal congestion(732 cases,26.72%).The three most common tongue manifestations among 2074 patients were thready pulse(733 cases,35.34%),deep pulse(347 cases,16.73%),and floating pulse(320 cases,15.42%).Regarding the tongue manifestations of 246 patients,light red tongue(164 cases,66.67%),red tongue(33 cases,13.41%),and red tongue tip(28 cases,11.38%)were the most frequent tongue color,and thin white coating(98 cases,11.38%),thin yellow coating(76 cases,30.89%),and yellow greasy coating(52 cases,21.14%)were the most common tongue coating.Taking each symptom as a factor,a total of five factors with an initial eigenvalue greater than 1 were obtained,whose cumulative contribution rate reached 53.8%and can be summarized into five TCM syndrome types,including wind-heat attacking the lung(44.80%),spleen-lung qi deficiency(24.42%),damp-heat accumulating in the lung(12.63%),concurrent wind-heat and qi deficiency(11.14%),and concurrent damp-heat and qi deficiency(7.01%).The top three underlying diseases were hypertension,diabetes,and coronary heart disease,whose TCM syndromes were significantly different(P<0.01).Conclusion The disease location is at lung and spleen for mild COVID-19 cases with Omicron variant in Shanghai.The pathogenesis is wind-heat,damp-heat and qi deficiency,and the main TCM syndrome types are wind-heat attacking the lung syndrome,and spleen-lung qi deficiency syndromes.