慢性肾脏病患者新型冠状病毒奥密克戎变异株感染后中医证候特征调查研究

Investigation on traditional Chinese medicine syndrome characteristics in patients with chronic kidney disease and infected with Omicron variant of COVID-19

目的分析慢性肾脏病患者新型冠状病毒奥密克戎变异株感染后的中医证候特征。方法收集上海中医药大学附属曙光医院诊治的合并慢性肾脏病的新型冠状病毒奥密克戎变异株感染者的相关资料,包括性别、年龄、基础疾病、慢性肾脏病分期等基本资料,咳嗽、发热、乏力、纳差、咽痛、口干、口苦、便溏、便秘等中医症状信息,以及舌象、脉象资料,分析此类患者的中医证候特征。通过病历系统查看患者的肺部CT图像资料,综合判断西医分型,进一步分析不同西医分型患者的中医辨证情况。结果①共筛查住院的新型冠状病毒奥密克戎感染者367例,纳入合并慢性肾脏病的53例患者进行研究。53例患者中,慢性肾脏病分期多为G3a、G2、G1和G5期,年龄>80岁者居多,女性多于男性,最常见的基础疾病为高血压病。②临床常见的中医症状为咳嗽、纳差、乏力、口苦和发热,分别占62.3%、47.2%、45.3%、37.7%和34.0%。③在舌象方面,60.4%的患者舌体胖大,62.3%舌色为红色,43.4%舌苔为薄苔、66.0%舌苔为黄苔;在脉象方面,56.6%的患者出现滑脉,52.8%出现细脉。④53例患者中,轻型21例、普通型29例、重型2例、危重型1例。⑤轻型、普通型患者最常见的中医证型分别为湿热蕴肺证和湿毒郁肺证,占比分别为34.0%和32.1%;重型患者气营两燔证、疫毒闭肺证各1例,占比均为1.9%;危重型患者符合中医内闭外脱证的辨证标准,占比为1.9%。结论本研究中合并慢性肾脏病的新型冠状病毒奥密克戎变异株感染者以老年患者居多,基础疾病较重,临床表现虽以呼吸系统为主,但同时伴有全身症状;轻型患者以湿热蕴肺证为主,普通型患者以湿毒郁肺证为主,重型患者可辨为疫毒闭肺证和气营两燔证,危重型患者可辨为内闭外脱证。

Objective To analyze the traditional Chinese medicine(TCM)syndrome characteristics in Omicron variant infected patients with chronic kidney disease(CKD)in Shanghai.Methods Cases of Omicron variant infected CKD patients who were hospitalized in Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine were included.The baseline data such as gender,age,underlying diseases and CKD stages,and TCM symptom information such as cough,fever,fatigue,anorexia,sore throat,dry mouth,bitter taste,loose stool and constipation,as well as tongue and pulse condition were collected to analyze TCM syndrome characteristics.The patients’lung CT images were reviewed through the medical record system to determine the severity of COVID-19 from the perspective of western medicine and the TCM syndrome differentiation was further conducted in patients with different severity of COVID-19.Results①A total of 367 hospitalized cases with Omicron infection were screened,and 53 cases with CKD were included for research.Among 53 cases,patients were classified as CKD stage G3a,G2,G1 or G5,and most of them were the elderly over 80 years old.There were more female patients than male ones,and one of the most common underlying diseases was hypertension.②The common clinical symptoms were cough(62.3%),anorexia(47.2%),fatigue(45.3%),bitter taste(37.7%)and fever(34.0%).③In terms of tongue condition,60.4%of the patients had fat tongue body,62.3%had red tongue color,43.4%had thin tongue coating and 66.0%had yellow tongue coating;In terms of pulse condition,56.6%of the patients had slippery pulse and 52.8%had fine pulse.④Among 53 patients,there were 21 mild cases,29 moderate cases,2 severe cases and 1 critical case.⑤The most common TCM syndromes of mild and moderate cases were damp-heat accumulating in the lungs syndrome(34.0%)and damp-toxin stagnating in the lungs syndrome(32.1%);There was one severe case identified as flaring heat in qifen and yingfen syndrome(1.9%)and the other as pestilential toxicity blocking the lungs syndrome(1.9%);The critical case met the syndrome differentiation criteria of inner blocking causing collapse syndrome(1.9%).Conclusions In our research,the majority of patients with COVID-19 Omicron variant infection combined with chronic kidney disease are the elderly with severe underlying diseases,and their clinical manifestations are mainly respiratory,together with systemic symptoms.Mild cases mainly have damp-heat accumulating in the lungs syndrome,moderate cases mainly have damp-toxin stagnating in the lungs syndrome,severe cases can be identified as pestilential toxicity blocking the lungs syndrome and flaring heat in qifen and yingfen syndrome,and critical cases can be identified as inner blocking causing collapse syndrome.