2022年冬季京冀鲁地区196例新型冠状病毒奥密克戎变异株感染者临床表现及中医证候分析

Clinical manifestations and traditional Chinese medicine pattern analysis of patients infected with SARS⁃CoV⁃2 Omicron variant in Beijing,Hebei,and Shandong in winter 2022

目的归纳总结2022年冬季京冀鲁地区新型冠状病毒(简称“新冠病毒”)奥密克戎变异株感染者临床表现及中医证候。方法对新冠病毒感染阳性成人患者进行“问卷星”在线调查,统计人口学信息、既往病史及临床症状,采用系统聚类法和因子分析法归纳总结中医证候特点。结果共纳入196例有效病例,以中青年为主,医务工作者人数超过40%,既往高频使用药物包括连花清瘟、布洛芬及对乙酰氨基酚。患者发病早期表现为发热、恶寒、头痛及肌肉关节酸痛;发病中期咽痛及痰少质黏难咳出比例增加;发病后期咳嗽、胸闷憋气、便溏症状凸显。因子分析及聚类分析显示,本病病位主要在卫表及肺,与脾有关,病性多为虚实夹杂,主要证候为湿毒夹寒束表、湿热内蕴及脾虚湿困。结论新冠病毒奥密克戎变异株感染者起病病机为湿毒疫邪郁闭卫阳,兼有风寒邪气致病特点,随病情进展可出现热化、燥化及脾虚湿困等转归,但也有部分患者起病即为湿热内蕴之证。

Objective We aimed to summarize the clinical manifestations and traditional Chinese medicine(TCM)patterns of infected patients with SARS⁃CoV⁃2 Omicron variant(hereinafter called“COVID⁃19”)in Beijing,Hebei,and Shandong in the winter of 2022.Methods A questionnaire survey was carried out with the“Questionnaire Star”online service among adult COVID⁃19 patients,and the demographic information,medical history,and clinical symptoms were recorded.The characteristics of TCM patterns were summarized by systematic clustering analysis and factor analysis.Results A total of 196 cases were included.Most of the patients were young or middle⁃aged.More than 40%of the patients were healthcare workers.The most frequently used medicines were Lianhua Qingwen(a traditional Chinese patent medicine and simple preparation),ibuprofen,and acetaminophen.The early symptoms of COVID⁃19 patients were fever,chilliness,headache,and muscle/joint pain.In the middle stage of COVID⁃19,the proportion of sore throat and sputum increased.The incidence of cough,chest tightness,and loose stool increased at the late stage of the disease.Factor analysis and cluster analysis showed that COVID⁃19 was mainly located in the defensive exterior and lung,related to spleen.The nature of the disease was mostly intermingled deficiency and excess.The main patterns were dampness toxin with pathogenic cold on the exterior,internal retention of damp⁃heat,dampness stagnancy due to spleen deficiency.Conclusion The pathogenesis of COVID⁃19 is obstruction of defense yang by dampness⁃toxin pestilence,with exogenous pathogenic wind cold.With disease progression,the dampness toxin pestilence might transform into heat and dryness or into spleen deficiency with dampness stagnancy.However,some patients show the pattern of internal damp⁃heat at the beginning of the disease.