武汉方舱医院新型冠状病毒感染者临床特征及中医证型的随访研究

Follow-up study on clinical characteristics and traditional Chinese medicine syndrome types of patients infected with novel coronavirus in Wuhan Fangcang Hospital

目的分析武汉方舱医院新型冠状病毒感染患者群的临床特征及中医证型,记录转归情况。方法纳入2020年2月7日-3月7日武汉东西湖方舱医院990例新冠肺炎患者,收集相关临床资料,进行为期1年非干预性在线问卷随访,观察转归情况。结果共纳入990例病例,其中轻型277例(27.98%)、普通型713例(72.02%);临床表现以发热畏寒(69.39%)、鼻塞流涕(63.03%)、咽痒咽痛(58.08%)、干咳(74.44%)、乏力(71.31%)为主;中医证型分布情况,轻型以寒湿郁肺证(75.09%)、湿热蕴肺证(24.91%)为主,普通型以湿毒郁肺证(53.58%)、寒湿阻肺证(34.64%)、疫毒夹燥证(11.78%)为主;转归情况,49.19%患者达到方舱出院标准,50.81%患者未达到出院标准转至定点医院治疗。仅有328例(33.13%)完成了为期1年的随访,各证型在门诊复诊、抽血检查、CT检查方面比例不同,差异均有统计学意义(χ^(2)=10.776、87.820、241.247,P均<0.05)。各证型患者再次住院、核酸复阳方面比例不同,但差异均无统计学意义(χ^(2)=8.325、8.325,P均>0.05)。结论不同证型的新冠患者转归及预后不同,武汉时期方舱医院患者群以寒湿郁肺证、湿毒郁肺证为主,这两种证型较其他证型病情容易反复。

Objective To analyze the clinical characteristics and prognosis of patients with novel coronavirus disease 2019(COVID-19) in the Wuhan Fangcang Hospital and the correlation with traditional Chinese medicine(TCM) syndrome types.Methods A total of 990 cases of COVID-19 patients admitted to the Wuhan Fangcang Hospital in 2020 were included.Relevant clinical data was collected, and a non-interventional online questionnaire follow-up was conducted for one year to observe the outcomes. Results A total of 990 cases were included, of which 277 cases(27.98%) were mild and 713 cases(72.02%) were common. The main clinical manifestations were fever and chills(69.39%), nasal congestion and rhinorrhea(63.03%), itchy and sore throat(58.08%), dry cough(74.44%), and fatigue(71.31%). The distribution of main TCM patterns in the mild type was obstruction of cold-dampness in the lung pattern(75.09%) and dampness-heat accumulated in the lung pattern(24.91%);in the common type,it was stagnation of toxic dampness in the lung pattern(53.58%),colddampness obstructing the lung pattern(34.64%),and pestilent toxic substances with dryness pattern(11.78%). Among them, 49.19% of patients met the discharge criteria and were discharged from the Fangcang Hospital, while 50.81% of patients did not meet the discharge criteria and were transferred to designated hospitals for further treatment. Only 328 cases(33.13%) completed the one-year follow-up. There were differences among different TCM patterns in terms of outpatient follow-up visits, blood tests, CT scans(χ^(2)=10.776, 87.820, 241.247;all P<0.05), but there were no significant differences in the proportion of rehospitalization, nucleic acid re-positivity among different TCM patterns (χ^(2)=8.325,8.325;all P>0.05). Conclusions Patients with different TCM patterns had different outcomes and prognoses. During the Wuhan period, the patients in the Fangcang Hospital were mainly characterized by obstruction of cold-dampness in the lung pattern and stagnation of toxic dampness in the lung pattern, and the two patterns were more prone to disease recurrence.