626例上海地区新型冠状病毒感染轻症患者发病初期中医证素分析

Analysis on the features of TCM syndrome element in 626 mild cases at the early stage with COVID-19 in Shanghai

目的 探讨新型冠状病毒肺炎(新冠肺炎)发病初期的中医证素特征。方法 纳入新冠肺炎奥密克戎变异株感染轻症患者626例,采集起病四诊信息,运用证素辨证学统计积分,归纳证素证型。结果 本研究共收集新冠肺炎轻症患者中医症状46项,频率排名前三的症状为喉痒、咳嗽、发热。最常见的舌脉为舌淡红、苔薄白、脉浮。15种证素中,病位频率前三位分别为表、肺、脾;实性病性证素频率前三位为风、热、痰;虚性病性证素频率前三位为气虚、阳虚、阴虚。青年组、壮年组、老年组在证素频率分布方面,风具有统计学差异(P<0.05),且青年组频率高于老年组(P<0.05);热具有统计学差异(P<0.05),且青年组与壮年组频率均高于老年组(P<0.05);湿具有统计学差异(P<0.05),且壮年组与老年组频率均高于青年组(P<0.05);痰具有统计学差异(P<0.05),且青年组频率低于老年组(P<0.05);气虚具有明显统计学差异(P<0.01),且青年组频率明显低于老年组(P<0.01),壮年组频率低于老年组(P<0.05);阳虚具有明显统计学差异(P<0.01),且青年组频率明显低于老年组(P<0.01);血虚具有统计学差异(P<0.05),仅有老年组存在病例。根据证素共归纳出14项实证证型, 7项虚证证型。频率排名前三的实证证型为肺气失宣(127例, 20.29%)、风热犯表(94例, 15.02%)、风袭表疏(59例, 9.42%)。频率排名前三的虚证证型为肺气虚(11例, 1.76%)、脾肺气虚(8例, 1.28%)、肺阴虚(5例, 0.80%)。结论 新冠肺炎奥密克戎变异株感染轻症患者初期病位在肺,以风为主,兼热较多;青年偏风热,壮年偏湿热,老年偏痰湿、虚损,易传变。

Objective To explore the characteristics of TCM syndrome elements in the early stage of COVID-19.Methods A total of 626 cases with Omicron variant of SARS-CoV-2 at the early stage were collected,TCM four-diagnosis information were sorted out.The syndrome element integral were calculated.The features of TCM syndromes and syndrome elements were summarized.Results In this study,46 TCM symptoms of mild COVID-19 patients were collected,and the top three symptoms with the highest frequency were laryngeal itching,cough and fever.The most common tongue and pulse were light red tongue,thin white fur,and floating pulse.Among the 15 syndromes,the top three frequencies of disease sites were surface,lung and spleen.The top three excess syndromes were wind,heat and phlegm.The top three syndromes of deficiency were qi deficiency,Yang deficiency and Yin deficiency.The frequency distribution of syndrome elements in youth group,middle-aged group and elderly group had statistical difference(P<0.05),and the frequency in youth group was higher than that in elderly group(P<0.05).There was statistical difference in fever frequency(P<0.05),and the frequency of fever in youth group and middle-aged group was higher than that in elderly group(P<0.05).There was statistical difference(P<0.05)in dampness,and the frequency of dampness in the middle-aged and elderly group was higher than that in the youth group(P<0.05).The frequency of sputum of the youth group was lower than that of the elderly group(P<0.05).There was statistical difference in Qi-deficiency(P<0.01),and the frequency of Qi-deficiency in youth group was significantly lower than that of elderly group(P<0.01),and the middle-aged group was lower than the elderly group(P<0.05).There was statistical difference in Yang deficiency(P<0.01),and the frequency of Yang deficiency in youth group was significantly lower than that of elderly group(P<0.01).There was statistical difference in blood deficiency(P<0.05),with cases present only in the elderly group.According to the syndrome elements,a total of 14 excess syndromes and 7 deficiency syndromes were summarized.The top three excess syndromes were lung Qi impairment(127 cases,20.29%),wind-heat attack(94 cases,15.02%),and wind-attack surface loss(59 cases,9.42%).The top three deficiency syndromes were lung qi deficiency(11 cases,1.76%),spleen lung qi deficiency(8 cases,1.28%)and lung Yin deficiency(5 cases,0.80%).Conclusion The initial diseased site of patients with mild infection of Omicron variant of SARS-CoV-2 is mainly in the lung,mainly wind,and more heat;youth patients tend to be wind-heat,middle-aged patients tended to be damp and hot,and the elderly patients are prone to phlegm dampness,asthenic disease,and are prone to transmission.