新型冠状病毒肺炎寒湿郁肺证临床研究分析  

Analysis of Clinical Study on COVID-19 of Cold Dampness Accumulating in the Lung Pattern

作　　者：孙鲁艳[1,2] 袁成民 程永香[2] 马艳 杨铂 吴谙诏[2] 刘倩[2] SUN Luyan;YUAN Chengmin;CHENG Yongxiang;MA Yan;YANG Bo;WU Anzhao;LIU Qian(Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Jinan Infectious Diseases Hospital,Jinan 250021,China)

机构地区：[1]山东中医药大学,山东济南250355 [2]济南市传染病医院,山东济南250021

出　　处：《山东中医杂志》2020年第11期1147-1152,共6页Shandong Journal of Traditional Chinese Medicine

基　　金：济南市新冠肺炎防控应急科技攻关计划项目(编号:202001006)。

摘　　要：目的:观察中西医结合治疗寒湿郁肺证新型冠状病毒肺炎(新冠肺炎)的临床疗效。方法:收集2020年1月24日至2020年2月26日在济南市传染病医院就诊的27例新冠肺炎寒湿郁肺证患者资料,对其流行病学特征、临床症状、舌象特征、胸部CT、既往史等进行描述分析,观察化验指标(淋巴细胞计数、CD4+值、红细胞沉降率、铁蛋白、C反应蛋白、谷草转氨酶、谷丙转氨酶)及中医证候积分在入院、入院第7天、入院第14天时的变化。结果:27例患者中男12例,女15例,平均年龄(41.07±11.35)岁,以咳嗽21例(77.78%)、发热19例(70.37%)、乏力19例(70.37%)为主要症状,多见舌淡红,苔白厚腻,住院期间淋巴细胞计数、CD4+数值及中医证候积分均逐渐改善,差异具有统计学意义(P<0.05),铁蛋白在住院第7天时曾出现一过性升高,后逐渐改善,且差异具有统计学意义(P<0.01),红细胞沉降率逐渐下降,但显效在第2周,差异有统计学意义(P<0.01),C反应蛋白在三个时间节点上无统计学差异(P>0.05),谷丙转氨酶、谷草转氨酶呈现升高趋势,差异具有统计学意义(P<0.01),考虑与应用洛匹那韦/利托那韦有关。轻型及普通型无一例转化为重型、危重型,所有患者均已好转。结论:本病寒湿证较多见,在西医治疗基础上加用藿朴夏苓汤合桂枝汤加减方宣肺健脾,和胃化湿,开畅三焦气机,调和营卫,在改善患者病情及预后方面疗效可靠,推测疗效可能与调节患者免疫、增加细胞免疫功能有关。Objective:To observe the clinical effect of the combination of traditional Chinese medicine(TCM)and western medicine in the treatment of COVID-19 of cold dampness accumulating in the lung pattern.Methods:The data of 27 patients with COVID-19 of cold dampness accumulating in the lung pattern from January 24,2020 to February 26,2020 hospitalized in the Jinan Infectious Diseases Hospital were collected.Descriptive analysis of its epidemiological characteristics,clinical symptoms,tongue features,chest computed tomography(CT)scan,past medical history were conducted,and laboratory examination(lymphocyte count,CD4^+-cell count,erythrocyte sedimentation rate(ESR),ferritin,C-reactive protein(CRP),aspartate aminotransferase,alanine aminortransferase were performed and TCM syndrome scores on the day of admission,7 and 14 days after admission were recorded and compared.Results:Among the 27 patients,12 cases were male with the average age of(41.07±11.35)years and 15 cases were female with the average age of(41.07±11.35)years.The major symptoms were cough with 21 cases(77.78%),fever with 19 cases(70.37%),and feeling of fatigue with 19 cases(70.37%).The tongue usually was red,the tongue coating was white thick and greasy.During the hospitalization,the lymphocyte count,CD4+-cell count and TCM syndrome scores gradually improved,with statistical difference(P<0.05).Ferritin had a transient rise on the 7th day of hospitalization and then gradually decreased with statistical difference(P<0.01).ESR gradually decreased and the change was obvious in the second week with significant difference(P<0.01).There was no statistical difference on CRP among the three time points(P>0.05).Alanine aminotransferase and aspartate aminotransferase showed an increasing trend with statistically difference(P>0.05),which might be caused by the application of lopinavir/ritonavir.None of the mild and normal types become severe and critical,and the condition in all patients had improved.Conclusions:The cold dampness accumulating in the lung pattern was com

关 键 词：新型冠状病毒肺炎 寒湿证 临床特点 病机 方药 

分 类 号：R256.1[医药卫生—中医内科学]