605例湖北地区重型、危重型新型冠状病毒肺炎患者的临床特点、药物治疗与预后的多中心回顾性队列研究  

Clinical Characteristics,Drug Treatments and Prognoses in605 Patients with Severe and Critical Corona Virus Disease2019 in Hubei,China:A Multi-Center,Retrospective,Cohort Study

作　　者：秦泠曦 吕文亮 杨旻[2,3] 肖勇[2,4] 李昊 孙勤国[6] 魏力 何东初[8] 李绪贵 曾勇 费新应 黄超群 曾江琴 向阳[1,2] 徐晓惠[1,2] 张思依 王仁礼[1,2] QIN Lingxi;LYU Wenliang;YANG Min;XIAO Yong;LI Hao;SUN Qinguo;WEI Li;HE Dongchu;LI Xugui;ZENG Yong;FEI Xinying;HUANG Chaoqun;ZENG Jiangqin;XIANG Yang;XU Xiaohui;ZHANG Siyi;WANG Renli(Clinical College of Traditional Chinese Medicine,Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China;Institute of Epidemic Rescarch,Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China;Basic Melical College Sehool of I.aboratoryMedicine,Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China;College of Information Engineering,Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China;The First Clinical College,Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China;Wuhan Third Hospital,Wuhan 430060,Hubei,China;Wuhan Integrated Traditional Chinese and Westerm Medicine Hospital,Wuhan 430022,Hubei,China;General Hospital of Central Theater of Chinese People's Liberation Army,Wuhan 430070,Hubei,China;Hubei 672 Orthopaedics Hospital of Integrated Chinese&Westerm Medicine,Wuhan 430079,Hubei,China;Huanggang Hospital of Traditional Chinese Medlicine,Huanggang 438000,Hubei,China;Huangshi'Traditional Chinese Medicine Hospital,Huangshi 435000,Hubei,China)

机构地区：[1]湖北中医药大学中医临床学院,湖北武汉430061 [2]湖北中医药大学疫病研究所,湖北武汉430061 [3]湖北中医药大学基础医学院,湖北武汉430061 [4]湖北中医药大学信息工程学院,湖北武汉430061 [5]湖北中医药大学第一临床学院,湖北武汉430061 [6]武汉市第三医院,湖北武汉430060 [7]武汉市中西医结合医院,湖北武汉430022 [8]中国人民解放军中部战区总医院,湖北武汉430070 [9]湖北六七二中西医结合骨科医院,湖北武汉430079 [10]黄冈市中医医院,湖北黄冈438000 [11]黄石市中医医院,湖北黄石435000

出　　处：《中华中医药学刊》2021年第3期89-95,共7页Chinese Archives of Traditional Chinese Medicine

基　　金：国家重点研发计划“公共安全风险防控与应急技术装备”重点专项(2020YFC0845300)。

摘　　要：目的回顾湖北地区重型、危重型新型冠状病毒肺炎患者的临床资料,比较分析不同药物治疗手段的有效性。方法此项多中心、回顾性队列研究,纳入了湖北省武汉市、鄂州市、黄冈市、黄石市共计8家定点医院2020年1月2日-2020年3月14日入院确诊的605例新型冠状病毒肺炎重型、危重型患者,收集患者相关临床数据,进行清洗、审核及统一标准,并比较不同药物治疗组疗效差异。主要结果中西医结合治疗组治愈率(64.4%)与中药组、西药组差异有统计学意义(P<0.01),与西药组比较,患者病死率(5.0%)、不良事件发生率(3.4%)、核酸未转阴人数占比(2.0%)较低,治疗后淋巴细胞绝对值、谷丙转氨酶及谷草转氨酶改善情况较佳(P<0.05)。中药组病死率(0.0%)、不良事件发生率(4.8%)与核酸未转阴人数占比(4.8%)与中西医结合治疗组差异无统计学意义(P>0.05),治愈率(47.6%)低于中西医结合治疗组,核酸转阴天数(M=2.0)较西药组及中西医结合治疗组短,差异有统计学意义(P<0.01)。西药组不良事件发生率(25.0%)与另外两组差异有统计学意义(P<0.01),在各实验室指标改善情况及治疗结局评价指标上未见显著优势(P>0.05)。通过logistic回归校正3组基线水平,以治愈为治疗结局评价指标,校正后中西医结合治疗组较中药、西药组疗效佳。结论中西医结合治疗新型冠状病毒肺炎重型、危重型患者疗效确切,可有效提高治愈率、降低病死率、缩短退热时间,有助于核酸转阴及缩短转阴时间,并对淋巴细胞减少及转氨酶升高起到一定改善作用。Objectives The study was aimed to compare the effectiveness among different drug treatments by retrospectively analyzing the clinical records of patients with severe and critical corona virus disease 2019(COVID-19)in Hubei,China.Methods This multi-center,retrospective,cohort study included 605 cases of patients with severe and critical COVID-19 from 8 designated hospitals in Wuhan,Ezhou,Huanggang and Huangshi of Hubei province.All included patients were admitted and confirmed from January 2,2020 to March 14,2020.After reviewing the patients’relevant data and unifying evaluation indexes of treatment outcomes,we compared the difference of curative effect among Chinese medicine treatment,western medicine treatment and the treatment integrating Chinese and Western medicine.Results The Chinese-Western medicine group had the highest cure rate(64.4%).Compared with the Western medicine group,the fatality rate(5.0%),adverse event rate(3.4%)and the positive-remained rate of RT-PCT test results(2.0%)were lower in the Chinese-Western medicine group,and it had better efficacy in improving lymphocyte count and reducing AST and ALT(P<0.05).There was no significant differences between Chinese medicine group and Chinese-Western medicine group in fatality rate,adverse event rate or positive-remained rate of RT-PCT test results(P>0.05).The cure rate(47.6%)was lower than that of the Chinese-Western medicine group,and it had the shortest time of RT-PCT test results turning to be negative(M=2.0).The Western medicine group had the highest adverse event rate(25.0%)and did not show advantage in improving abnormal laboratory indexes or getting better evaluation indexes(P>0.05).The baseline levels of the three groups were corrected through Logistic regression,and the cure outcome was used as the evaluation index of treatment outcome.After correction,the Chinese-Western medicine group had better efficacy than the other two groups.Conclusion The Chinese-Western medicine group is effective in treating severe and critical cases of COVID-19,a

关 键 词：新型冠状病毒肺炎 临床疗效 中西医结合治疗 回顾性队列研究 

分 类 号：R285.5[医药卫生—中药学]