间质性肺疾病合并新型冠状病毒感染中医特征分析  

TCM pattern analysis of interstitial lung disease with COVID-19

作　　者：李雪[1] 王玉光[1] 周继朴[1] 刘萌[1] 刘建[1] 马家驹[1] 郭亚丽[1] LI Xue;WANG Yuguang;ZHOU Jipu;LIU Meng;LIU Jian;MA Jiaju;GUO Yali(Department of Respiratory Medicine,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010)

机构地区：[1]首都医科大学附属北京中医医院呼吸科,北京100010

出　　处：《现代中医临床》2023年第4期21-27,共7页Modern Chinese Clinical Medicine

基　　金：首都卫生发展科研专项项目(No.首发2020-2-2233);高层次公共卫生技术人才建设项目(No.2022-2-016)。

摘　　要：目的分析间质性肺疾病(ILD)合并新型冠状病毒感染(简称“新冠感染”)患者的中医症状、证候分布特点,并探究其病因病机。方法采用横断面调查研究,选取69例2022年12月—2023年1月在我院门诊和病房诊断为新冠感染的ILD患者,收集门诊首诊或入院第一天的中医四诊信息、一般情况及西医临床资料。结果69例患者首发症状以肺卫症状多见,同时兼有脾系症状。69例患者共涉及23种症状。与轻、中型患者相比,重型、危重型患者中喘、胸闷、排便不爽、畏寒、恶风和痰中带血的比例较高(P<0.05);而头痛的比例较低(P<0.05)。69例患者中,舌质共3种,舌苔和脉象分别为6种。与轻型及中型患者相比,重型及危重型患者中燥苔和细脉比例较高(P<0.05)。69例患者中有50例(72.5%)为虚实夹杂证,19例(27.5%)为实证。结合脏腑辨证,证候类型共计12个。与轻型和中型患者相比,重型及危重型患者中肾气虚证、肾阴阳两虚、热入营血证和疫毒闭肺证比例较高(P<0.05),寒湿郁肺证的比例较低(P<0.05)。69例患者总体病位分布主要在肺和脾。与轻型和中型患者相比,重型及危重型患者中病位在肾和营血分的比例较高(P<0.05)。结论新冠感染系感受疫疠之气所致,ILD患者感染新冠病毒可表现为湿毒为胜,病机涉及正虚(肺、脾、肾)和邪实(湿热邪毒)两部分,病程初起病位在肺卫,进展期以肺脾多见,重型和危重型累及肾及营血。Objective To analyze the TCM patterns of interstitial lung disease(ILD)with corona virus disease 2019,and explore its etiology and pathogenesis.Methods A cross-sectional study was conducted,in which 69 ILD patients diagnosed with COVID-19 in our hospital’s outpatient and wards from December 2022 to January 2023 were included.Their four TCM diagnostic information,general conditions and clinical data of western medicine were collected on the first visit or the day of admission.Results Among the 69 patients,the initial manifestation was predominantly lung-wei syndrome,accompanied by spleen syndromes.23 symptoms were recorded from the 69 patients.Compared with the mild and moderate cases,the proportion of dyspnea,chest tightness,incomplete defecation,fear of cold,aversion of wind,blood in sputum,dry coating on the tongue and thready pulse in severe and critical patients was significantly higher(P<0.05);while the proportion of headaches was significantly low(P<0.05).Among the 69 patients,there were 3 types of tongue body,and 6 types of tongue coating and pulse pattern,respectively.Compared with mild and moderate patients,the proportion of dry coating on the tongue and thready pulse was higher in severe and critical patients(P<0.05).Among the 69 patients,50(72.5%)had a mixture of deficiency and excess,while 19(27.5%)had excess patterns.From the perspective of zang-fu organ syndrome differentiation,there were a total of 12 syndrome types.Compared with the mild and moderate patients,the proportion of kidney-qi deficiency,kidney-yin and yang deficiency,heat entering ying-blood and pestilence blocking the lung in severe and critical patients was significantly higher(P<0.05).The proportion of cold-dampness stagnation in the lung was significantly lower(P<0.05).The affected area of the 69 patients is mainly located in the lung and spleen.Compared with the mild and moderate patients,the proportion of affected area in the kidney and ying-blood level is higher in severe and critical patients(P<0.05).Conclusion COVID-19 is cau

关 键 词：间质性肺疾病 新型冠状病毒 症状 证候 病因病机 

分 类 号：R259[医药卫生—中西医结合]