流行性感冒中医证候学特征横断面调查及随访研究

发布时间：2018-07-31 20:47

【摘要】：目的:通过分析相关文献并经过专家论证后制定流感中医证候学调查问卷及统计学软件,收集符合要求的临床病例,分析当前季节流感样及流感中医证候学特征、流感样病例与流感病例之间的可能关系;分析流感中医证型与病毒亚型之间的可能关系;电话随访部分患者以评价发热门诊治疗流感临床效果,为探索中医药有效防治流感奠定基础。方法:2015年10月至2016年3月于中日友好医院发热门诊,收集724份符合标准的病例资料。通过查阅中医与西医流感相关诊疗指南、期刊论著、古籍经典等资料,收集流行性感冒的症状与中医证候信息,设计临床调查表;经相关临床专家、循证医学相关专家进行反复论证后,形成"流行性感冒中医证候学特征调查问卷"并制作电子信息录入软件。该临床研究采用前瞻、开放式,有监督与无监督相结合的观察性研究方法收集病例后将相关信息并输入临床信息采集与分析系统,运用SPSS13.0软件采用描述性统计方法分析患者的一般资料,对计数资料进行频数分析;所有病例所涉及的症状、证候等信息分别进行构成比分析、因子分析、聚类分析和回归分析。结果:1.流感样病例中医证候学特征通过研究表明流感样患者就诊高峰为2015年11月至2016年3月,经分析纳入的724例患者中以女性456例(62.98%)为主;"已婚"者536例(74.34%)居多;在家中居住676例(93.50%)占主要地位。流感样病例诱发以"着凉"最多285例(54.70%);报告突然起病627例(87.94%);706人次均主诉为"发热"(97.51%);初起症状以"发热"最多,有302例(41.71%);全部病例均报告至少一项全身症状其中症状突出者有:恶寒者492例(68.05%)、全身酸痛症状明显有541例(75.03%)、头痛者517(71.61%)、乏力者600例(82.87%)。其中较为显著的局部症状有:流涕440例(60.77%)、咳嗽症状者588例(81.22%)、咽痒症状者435例(60.08%)、口干症状者544例(75.14%)。胃肠反应和全身炎性反应均不显著。四诊合参后中医证型中"风热犯卫"证208例(28.81%);"风寒束表"证107例(14.82%);"表寒里热"证404例(55.96%);"湿热壅滞"证3例(0.42%)。2.流感患者中医证候学特征病毒核酸为阳性者,病毒为甲型H1N1型114例(28.15%)、甲型H3N2型150例(37.04%)、甲型 H9N2型1例(0.25%)、乙型(B 型)139 例(34.32%)、丙型(C 型)1例(0.25%),主要对甲型H1N1、甲型H3N2、乙型(B型)进行相关分析。甲型H1N1病毒亚型人群特征为:女性80例(70.18%)显著较多;甲型H1N1病毒感染群体平均年龄为42.46±15.42岁;已婚91例(79.82%)人群较多;在家中居住的107例(93.86%);着凉获病的有52例(45.61%);高度发热的患者有27(23.68%);就诊时病程为42.95±37.71小时;突然起病的患者有101例(89.38%);主诉报告了发热有112例(98.2%);初起症状中发热39例(34.8%)为最多。全身症状中显著临床表现:恶寒者有76例(66.7%)、全身酸痛96例(83.9%)、头痛85例(74.6%)、乏力102例(89.5%)。局部症状中临床症状显著的有:咳痰76例(66.7%)、咽痒75例(65.8%)、咽痛 63 例(56.8%)、流涕 75 例(65.8%)、咳嗽 109 例(95.6%)、咽部充血 63 例(51.8%)、口干 92 例(80.7%)、口渴 85 例(64.9%)。甲型H3N2病毒亚型人群特征女性96例(64%)居多;甲型H3N2病毒感染群体平均年龄为45.87±18.16岁;已婚120例(80%);在家中居住的有138例(92%);因着凉获病的有58例(38.67%);高度发热16例(10.67%);就诊时病程为58.17±70.40小时;突然起病的患者有126例(84%);主诉149例(99.3%)报告了发热;初起症状中发热患者最多56例(37.8%)。全身症状中显著临床表现:恶寒者有99例(76.0%)、全身酸痛107例(71.3%)、头痛116例(77.9%)、乏力125例(83.3%)。局部症状中临床症状显著的有:咳痰96例(64.4%)、咽痒100例(66.7%)、咽痛96例(64.9%)、流涕 110 例(73.3%)、咳嗽 127 例(84.7%)、咽部充血 96 例(64.9%)、口干 108 例(73.0%)、口渴 99 例(67.8%)。乙型流感人群中女性86例(61.87%)显著较高;乙型(B型)病毒感染群体平均年龄为37.64± 17.40岁;已婚93例(67.39%);在家中居住的130例(93.53%);因着凉获病的有52例(37.41%);高度发热有18例(12.95%);就诊时病程为65.18±49.52小时;突然起病的流感患者有122例(88.41%);主诉133例(95.7%)报告了发热;初起症状中仍以发热为多46例(33.8%)。全身症状中显著临床表现:恶寒者有104 例(74.8%)、全身酸痛 105 例(75.4%)、头痛 101 例(73.2%)、乏力 113 例(81.3%)。局部临床症状显著的有:咳痰92例(66.2%)、咽痒96例(69.1%)、咽痛83例(61.0%)、流涕 91 例(65.5%)、咳嗽 127 例(91.4%)、咽部充血 83 例(61.0%)、口干 113 例(81.9%)、口渴 107 例(77.5%)。三种流感病毒确诊患者全身炎性反应少见,腹部症状中是以恶心为主。其中流感阳性患者甲型H1N1流感中医证型分布风热犯卫24(21.1%)、风寒束表11(9.6%)、表寒里热77(67.5%)、湿热壅滞2(1.8%);甲型H3N2流感中医证型分布风热犯卫35(23.%)、风寒束表17(11.3%)、表寒里热98(65.3%)、湿热壅滞0(0.0%);乙型流感中医证型分布风热犯卫29(21.0%)、风寒束表21(15.2%)、表寒里热88(63.8%)、湿热壅滞0(0.0%)。3.流感门诊治疗效果随访724例被调查者中183例报告了自行服药种类其中:单纯服用抗生素的116例(63.39%)、单纯服用中成药的12例(6.56%)、单纯服用退热药的11例(6.01%)、其余均为两种或三种药物联用44例(24.04%)。未用西药的22例(7.53%),仅使用退热药的52例(17.81%),仅使用镇咳药的4例(1.37%),仅使用抗病毒药的34例(11.64%),仅使用化痰药的9例(3.08%),仅使用抗生素的11例(3.77%),仅针对鼻涕喷嚏给药的4例(1.37%),使用两种以上药物包含退热药的127例(43.49%),使用两种以上药物不包含退热药的29例(9.93%)。中成药对症处理的170例(47.2%)、非对症处理175例(48.6%),其中对证处理多为表寒里热证,但是患者是否对证处理对退热时间、病程及临床疗效并无显著差异。结论:流感样病例及流感病例就诊高峰出现在2015年12月至2016年3月,流感样患者及流感患者均以女性为主,多为已婚在家中居住人群,考虑流感样病例爆发不除外于与环境气候、患者体质和周围环境相关。且流感患者是以全身症状(恶寒、乏力、全身酸痛、头痛)和呼吸道症状(咽痛、咳嗽、咳痰)为主,中医辨证以表寒里热证为主。不同病毒亚型流感临床症状稍有区别:甲型流感病毒致病发热、全身症状和咽部症状较重;乙型流感病毒致病较为温和,且胃肠症状较重。流感病例中表寒里热证显著高于非流感人群;不同病毒亚型中医症状均是以表寒里热证为主,但不同病毒亚型和中医证型的对照关系尚无统计学差异。通过随访门诊就诊患者发现,就诊患者在患病初期有自行用药的现象且多为抗生素,患病初期患者门诊多给予解热镇痛、抗病毒及中成药,服药后患者发热、全身症状及局部症状均有明显好转,但本研究中中成药是否对证处理对临床效果的影响无统计学差异。本研究提示在今后的研究中应注意对流感样病例的监测,对不同人群和体质的流感中医证型可进一步明确,流感患者中成药的对证处理需要进一步关注,以做到有效的中医药防治工作。
[Abstract]:Objective: to establish the questionnaire and statistical software of TCM syndrome of influenza, collect the clinical cases and analyze the characteristics of influenza and influenza syndrome, the relationship between influenza like cases and influenza cases, and analyze the TCM syndrome type and the virus subtype of influenza. The possible relationship between the patients was evaluated by telephone follow-up to evaluate the clinical effect of influenza in the fever clinic and to establish the foundation for the effective prevention and treatment of influenza in Chinese medicine. Methods: from October 2015 to March 2016 in the fever clinic of China-Japan Friendship Hospital, 724 cases were collected, and the guidelines for diagnosis and treatment of influenza in Chinese medicine and Western medicine were collected. Periodical books, classic books of ancient books, collection of symptoms of influenza and TCM syndrome information, design of clinical questionnaire, after repeated demonstration by relevant clinical experts and evidence-based experts, form "questionnaire of TCM syndrome characteristics of influenza" and make electronic information entry software. An observational research method combined with supervision and unsupervision is used to collect information and input clinical information collection and analysis system. SPSS13.0 software is used to analyze the general data of patients with descriptive statistics and analyze the frequency of the data; the symptoms, syndromes and other information involved in the cases are entered respectively. Analysis of factor analysis, factor analysis, cluster analysis and regression analysis. Results: 1. influenza like cases of TCM syndrome characteristics through the study showed that the peak of influenza like patients was from November 2015 to March 2016, 456 cases (62.98%) were dominant in 724 cases, 536 cases (74.34%) were married, 676 cases (93) were living at home. .50%) accounted for the main status. Influenza like cases induced a maximum of 285 cases (54.70%) with "cold"; 627 cases (87.94%) were reported abruptly; 706 people complained of "fever" (97.51%); the first symptoms were "fever" and 302 (41.71%); all cases reported at least one of the symptoms of general symptoms: 492 cases of chill (68.05%), and sore body. There were 541 cases (75.03%), 517 (71.61%) and 600 (82.87%) with headache, 440 cases (60.77%), 588 (81.22%) with cough symptoms, 435 (60.08%) with itchy symptoms and 544 cases (75.14%). The gastrointestinal reaction and systemic inflammatory response were not significant. "Wind and heat offense guard" syndrome 208 cases (28.81%); "wind cold beam table" syndrome in 107 cases (14.82%); "surface cold heat" syndrome in 404 cases (55.96%); "Damp heat stagnation" syndrome 3 cases (0.42%) of.2. influenza syndrome virus nucleic acid is positive, the virus is type a H1N1 type 114 cases (28.15%), a type a H3N2 type 150 cases (37.04%), H9N2 type 1 cases (0.25%), Japanese (B type) cases (B type) examples .32%), type A (type C) 1 cases (0.25%), mainly to a type a H1N1, a H3N2, B (B type). The characteristics of the group a H1N1 virus subtype are: 80 cases (70.18%) of women; the average age of the group a H1N1 virus infected population is 42.46 + 15.42 years old; 91 married (79.82%) people are married; 107 cases (93.86%) living in the home; catch cold. There were 52 cases (45.61%), 27 (23.68%) patients with high fever, 42.95 + 37.71 hours, 101 patients (89.38%) and 112 (98.2%) fever (98.2%), and 39 (34.8%) fever in initial symptoms. There were 85 cases of pain (74.6%) and 102 cases of asthenia (89.5%). There were 76 cases of expectoration (66.7%), 75 cases of pharynx itching (65.8%), 63 cases of pharynx (56.8%), 75 runny cases (65.8%), cough 109 cases (95.6%), pharynx congestion, thirst, and thirst. The average age of the group a H3N2 virus was 45.87 + 18.16 years old; 120 married (80%) married, 138 (92%) living in the family; 58 cases (38.67%) for catching cold; 16 (10.67%) with high fever (10.67%); the course of illness was 58.17 + 70.40 hours; suddenly the patient had 126 cases (84%); the main complaint reported fever; initial symptoms. The patients with fever were 56 (37.8%). There were 99 cases (76%), 107 cases (71.3%), 116 cases (77.9%) and 125 cases (83.3%). The clinical symptoms in local symptoms were 96 (64.4%), pharynx itching, pharynx and sore throat. There were 96 cases of hyperemia in the pharynx (64.9%), 108 cases of dry mouth (73%), 99 thirst (67.8%), 86 cases (61.87%) in the population of influenza B (61.87%); the average age of B virus infected population was 37.64 + 17.40 years, 93 (67.39%) married (67.39%); 95%); the course of medical treatment was 65.18 + 49.52 hours, 122 cases (88.41%) of the patients with sudden onset of influenza, 133 cases (95.7%) reported fever, and 46 cases (33.8%) with fever in the initial symptom (33.8%). There were 104 cases (74.8%), 104 cases (75.4%), headache, headache and fatigue. There were 92 cases of local clinical symptoms: 92 cases of expectoration (66.2%), 96 cases of pharynx itching (69.1%), 83 cases of pharynx pain (61%), 91 cases of runny nose (65.5%), 127 cases of cough (91.4%), 83 cases of pharyngeal hyperemia (61%), dry mouth 113 cases (81.9%), thirst cases. Influenza A patients with influenza A (H1N1) influenza in TCM syndrome types are 24 (21.1%), 11 (9.6%) of wind cold beam, 77 (67.5%) in surface cold, 2 (1.8%) in damp heat, 35 (23%), 17 (11.3%) in the distribution of wind and heat in Chinese Medicine of a type A influenza, 17 (11.3%) of wind cold beam, heat and heat in the cold water, and the distribution of wind and heat in Chinese traditional Chinese Medicine 9 (21%), wind cold beam table 21 (15.2%), surface cold heat 88 (63.8%), damp heat stagnation 0 (0%).3. influenza clinic treatment effect follow-up, 183 cases reported in 183 cases of self-propelled drugs: 116 cases of antibiotics alone (63.39%), 12 cases (6.56%), only taking antipyretic drugs, the rest were all kinds. There were 44 cases (24.04%) combined with three drugs, 22 cases (7.53%) without western medicine, 52 cases with only antipyretic drugs (17.81%), 4 cases with only antitussive drugs (1.37%), 34 cases (11.64%) using only antiphlegm drugs, only 9 cases (3.08%) using the phlegm medicine, only using antibiotics. There were 127 cases (43.49%) containing antipyretic drugs, 29 cases (9.93%) that did not contain antipyretic drugs with more than two drugs. 170 cases (47.2%) were treated with Chinese patent medicine (47.2%) and 175 cases (48.6%) with non symptomatic treatment. Among them, most of the syndromes were heat syndrome in the surface cold, but there was no significant difference in the time, course and clinical efficacy of the patient's treatment. Conclusion: flow Influenza like patients and influenza cases appeared in December 2015 to March 2016. Influenza like patients and influenza patients were dominated by women, most of whom were married at home. The outbreak of influenza like cases was related to the environmental climate, the patient's physique and the surrounding environment. Body pain, headache) and respiratory symptoms (sore throat, cough, expectoration) mainly, TCM syndrome differentiation with cold heat syndrome mainly. Different virus subtype influenza clinical symptoms are slightly different: influenza A virus fever, systemic symptoms and pharynx symptoms are heavier; influenza B virus is more mild, and gastrointestinal symptoms are heavier. In influenza cases in cold cases The heat syndrome was significantly higher than that of non influenza people; the symptoms of different virus subtypes were mainly in the heat syndrome of the surface cold, but there was no statistical difference between the different virus subtypes and the TCM syndrome types. There was a significant improvement in fever, general symptoms and local symptoms in patients with antipyretic and antipyretic analgesic, antiviral and Chinese medicine. However, there was no significant difference in the effect of Chinese patent medicine on the clinical effects in the study. The TCM syndromes of influenza can be further clarified, and the treatment of TCM syndromes of influenza patients needs further attention in order to achieve effective prevention and treatment of TCM.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R259

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