【摘要】：目的:通過分析相關(guān)文獻(xiàn)并經(jīng)過專家論證后制定流感中醫(yī)證候?qū)W調(diào)查問卷及統(tǒng)計(jì)學(xué)軟件,收集符合要求的臨床病例,分析當(dāng)前季節(jié)流感樣及流感中醫(yī)證候?qū)W特征、流感樣病例與流感病例之間的可能關(guān)系;分析流感中醫(yī)證型與病毒亞型之間的可能關(guān)系;電話隨訪部分患者以評價(jià)發(fā)熱門診治療流感臨床效果,為探索中醫(yī)藥有效防治流感奠定基礎(chǔ)。方法:2015年10月至2016年3月于中日友好醫(yī)院發(fā)熱門診,收集724份符合標(biāo)準(zhǔn)的病例資料。通過查閱中醫(yī)與西醫(yī)流感相關(guān)診療指南、期刊論著、古籍經(jīng)典等資料,收集流行性感冒的癥狀與中醫(yī)證候信息,設(shè)計(jì)臨床調(diào)查表;經(jīng)相關(guān)臨床專家、循證醫(yī)學(xué)相關(guān)專家進(jìn)行反復(fù)論證后,形成"流行性感冒中醫(yī)證候?qū)W特征調(diào)查問卷"并制作電子信息錄入軟件。該臨床研究采用前瞻、開放式,有監(jiān)督與無監(jiān)督相結(jié)合的觀察性研究方法收集病例后將相關(guān)信息并輸入臨床信息采集與分析系統(tǒng),運(yùn)用SPSS13.0軟件采用描述性統(tǒng)計(jì)方法分析患者的一般資料,對計(jì)數(shù)資料進(jìn)行頻數(shù)分析;所有病例所涉及的癥狀、證候等信息分別進(jìn)行構(gòu)成比分析、因子分析、聚類分析和回歸分析。結(jié)果:1.流感樣病例中醫(yī)證候?qū)W特征通過研究表明流感樣患者就診高峰為2015年11月至2016年3月,經(jīng)分析納入的724例患者中以女性456例(62.98%)為主;"已婚"者536例(74.34%)居多;在家中居住676例(93.50%)占主要地位。流感樣病例誘發(fā)以"著涼"最多285例(54.70%);報(bào)告突然起病627例(87.94%);706人次均主訴為"發(fā)熱"(97.51%);初起癥狀以"發(fā)熱"最多,有302例(41.71%);全部病例均報(bào)告至少一項(xiàng)全身癥狀其中癥狀突出者有:惡寒者492例(68.05%)、全身酸痛癥狀明顯有541例(75.03%)、頭痛者517(71.61%)、乏力者600例(82.87%)。其中較為顯著的局部癥狀有:流涕440例(60.77%)、咳嗽癥狀者588例(81.22%)、咽癢癥狀者435例(60.08%)、口干癥狀者544例(75.14%)。胃腸反應(yīng)和全身炎性反應(yīng)均不顯著。四診合參后中醫(yī)證型中"風(fēng)熱犯衛(wèi)"證208例(28.81%);"風(fēng)寒束表"證107例(14.82%);"表寒里熱"證404例(55.96%);"濕熱壅滯"證3例(0.42%)。2.流感患者中醫(yī)證候?qū)W特征病毒核酸為陽性者,病毒為甲型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%),主要對甲型H1N1、甲型H3N2、乙型(B型)進(jìn)行相關(guān)分析。甲型H1N1病毒亞型人群特征為:女性80例(70.18%)顯著較多;甲型H1N1病毒感染群體平均年齡為42.46±15.42歲;已婚91例(79.82%)人群較多;在家中居住的107例(93.86%);著涼獲病的有52例(45.61%);高度發(fā)熱的患者有27(23.68%);就診時(shí)病程為42.95±37.71小時(shí);突然起病的患者有101例(89.38%);主訴報(bào)告了發(fā)熱有112例(98.2%);初起癥狀中發(fā)熱39例(34.8%)為最多。全身癥狀中顯著臨床表現(xiàn):惡寒者有76例(66.7%)、全身酸痛96例(83.9%)、頭痛85例(74.6%)、乏力102例(89.5%)。局部癥狀中臨床癥狀顯著的有:咳痰76例(66.7%)、咽癢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病毒亞型人群特征女性96例(64%)居多;甲型H3N2病毒感染群體平均年齡為45.87±18.16歲;已婚120例(80%);在家中居住的有138例(92%);因著涼獲病的有58例(38.67%);高度發(fā)熱16例(10.67%);就診時(shí)病程為58.17±70.40小時(shí);突然起病的患者有126例(84%);主訴149例(99.3%)報(bào)告了發(fā)熱;初起癥狀中發(fā)熱患者最多56例(37.8%)。全身癥狀中顯著臨床表現(xiàn):惡寒者有99例(76.0%)、全身酸痛107例(71.3%)、頭痛116例(77.9%)、乏力125例(83.3%)。局部癥狀中臨床癥狀顯著的有:咳痰96例(64.4%)、咽癢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%)顯著較高;乙型(B型)病毒感染群體平均年齡為37.64± 17.40歲;已婚93例(67.39%);在家中居住的130例(93.53%);因著涼獲病的有52例(37.41%);高度發(fā)熱有18例(12.95%);就診時(shí)病程為65.18±49.52小時(shí);突然起病的流感患者有122例(88.41%);主訴133例(95.7%)報(bào)告了發(fā)熱;初起癥狀中仍以發(fā)熱為多46例(33.8%)。全身癥狀中顯著臨床表現(xiàn):惡寒者有104 例(74.8%)、全身酸痛 105 例(75.4%)、頭痛 101 例(73.2%)、乏力 113 例(81.3%)。局部臨床癥狀顯著的有:咳痰92例(66.2%)、咽癢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%)。三種流感病毒確診患者全身炎性反應(yīng)少見,腹部癥狀中是以惡心為主。其中流感陽性患者甲型H1N1流感中醫(yī)證型分布風(fēng)熱犯衛(wèi)24(21.1%)、風(fēng)寒束表11(9.6%)、表寒里熱77(67.5%)、濕熱壅滯2(1.8%);甲型H3N2流感中醫(yī)證型分布風(fēng)熱犯衛(wèi)35(23.%)、風(fēng)寒束表17(11.3%)、表寒里熱98(65.3%)、濕熱壅滯0(0.0%);乙型流感中醫(yī)證型分布風(fēng)熱犯衛(wèi)29(21.0%)、風(fēng)寒束表21(15.2%)、表寒里熱88(63.8%)、濕熱壅滯0(0.0%)。3.流感門診治療效果隨訪724例被調(diào)查者中183例報(bào)告了自行服藥種類其中:單純服用抗生素的116例(63.39%)、單純服用中成藥的12例(6.56%)、單純服用退熱藥的11例(6.01%)、其余均為兩種或三種藥物聯(lián)用44例(24.04%)。未用西藥的22例(7.53%),僅使用退熱藥的52例(17.81%),僅使用鎮(zhèn)咳藥的4例(1.37%),僅使用抗病毒藥的34例(11.64%),僅使用化痰藥的9例(3.08%),僅使用抗生素的11例(3.77%),僅針對鼻涕噴嚏給藥的4例(1.37%),使用兩種以上藥物包含退熱藥的127例(43.49%),使用兩種以上藥物不包含退熱藥的29例(9.93%)。中成藥對癥處理的170例(47.2%)、非對癥處理175例(48.6%),其中對證處理多為表寒里熱證,但是患者是否對證處理對退熱時(shí)間、病程及臨床療效并無顯著差異。結(jié)論:流感樣病例及流感病例就診高峰出現(xiàn)在2015年12月至2016年3月,流感樣患者及流感患者均以女性為主,多為已婚在家中居住人群,考慮流感樣病例爆發(fā)不除外于與環(huán)境氣候、患者體質(zhì)和周圍環(huán)境相關(guān)。且流感患者是以全身癥狀(惡寒、乏力、全身酸痛、頭痛)和呼吸道癥狀(咽痛、咳嗽、咳痰)為主,中醫(yī)辨證以表寒里熱證為主。不同病毒亞型流感臨床癥狀稍有區(qū)別:甲型流感病毒致病發(fā)熱、全身癥狀和咽部癥狀較重;乙型流感病毒致病較為溫和,且胃腸癥狀較重。流感病例中表寒里熱證顯著高于非流感人群;不同病毒亞型中醫(yī)癥狀均是以表寒里熱證為主,但不同病毒亞型和中醫(yī)證型的對照關(guān)系尚無統(tǒng)計(jì)學(xué)差異。通過隨訪門診就診患者發(fā)現(xiàn),就診患者在患病初期有自行用藥的現(xiàn)象且多為抗生素,患病初期患者門診多給予解熱鎮(zhèn)痛、抗病毒及中成藥,服藥后患者發(fā)熱、全身癥狀及局部癥狀均有明顯好轉(zhuǎn),但本研究中中成藥是否對證處理對臨床效果的影響無統(tǒng)計(jì)學(xué)差異。本研究提示在今后的研究中應(yīng)注意對流感樣病例的監(jiān)測,對不同人群和體質(zhì)的流感中醫(yī)證型可進(jìn)一步明確,流感患者中成藥的對證處理需要進(jìn)一步關(guān)注,以做到有效的中醫(yī)藥防治工作。
[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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R259

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