甲型H3N2亚型流感的中医传变规律及病名探析——基于北京地区934例甲型H3N2亚型流感临床资料
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摘要
目的:通过观察北京地区2015年及2016年冬季934例甲型H3N2流感阳性病例的症状变化规律,探讨甲型H3N2流感的中医病名。方法:通过回顾2015年11月至2016年3月、2016年11月至2017年2月于首都医科大学附属北京朝阳医院、首都医科大学附属友谊医院、潞河医院、北京中医药大学附属东方医院,北京中医药大学附属东直门医院收集的934例甲型H3N2流感阳性病例,分析于发病第1天、第2天、第3天、第4天前来就诊患者的症状学表现,研究甲型H3N2流感的中医传变规律,从而对甲型H3N2流感的中医病名进行分析总结。结果:934例甲型H3N2流感病例起病第1天、第2天、第3天、第4天样本量分别为349例、414例、154例、17例,其中男399例,女531例;年龄14~89岁,平均年龄(41.22±16.63)岁;BMI<18.535例,18.5~23.9 385例,24~27 184例,27~32 71例,>32 14例。甲型H3N2流感优势症状比较:其中第1天症状主要表现为发热、恶寒、咳嗽、咽痛、清涕、肌肉酸痛为主要表现;第2天在第1天症状的基础上,出现头痛;第3天与第2天比较,咽痛比例下降,不再为优势症状;起病第4天口干口渴,头晕头重的症状明显,其中发热、恶寒、咳嗽、口渴、头痛的变化具有统计学意义(P<0.05)。934例甲型H3N2流感病例的其他症状如寒战、肢体困重、咳痰、鼻塞、咽痒、心悸、纳差、乏力、尿黄等变化具有统计学意义。舌质表现为红舌向暗红舌的演变,舌苔由薄白逐渐转为黄腻,脉象上以浮脉为主,随着疾病的演变,紧脉逐渐减少,滑脉及数脉逐渐增加。结论:甲型H3N2属太阳伤寒,寒邪束表日久容易化热产生里热证候。
Objective: To explore the TCM names of disease of A(H3N2) influenza through observing the change rules of symptoms of 934 cases of A(H3N2) influenza in Beijing during winter of 2015 and 2016. Methods: A total of 934 cases of A(H3N2)influenza in Beijing Chaoyang Hospital,Capital Medical University,Beijing Friendship Hospital Capital Medical University,Capital Medical University,Beijing Luhe Hospital,Capital Medical University,Dongfang Hospital Affiliated to Beijing University of Chinese Medicine,Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine from November 2015 to March 2016 and November 2016 to February 2017 were reviewed,and symptoms of patients at day 1,day 2,day 3 and day 4 were analyzed. Changes of TCM symptoms of A(H3N2) influenza were studied,so as to analyze and conclude TCM names of disease of A(H3N2) influenza. Results: The sample size of the 934 cases of A(H3N2) influenza on day 1,day 2,day 3 and day 4 were 349 cases,414 cases,154 cases and 17 cases,respectively,including 399 males and 531 females. The age ranged from 14 to 89 years( mean,41. 22 ±16. 63 years). The BMI was < 18. 5 in 35 cases,18. 5 to 23. 9 in 385 cases,24 to 27 in 184 cases,27 to 32 in 71 cases and > 32 in14 cases. Symptoms of Influenza A(H3N2) were fever,aversion to cold,cough,sore throat,clear nasal discharge and muscle ache were the main symptoms on the first day; headache appeared on day 2 based on day 1; the proportion of sore throat decreased,and no longer as dominant symptom compared with day 3. From day 4,dry mouth,thirst,dizziness and headache were significant. Among them,the changes of fever,aversion to cold,cough,thirst and headache were statistically significant( P < 0. 05). The changes of other symptoms of chills,heavy limbs,expectoration,stuffy nose,itchy throat,palpitations,anorexia,fatigue and yellow urinary were statistically significant. Tongue showed the changes from red tongue to dark red tongue. The tongue fur was changed from thin white to yellow greasy. The pulse was dominated by floating pulse. With the evolution of the disease,the tight pulse gradually decreased,and slippery pulse and rapid pulse gradually increased. Conclusion: Influenza A(H3N2) belongs to greater yang cold damage,and cold pathogen fettering the exterior for a long time could produce heat and transforms to heat syndrome.
Objective: To explore the TCM names of disease of A(H3N2) influenza through observing the change rules of symptoms of 934 cases of A(H3N2) influenza in Beijing during winter of 2015 and 2016. Methods: A total of 934 cases of A(H3N2)influenza in Beijing Chaoyang Hospital,Capital Medical University,Beijing Friendship Hospital Capital Medical University,Capital Medical University,Beijing Luhe Hospital,Capital Medical University,Dongfang Hospital Affiliated to Beijing University of Chinese Medicine,Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine from November 2015 to March 2016 and November 2016 to February 2017 were reviewed,and symptoms of patients at day 1,day 2,day 3 and day 4 were analyzed. Changes of TCM symptoms of A(H3N2) influenza were studied,so as to analyze and conclude TCM names of disease of A(H3N2) influenza. Results: The sample size of the 934 cases of A(H3N2) influenza on day 1,day 2,day 3 and day 4 were 349 cases,414 cases,154 cases and 17 cases,respectively,including 399 males and 531 females. The age ranged from 14 to 89 years( mean,41. 22 ±16. 63 years). The BMI was < 18. 5 in 35 cases,18. 5 to 23. 9 in 385 cases,24 to 27 in 184 cases,27 to 32 in 71 cases and > 32 in14 cases. Symptoms of Influenza A(H3N2) were fever,aversion to cold,cough,sore throat,clear nasal discharge and muscle ache were the main symptoms on the first day; headache appeared on day 2 based on day 1; the proportion of sore throat decreased,and no longer as dominant symptom compared with day 3. From day 4,dry mouth,thirst,dizziness and headache were significant. Among them,the changes of fever,aversion to cold,cough,thirst and headache were statistically significant( P < 0. 05). The changes of other symptoms of chills,heavy limbs,expectoration,stuffy nose,itchy throat,palpitations,anorexia,fatigue and yellow urinary were statistically significant. Tongue showed the changes from red tongue to dark red tongue. The tongue fur was changed from thin white to yellow greasy. The pulse was dominated by floating pulse. With the evolution of the disease,the tight pulse gradually decreased,and slippery pulse and rapid pulse gradually increased. Conclusion: Influenza A(H3N2) belongs to greater yang cold damage,and cold pathogen fettering the exterior for a long time could produce heat and transforms to heat syndrome.
引文
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[3]曾军.流感样疾病的诊断和鉴别诊断[J].中华医学信息导报,2003,16(22):15.
[4]朱文锋,贺泽龙.论坚持中医病名诊断的必要性[J].辽宁中医杂志,2000,37(2):50-52.
[5]吕立刚,叶放.从“头痛、高热”救误案谈辨中医病名的重要性[J].国医论坛,2013,28(5):52-53.
[6]唐小淇,曲妮妮.“卫气营血”和“三焦”传变与防治H7N9型禽流感[J].实用中医内科杂志,2015,29(6):8-9.
[7]陈晓蓉,杨宗国,陆云飞.新型人感染H7N9禽流感中医证候分布规律及辨证论治思路[J].中华中医药杂志,2013,28(10):2825-2829.
[8]张磊,何翠.2009~2010年北京地区甲型流感监测分析[J].中国病原生物学杂志,2011,6(2):104-107,100.
[9]王玉光,马月霞,郭亚丽.2013与2014年北京地区冬季流感样病例中医证候规律调查分析[J].北京中医药,2014,33(12):915-918.
[10]王玉光,马月霞,刘卫红.北京地区2015年冬季流感样病例中医病证特征观察[J].北京中医药,2016,35(2):99-101.