531例流感样疾病病毒病原学与中医证候相关性分析
摘要
背景
流感样疾病是临床常见病及多发病,一定程度影响了患者生活及工作质量,近年来一直成为大家关注的公共卫生问题。现代医学对本病治疗主要以对症治疗为主。中医药在治疗外感热病方面积累了丰富的临床经验。近年来中医药在病毒性感染引起的流感样疾病方面的治疗优势受到广泛的关注,主要以传统中医药里的某一方药的疗效评价类的文献报道为主,而对病毒性流感样疾病的中医辨证分型尚无统一标准,尤其是运用流行病学调查的方法研究病毒性流感样疾病的中医证候规律的研究较少。研究并掌握病毒性流感样疾病的证候规律,为制定有效的临床治疗方案提供决策依据,对提高流感样疾病的临床疗效有重要意义。
目的
本研究旨在探讨经病毒病原学证实的流感样病例患者的疾病规律与中医证候分型,为进一步开展本病的长期大样本、多中心的中医证候规范化研究打下基础。
方法
本研究通过对从2009年2月至2011年9月期间,在广东省中医院发热门诊就诊的所有作咽拭子检查得到病毒病原学证实的流感样疾病病例患者共531例进行临床流行病学调查,对其性别、年龄、病毒病原学证据、发病时间及季节、就诊时间、既往史、西医诊断、最高体温、就诊次数、症状、体征、实验室检查等方面进行分析,将所收集的病历信息用SPSS18.0软件建成数据库。流感样疾病患者的一般临床资料及中医四诊信息的统计采用描述性分析方法。将所有中医四诊信息的频数分析结果进行排序,结合临床对统计结果进行整理,将经整理后的中医信息条目进行聚类分析,采用系统聚类法进行样品聚类分析,然后提炼出各类病毒感染性流感样疾病的基本证候,参照中医辨证分型标准赋予适当证型名称,并对各个证候内的四诊信息进行权重计算,初步分析流感样病例中医证候与病原学的相关性,归纳临床操作性强的中医证候规律。
结果
临床回顾性研究得出经病毒病原学证实的流感样病例患者的基本特点：1.病毒感染性流感样病例以青壮年多见,发病率无性别差异,但有其季节分布性；2.患者大多无特殊既往病史,一般病程较短,最高体温多在39.0℃以内,约4成患者需要使用抗生素。3.大部分患者以感染普通甲型流感病毒、甲型H1N1流感病毒和乙型流感病毒为主,其西医诊断主要为急性上呼吸道感染；4.流感样病例患者的症状、体征及血常规有其特异性,根据四诊信息的特异性归纳出4种中医证候,包括外感风邪证、外感风寒化热证、外感风热证、外感风热夹湿证。5.普通甲型流感病毒、甲型H1N1流感病毒和乙型流感病毒的发病高峰有其季节性,其中医证候通过聚类分析得到3种分型：外感风寒化热证、外感风寒化热夹湿证、外感风热证。6.三种主要病毒病原体均有超过20%的患者符合SIRS诊断标准,而以普通甲型流感病毒占比最高。外感风热证患者的感染-炎症反应较其它证型更为严重。
结论
运用数理统计学方法探讨病毒感染性流感样疾病的中医证候规律体现了传统中医理论与现代科研方法学的有机结合,为临床对流感样疾病的辨证论治提供了相对客观化的辩证参考依据。
Background
Influenza-like illness is a common disease and frequently-occurring disease, and affects the patient's quality of life and work to a certain extent.In recent years, it has been a public health problem to everyone. The main modern medical treatment of this disease is symptomatic treatment. Chinese medicine has accumulated rich clinical experience in the treatment of exogenous fever. In recent years, the advantage of Chinese medicine in the influenza-like illness caused by viral infection received widespread attention. Reports in the literature are mainly on the evaluation of the efficacy of some prescriptions in traditional Chinese medicine. But there have been no uniform standards in the TCM Syndrome Differentiation in the influenza-like illness caused by viral infection. And yet, there are few researches Using epidemiological survey methods to study the TCM Syndromes of the influenza-like illness caused by viral infection. Studying the laws of the TCM syndromes of the influenza-like illness caused by viral infection can provide basis for decision making in an effective clinical treatment program, and improve the clinical efficacy of influenza-like illness.
Objective
The purpose of this study is to investigate the laws and the TCM syndromes of the influenza-]ike illness confirmed by the viral etiology tests. It lays the foundation for the standardized study of TCM syndromes in multi-centers、 long-term and large samples for a further development.
Methods
In this study, from February2009to September2011, at the fever clinic in the Guangdong Province Hospital of TCM, a total of531cases of influenza-like illness confirmed by viral etiology tests from throat swabs are checked for clinical Epidemiological investigation. The details include gender、age、 evidence of viral etiology、onset time and season、visiting time、Past history、 western medical diagnosis、the highest body temperature、number of visits、 symptoms、signs、laboratory tests and so on. The medical record information will be collected to build the database using the SPSS18.0. The general clinical data and information of four diagnostic methods of the patients with influenza-like illness is analyzed by descriptive analysis method. We sorted all the results by frequency analysis of the TCM information of four diagnostic methods, organized the statistical results combined with clinical, then did the cluster analysis using the tidied TCM information items. By the system clustering method, we did the the sample cluster analysis, extracted the basic TCM syndrome from various types of influenza-like disease of viral infections, gave names to the appropriate syndromes referred to the TCM classification criteria, did the weight calculation of information of TCM four diagnostic methods from various syndromes, analyzed the correlation of the TCM syndromes of influenza-like illness and the viral etiology preliminarily, to summarize clinical operable TCM Syndromes.
Result
Retrospective studies showed the basic characteristics of the patients with influenza-like illness confirmed by the viral etiology:1. Influenza-like illnesses of viral infection are more common in young adults,.The incidence have not gender differences, but have seasonal distribution;2. Most patients haven't special past medical history. Generally their course of disease is in a shorter duration, and the highest temperature is39.0℃or less. About40%patients require the use of antibiotics;3. Most patients infected with the common influenza-A virus, H1N1influenza-A virus and influenza-B virus. The western clinic diagnosis is acute upper respiratory tract infections;4.ILI patients's symptoms, signs and blood tsets have its specificity. Four kinds of TCM syndromes of influenza-like illness are generalized according to the specificity of four diagnostic information, including the exogenous pathogenic wind syndrome, exogenous cold turning hot syndrome, exogenous wind-heat syndrome and exogenous wind-heat with dampness syndrome;5. The incidence peak of the common influenza-A virus, H1N1influenza-A virus and inf luenza-B virus is seasonal. Three kinds of TCM syndromes by cluster analysis are generalized:exogenous cold turning heat syndrome, exogenous cold turning heat with dampness syndrome, exogenous wind-heat syndrome;6. More than20%of the patients in the three major viral pathogens fulfill the diagnostic criteria of SIRS, while common influenza-A virus have the highest proportion. Infection-inflammation response with exogenous wind-heat syndrome is more severe than other syndromes.
Conclusion
The use of mathematical statistical methods to investigate the TCM Syndromes of influenza-like disease of viral infection reflects the organic combination of traditional Chinese medicine theory and modern scientific research methods, and provides relatively objective dialectic references for the clinical diagnosis and treatment of influenza-like illness.
流感样疾病是临床常见病及多发病,一定程度影响了患者生活及工作质量,近年来一直成为大家关注的公共卫生问题。现代医学对本病治疗主要以对症治疗为主。中医药在治疗外感热病方面积累了丰富的临床经验。近年来中医药在病毒性感染引起的流感样疾病方面的治疗优势受到广泛的关注,主要以传统中医药里的某一方药的疗效评价类的文献报道为主,而对病毒性流感样疾病的中医辨证分型尚无统一标准,尤其是运用流行病学调查的方法研究病毒性流感样疾病的中医证候规律的研究较少。研究并掌握病毒性流感样疾病的证候规律,为制定有效的临床治疗方案提供决策依据,对提高流感样疾病的临床疗效有重要意义。
目的
本研究旨在探讨经病毒病原学证实的流感样病例患者的疾病规律与中医证候分型,为进一步开展本病的长期大样本、多中心的中医证候规范化研究打下基础。
方法
本研究通过对从2009年2月至2011年9月期间,在广东省中医院发热门诊就诊的所有作咽拭子检查得到病毒病原学证实的流感样疾病病例患者共531例进行临床流行病学调查,对其性别、年龄、病毒病原学证据、发病时间及季节、就诊时间、既往史、西医诊断、最高体温、就诊次数、症状、体征、实验室检查等方面进行分析,将所收集的病历信息用SPSS18.0软件建成数据库。流感样疾病患者的一般临床资料及中医四诊信息的统计采用描述性分析方法。将所有中医四诊信息的频数分析结果进行排序,结合临床对统计结果进行整理,将经整理后的中医信息条目进行聚类分析,采用系统聚类法进行样品聚类分析,然后提炼出各类病毒感染性流感样疾病的基本证候,参照中医辨证分型标准赋予适当证型名称,并对各个证候内的四诊信息进行权重计算,初步分析流感样病例中医证候与病原学的相关性,归纳临床操作性强的中医证候规律。
结果
临床回顾性研究得出经病毒病原学证实的流感样病例患者的基本特点：1.病毒感染性流感样病例以青壮年多见,发病率无性别差异,但有其季节分布性；2.患者大多无特殊既往病史,一般病程较短,最高体温多在39.0℃以内,约4成患者需要使用抗生素。3.大部分患者以感染普通甲型流感病毒、甲型H1N1流感病毒和乙型流感病毒为主,其西医诊断主要为急性上呼吸道感染；4.流感样病例患者的症状、体征及血常规有其特异性,根据四诊信息的特异性归纳出4种中医证候,包括外感风邪证、外感风寒化热证、外感风热证、外感风热夹湿证。5.普通甲型流感病毒、甲型H1N1流感病毒和乙型流感病毒的发病高峰有其季节性,其中医证候通过聚类分析得到3种分型：外感风寒化热证、外感风寒化热夹湿证、外感风热证。6.三种主要病毒病原体均有超过20%的患者符合SIRS诊断标准,而以普通甲型流感病毒占比最高。外感风热证患者的感染-炎症反应较其它证型更为严重。
结论
运用数理统计学方法探讨病毒感染性流感样疾病的中医证候规律体现了传统中医理论与现代科研方法学的有机结合,为临床对流感样疾病的辨证论治提供了相对客观化的辩证参考依据。
Background
Influenza-like illness is a common disease and frequently-occurring disease, and affects the patient's quality of life and work to a certain extent.In recent years, it has been a public health problem to everyone. The main modern medical treatment of this disease is symptomatic treatment. Chinese medicine has accumulated rich clinical experience in the treatment of exogenous fever. In recent years, the advantage of Chinese medicine in the influenza-like illness caused by viral infection received widespread attention. Reports in the literature are mainly on the evaluation of the efficacy of some prescriptions in traditional Chinese medicine. But there have been no uniform standards in the TCM Syndrome Differentiation in the influenza-like illness caused by viral infection. And yet, there are few researches Using epidemiological survey methods to study the TCM Syndromes of the influenza-like illness caused by viral infection. Studying the laws of the TCM syndromes of the influenza-like illness caused by viral infection can provide basis for decision making in an effective clinical treatment program, and improve the clinical efficacy of influenza-like illness.
Objective
The purpose of this study is to investigate the laws and the TCM syndromes of the influenza-]ike illness confirmed by the viral etiology tests. It lays the foundation for the standardized study of TCM syndromes in multi-centers、 long-term and large samples for a further development.
Methods
In this study, from February2009to September2011, at the fever clinic in the Guangdong Province Hospital of TCM, a total of531cases of influenza-like illness confirmed by viral etiology tests from throat swabs are checked for clinical Epidemiological investigation. The details include gender、age、 evidence of viral etiology、onset time and season、visiting time、Past history、 western medical diagnosis、the highest body temperature、number of visits、 symptoms、signs、laboratory tests and so on. The medical record information will be collected to build the database using the SPSS18.0. The general clinical data and information of four diagnostic methods of the patients with influenza-like illness is analyzed by descriptive analysis method. We sorted all the results by frequency analysis of the TCM information of four diagnostic methods, organized the statistical results combined with clinical, then did the cluster analysis using the tidied TCM information items. By the system clustering method, we did the the sample cluster analysis, extracted the basic TCM syndrome from various types of influenza-like disease of viral infections, gave names to the appropriate syndromes referred to the TCM classification criteria, did the weight calculation of information of TCM four diagnostic methods from various syndromes, analyzed the correlation of the TCM syndromes of influenza-like illness and the viral etiology preliminarily, to summarize clinical operable TCM Syndromes.
Result
Retrospective studies showed the basic characteristics of the patients with influenza-like illness confirmed by the viral etiology:1. Influenza-like illnesses of viral infection are more common in young adults,.The incidence have not gender differences, but have seasonal distribution;2. Most patients haven't special past medical history. Generally their course of disease is in a shorter duration, and the highest temperature is39.0℃or less. About40%patients require the use of antibiotics;3. Most patients infected with the common influenza-A virus, H1N1influenza-A virus and influenza-B virus. The western clinic diagnosis is acute upper respiratory tract infections;4.ILI patients's symptoms, signs and blood tsets have its specificity. Four kinds of TCM syndromes of influenza-like illness are generalized according to the specificity of four diagnostic information, including the exogenous pathogenic wind syndrome, exogenous cold turning hot syndrome, exogenous wind-heat syndrome and exogenous wind-heat with dampness syndrome;5. The incidence peak of the common influenza-A virus, H1N1influenza-A virus and inf luenza-B virus is seasonal. Three kinds of TCM syndromes by cluster analysis are generalized:exogenous cold turning heat syndrome, exogenous cold turning heat with dampness syndrome, exogenous wind-heat syndrome;6. More than20%of the patients in the three major viral pathogens fulfill the diagnostic criteria of SIRS, while common influenza-A virus have the highest proportion. Infection-inflammation response with exogenous wind-heat syndrome is more severe than other syndromes.
Conclusion
The use of mathematical statistical methods to investigate the TCM Syndromes of influenza-like disease of viral infection reflects the organic combination of traditional Chinese medicine theory and modern scientific research methods, and provides relatively objective dialectic references for the clinical diagnosis and treatment of influenza-like illness.
引文
[1]中华人民共和国卫生部.《全国流感监测方案(2010年版)》.卫办疾控发(2010)150号.
[2]娄海容SARS的临床表现及结局——国外文献综述[J].现代医院.2003,3(4)：41-42.
[3]禽流感患者识别与救治[J].实用心脑肺血管病杂志.2009,1(17)：15.
[4]李铁钢,刘维斯,杨智聪,王玉林,李美霞.2003-2007年广州市流感样病例暴发疫情分析.华南预防医学.2008,34(6)：28-30.
[5]马明英,郭仁荣.流行性感冒流行病学进展.安徽预防医学杂志[J].2000.6(6)：476-477.
[6]任成山,钱桂生.甲型H1N1流行性感冒的临床特征与防控策略[J].中华肺部疾病杂志.2009,2(3)：133-138.
[7]张玫.机体抗流感病毒免疫防御机制研究进展[J].黑龙江医药.2010,23(3)：373-376.
[8]王玉红,邓敏.甲型H1N1流感的病原学与发病机制研究进展[J].中华医院感染学杂志.2010,20(24)：4047-4048.
[9]马蕾,李国坚,蒋就喜.人高致病性禽流感病毒的分子生物学研究进展[J].医学综述.2010.16(2)：176-178.
[10]李晓峰,秦鄂德.禽流感病毒的传播、致病机制及其防治[J].解放军医学杂志2009.2(1)：125-130.
[11]林立,李昌崇.呼吸道合胞病毒感染发病机制[J].中华儿科杂志.2006,44(9)：673-675.
[12]杨志云,陈志海.鼻病毒的研究进展[J].现代预防医学.2010,17(14)：2790-2792.
[13]陈娜娜,向冬喜,郑丛龙.腺病毒及其研究进展[J].大连医科大学学报.2010,32(5)：586-590.
[14]McIntosh K徐德芳.发展中国家重症急性呼吸道感染的发病机理：呼吸道合胞病毒和副流感病毒[J].国外医学(微生物学分册).1992,01：13-15.
[15]李金萍.冠状病毒概述.生命科学仪器[J].2007,5(1)：43-46.
[16]王福生,徐东平.SARS冠状病毒的特点和致病机制的研究.传染病信息[J].2003,16(2)：67-68.
[17]黄蓉,段荣.呼吸道病毒检测方法进展与临床意义[J].实验与检验医学.2009,27(4)：393-396.
[18]杨丽华,王小光,丁克颖,骆邻飞,吴菊英,刘继倩.上海市闵行区甲型H1N1流感监测及临床相关特征分析[J].中国卫生检验杂志.2011.21(4)：806-809.
[19]刘春宇.抗流行性感冒病毒药物研究综述[J].中国医药指南.2009,7(11)：205-206.
[20]齐顺祥,刘艳芳,韩光跃,王晓晖,彭世强,刘兰芬.河北省甲型流感病毒金刚烷胺耐药性研究[J].中国病原生物学杂志.2010,5(8)：575-577.
[21]王晓中.奥斯他韦等抗流感病毒药物的应用现状和其耐药机制研究进展[J].口岸卫生控制.2010.15(1)：51-55.
[22]W.H.O. Report Tamiflu-Resistant Flu in U.S. Canada. NEWS. CID.2008:46 (1 April) III.
[23]苏彤,李淑华,鹿文英,韩磊,韩一芳,曹广文.一株新型甲型H1N1流感病毒H275Y的奥司他韦耐药变异分析[J].解放军医学杂志.2009,34(12)：1412-1418.
[24]Kawai N,Ikematsu H,Hirotsu N, et al.Clinical effectiveness of oseltamivir and zanamivir for treatment of influenza A virus subtype H1N1 with the H274Y mutation:a Japanese, multicenter study of the 2007-2008 and 2008-2009 influenza seasons. Clin Infect Dis,2009,49(12):1828-1835.
[25]抗流感病毒药物辛酸拉尼米韦[J].药学进展.2011.35(2)：93-95.
[26]蒋虹,金光,丛喆,鲍琳琳,秦川,魏强.奥司他韦、利巴韦林和盐酸金刚乙胺对甲型H1N1流感病毒的抑制作用[J].中国比较医学杂志.2011,21(2)：23-25.
[27]杨帆,刘艾林,杜冠华.阿比朵尔药理作用与临床应用研究进展[J].中国药学杂志.2010.45(2)：90-92.
[28]李际强,吴小秋,罗翌.外感热病的病因及致病机理探析[J].辽宁中医杂志.2007,34(4)：429-430.
[29]陆翔.时逸人伤寒温病观探析[J].中医杂志.2011,52(4)：278-280.
[30]薛燕星,胡东鹏,陈劲松.外感热病必须融会贯通“伤寒”“温病”和“温疫”学说——薛伯寿教授治疗外感热病学术思想系列之四[J].世界中西医结合杂志.2011,6(10)：832-833.
[31]李素云,李亚,李建生,王明航,王海峰,余学庆.急性上呼吸道感染中医证候及其临床特征的文献研究[J].中医研究.2010,23(3)：71-74.
[32]罗翌,郑丹文,李际强.当代名老中医治疗急性上呼吸道感染的辨证治疗经验统计分析[J].中国中医药现代远程教育.2005(05)：221-222.
[33]彭胜权,李迎敏,林培政等.岭南温病研究.新中医[J].1997,29(10)：2-4.
[34]王伟彪,郑洪.岭南人体质特点与何梦瑶火热论[J].广东医学.1998,19(1)：68-69.
[35]刘叶,钟嘉熙.钟嘉熙教授治疗岭南上呼吸道病毒感染经验撷要[J].北京中医药大学学报(中医临床版).2007,14(5)：24-25.
[36]罗翌,严夏,李际强,李俊,方志坚,华荣.急性上呼吸道感染发热2502例中医证侯分析[J].浙江中医杂志.2005(05)：221-222.
[37]汤朝晖,刘叶,陈宏标,罗炳德,林培政.101例成人急性上呼吸道感染患者的中医证候学分析[J].辽宁中医杂志.2010.37(1)：53-54.
[38]齐文升,马荣,蓝海涛,王颖辉,何龙.2009-2010年314例流感样疾病中医证候特征调研.中国中医药现代远程教育.2010,8(17)：172-175.
[39]王晓才,李安德,黄象安.478例流感样病例的证候特点分析[J].北京中医药大学学报.2011,34(2)：135-139.
[40]胡旭.姜良铎.成人反复上呼吸道感染缓解期的症候学研究[J].浙江中医结合杂志.2005,15(11)：676-677.
[41]余小萍,傅慧婷.中医药防治流感的免疫调节机制的研究概况[J].辽宁中医杂志.2006,33(8)： 1044-1046.
[42]徐咏书,何士勤,孙坚.中草药抗流感病毒的实验研究状况[J].实验与检验医学.2010,28(1)：55-56,85.
[43]李敏,杨瑞芳.黄芩药理学研究进展[J].临床和实验医学杂志.2009,8(1)：137-138.
[44]贺福元,邓凯文,唐昱,李鹏,黄胜,邱云,邹欢,周宏灏.鱼腥草及其制剂的药理与免疫毒理作用研究进展[J].中国药理学与毒理学杂志.2009,23(4)：325-329.
[45]彭爱红.板蓝根药理活性成分及临床应用进展[J].中国当代医药.2010,17(12)：13-14.
[46]孟祥乐,李俊平,李丹,孙习鹏,李颜,余奇,万丽丽,郭澄.连翘的化学成分及其药理活性研究进展[J].中国药房.2010,21(43)：4117-4119.
[47]白丽红,邹宇.金银花的药理分析与应用[J].中国现代药物应用.2011,5(4)：159-160.
[48]潘竞锵,刘惠纯,韩超,刘广南,汤少玲,肖柳英,张丹,林洁茹,郑琳颖,李博萍.银翘散浓缩袋泡剂抗炎解热镇痛抗菌和抗病毒作用[J].广东药学.2003,13(1)：43-47.
[49]阴继爱,戴岳,安树庞.葛根汤的药理和临床研究概况[J].中华中医药学刊.2007,25(6)：1275-1278.
[50]滕晶.桂枝汤双向调节作用药理研究及临床应用概况[J].山东中医药大学学报.2004,28(5)：394-397.
[51]董红红,秦雪梅,郭小青,张丽增.正柴胡饮药理与临床应用研究[J].山西中医.2007,23(2)：56-57.
[52]朱晓宏.小青龙汤现代药理研究及临床应用概况[J].国医论坛.2007,22(6)：52-53.
[53]李际强,张春学,胡溪柳,符林春,朱宇同.升降散抗小鼠流感病毒性肺炎的实验研究[J].实用中医内科杂志.2004,18(1)：28-29.
[54]钱占红,韩雪梅.蒿芩清胆汤临床应用及实验研究概况[J].新中医.2008,40(10)：117-118.
[55]高锐卿,苗相本.玉屏风散在呼吸系统疾病中的药理及临床研究进展[J].浙江中医杂志.2003,07：318-319.
[56]Chen Wang, Bin Cao, Qing-Quan Liu,et al. Oseltamivir Compared With the Chinese Traditional Therapy Maxingshigan-Yinqiaosan in the Treatment of H1N1 Influenza[J]. Annals of Internal Medicine,2011,155(4):217-225.
[57]刘春援,李晓强,蔡绍乾.连花清瘟胶囊的药理与临床研究进展[J].中药药理与临床.2010,26(6)：84-85,21.
[58]卫青,罗宏.连花清瘟胶囊与奥司他韦治疗轻症甲型H1N1流感的疗效观察[J].光明中医.2010,25(12)：2318-2319.
[59]王微,符思,张思新.清开灵治疗病毒性呼吸道疾病40例[J].北京中医药大学学报.1996,19(2)：67.
[60]张炜,毕小利.抗病毒口服液治疗急性上呼吸道感染风热证的RCT研究[J].辽宁中医杂志.2003,30(8)：645.
[61]王慧.双黄连治疗急性上呼吸道感染70例疗效观察[J].中国实用医药.2011,6(6)：170-171.
[62]李瑞梅.痰热清注射液治疗急性上呼吸道感染35例[J].中国中医急症.2011,20(5)：828.
[63]蔡蕊.热毒宁注射液治疗急性上呼吸道感染疗效观察[J].实用中医药杂志.2009,25(8)：555.
[64]罗翌,胡聪,李际强.新香冲剂治疗病毒性上呼吸道感染疗效观察[J].辽宁中医杂志.2007,34(12)：1726-1728.
[65]余衍亮,奚肇庆,张晓云,罗翌,刘清泉,张念志,孙伯青,孙菊光,杜梁枫,郑艳,张丽,耿连艺,张肠.上感颗粒对急性上呼吸道感染患者的退热疗效分析[J].中医杂志.2011,52(6)：486-488.
[66]杨红.流行性感冒的分子流行病学研究进展[J].甘肃科技纵横.2003,32(5)：127,118.
[2]娄海容SARS的临床表现及结局——国外文献综述[J].现代医院.2003,3(4)：41-42.
[3]禽流感患者识别与救治[J].实用心脑肺血管病杂志.2009,1(17)：15.
[4]李铁钢,刘维斯,杨智聪,王玉林,李美霞.2003-2007年广州市流感样病例暴发疫情分析.华南预防医学.2008,34(6)：28-30.
[5]马明英,郭仁荣.流行性感冒流行病学进展.安徽预防医学杂志[J].2000.6(6)：476-477.
[6]任成山,钱桂生.甲型H1N1流行性感冒的临床特征与防控策略[J].中华肺部疾病杂志.2009,2(3)：133-138.
[7]张玫.机体抗流感病毒免疫防御机制研究进展[J].黑龙江医药.2010,23(3)：373-376.
[8]王玉红,邓敏.甲型H1N1流感的病原学与发病机制研究进展[J].中华医院感染学杂志.2010,20(24)：4047-4048.
[9]马蕾,李国坚,蒋就喜.人高致病性禽流感病毒的分子生物学研究进展[J].医学综述.2010.16(2)：176-178.
[10]李晓峰,秦鄂德.禽流感病毒的传播、致病机制及其防治[J].解放军医学杂志2009.2(1)：125-130.
[11]林立,李昌崇.呼吸道合胞病毒感染发病机制[J].中华儿科杂志.2006,44(9)：673-675.
[12]杨志云,陈志海.鼻病毒的研究进展[J].现代预防医学.2010,17(14)：2790-2792.
[13]陈娜娜,向冬喜,郑丛龙.腺病毒及其研究进展[J].大连医科大学学报.2010,32(5)：586-590.
[14]McIntosh K徐德芳.发展中国家重症急性呼吸道感染的发病机理：呼吸道合胞病毒和副流感病毒[J].国外医学(微生物学分册).1992,01：13-15.
[15]李金萍.冠状病毒概述.生命科学仪器[J].2007,5(1)：43-46.
[16]王福生,徐东平.SARS冠状病毒的特点和致病机制的研究.传染病信息[J].2003,16(2)：67-68.
[17]黄蓉,段荣.呼吸道病毒检测方法进展与临床意义[J].实验与检验医学.2009,27(4)：393-396.
[18]杨丽华,王小光,丁克颖,骆邻飞,吴菊英,刘继倩.上海市闵行区甲型H1N1流感监测及临床相关特征分析[J].中国卫生检验杂志.2011.21(4)：806-809.
[19]刘春宇.抗流行性感冒病毒药物研究综述[J].中国医药指南.2009,7(11)：205-206.
[20]齐顺祥,刘艳芳,韩光跃,王晓晖,彭世强,刘兰芬.河北省甲型流感病毒金刚烷胺耐药性研究[J].中国病原生物学杂志.2010,5(8)：575-577.
[21]王晓中.奥斯他韦等抗流感病毒药物的应用现状和其耐药机制研究进展[J].口岸卫生控制.2010.15(1)：51-55.
[22]W.H.O. Report Tamiflu-Resistant Flu in U.S. Canada. NEWS. CID.2008:46 (1 April) III.
[23]苏彤,李淑华,鹿文英,韩磊,韩一芳,曹广文.一株新型甲型H1N1流感病毒H275Y的奥司他韦耐药变异分析[J].解放军医学杂志.2009,34(12)：1412-1418.
[24]Kawai N,Ikematsu H,Hirotsu N, et al.Clinical effectiveness of oseltamivir and zanamivir for treatment of influenza A virus subtype H1N1 with the H274Y mutation:a Japanese, multicenter study of the 2007-2008 and 2008-2009 influenza seasons. Clin Infect Dis,2009,49(12):1828-1835.
[25]抗流感病毒药物辛酸拉尼米韦[J].药学进展.2011.35(2)：93-95.
[26]蒋虹,金光,丛喆,鲍琳琳,秦川,魏强.奥司他韦、利巴韦林和盐酸金刚乙胺对甲型H1N1流感病毒的抑制作用[J].中国比较医学杂志.2011,21(2)：23-25.
[27]杨帆,刘艾林,杜冠华.阿比朵尔药理作用与临床应用研究进展[J].中国药学杂志.2010.45(2)：90-92.
[28]李际强,吴小秋,罗翌.外感热病的病因及致病机理探析[J].辽宁中医杂志.2007,34(4)：429-430.
[29]陆翔.时逸人伤寒温病观探析[J].中医杂志.2011,52(4)：278-280.
[30]薛燕星,胡东鹏,陈劲松.外感热病必须融会贯通“伤寒”“温病”和“温疫”学说——薛伯寿教授治疗外感热病学术思想系列之四[J].世界中西医结合杂志.2011,6(10)：832-833.
[31]李素云,李亚,李建生,王明航,王海峰,余学庆.急性上呼吸道感染中医证候及其临床特征的文献研究[J].中医研究.2010,23(3)：71-74.
[32]罗翌,郑丹文,李际强.当代名老中医治疗急性上呼吸道感染的辨证治疗经验统计分析[J].中国中医药现代远程教育.2005(05)：221-222.
[33]彭胜权,李迎敏,林培政等.岭南温病研究.新中医[J].1997,29(10)：2-4.
[34]王伟彪,郑洪.岭南人体质特点与何梦瑶火热论[J].广东医学.1998,19(1)：68-69.
[35]刘叶,钟嘉熙.钟嘉熙教授治疗岭南上呼吸道病毒感染经验撷要[J].北京中医药大学学报(中医临床版).2007,14(5)：24-25.
[36]罗翌,严夏,李际强,李俊,方志坚,华荣.急性上呼吸道感染发热2502例中医证侯分析[J].浙江中医杂志.2005(05)：221-222.
[37]汤朝晖,刘叶,陈宏标,罗炳德,林培政.101例成人急性上呼吸道感染患者的中医证候学分析[J].辽宁中医杂志.2010.37(1)：53-54.
[38]齐文升,马荣,蓝海涛,王颖辉,何龙.2009-2010年314例流感样疾病中医证候特征调研.中国中医药现代远程教育.2010,8(17)：172-175.
[39]王晓才,李安德,黄象安.478例流感样病例的证候特点分析[J].北京中医药大学学报.2011,34(2)：135-139.
[40]胡旭.姜良铎.成人反复上呼吸道感染缓解期的症候学研究[J].浙江中医结合杂志.2005,15(11)：676-677.
[41]余小萍,傅慧婷.中医药防治流感的免疫调节机制的研究概况[J].辽宁中医杂志.2006,33(8)： 1044-1046.
[42]徐咏书,何士勤,孙坚.中草药抗流感病毒的实验研究状况[J].实验与检验医学.2010,28(1)：55-56,85.
[43]李敏,杨瑞芳.黄芩药理学研究进展[J].临床和实验医学杂志.2009,8(1)：137-138.
[44]贺福元,邓凯文,唐昱,李鹏,黄胜,邱云,邹欢,周宏灏.鱼腥草及其制剂的药理与免疫毒理作用研究进展[J].中国药理学与毒理学杂志.2009,23(4)：325-329.
[45]彭爱红.板蓝根药理活性成分及临床应用进展[J].中国当代医药.2010,17(12)：13-14.
[46]孟祥乐,李俊平,李丹,孙习鹏,李颜,余奇,万丽丽,郭澄.连翘的化学成分及其药理活性研究进展[J].中国药房.2010,21(43)：4117-4119.
[47]白丽红,邹宇.金银花的药理分析与应用[J].中国现代药物应用.2011,5(4)：159-160.
[48]潘竞锵,刘惠纯,韩超,刘广南,汤少玲,肖柳英,张丹,林洁茹,郑琳颖,李博萍.银翘散浓缩袋泡剂抗炎解热镇痛抗菌和抗病毒作用[J].广东药学.2003,13(1)：43-47.
[49]阴继爱,戴岳,安树庞.葛根汤的药理和临床研究概况[J].中华中医药学刊.2007,25(6)：1275-1278.
[50]滕晶.桂枝汤双向调节作用药理研究及临床应用概况[J].山东中医药大学学报.2004,28(5)：394-397.
[51]董红红,秦雪梅,郭小青,张丽增.正柴胡饮药理与临床应用研究[J].山西中医.2007,23(2)：56-57.
[52]朱晓宏.小青龙汤现代药理研究及临床应用概况[J].国医论坛.2007,22(6)：52-53.
[53]李际强,张春学,胡溪柳,符林春,朱宇同.升降散抗小鼠流感病毒性肺炎的实验研究[J].实用中医内科杂志.2004,18(1)：28-29.
[54]钱占红,韩雪梅.蒿芩清胆汤临床应用及实验研究概况[J].新中医.2008,40(10)：117-118.
[55]高锐卿,苗相本.玉屏风散在呼吸系统疾病中的药理及临床研究进展[J].浙江中医杂志.2003,07：318-319.
[56]Chen Wang, Bin Cao, Qing-Quan Liu,et al. Oseltamivir Compared With the Chinese Traditional Therapy Maxingshigan-Yinqiaosan in the Treatment of H1N1 Influenza[J]. Annals of Internal Medicine,2011,155(4):217-225.
[57]刘春援,李晓强,蔡绍乾.连花清瘟胶囊的药理与临床研究进展[J].中药药理与临床.2010,26(6)：84-85,21.
[58]卫青,罗宏.连花清瘟胶囊与奥司他韦治疗轻症甲型H1N1流感的疗效观察[J].光明中医.2010,25(12)：2318-2319.
[59]王微,符思,张思新.清开灵治疗病毒性呼吸道疾病40例[J].北京中医药大学学报.1996,19(2)：67.
[60]张炜,毕小利.抗病毒口服液治疗急性上呼吸道感染风热证的RCT研究[J].辽宁中医杂志.2003,30(8)：645.
[61]王慧.双黄连治疗急性上呼吸道感染70例疗效观察[J].中国实用医药.2011,6(6)：170-171.
[62]李瑞梅.痰热清注射液治疗急性上呼吸道感染35例[J].中国中医急症.2011,20(5)：828.
[63]蔡蕊.热毒宁注射液治疗急性上呼吸道感染疗效观察[J].实用中医药杂志.2009,25(8)：555.
[64]罗翌,胡聪,李际强.新香冲剂治疗病毒性上呼吸道感染疗效观察[J].辽宁中医杂志.2007,34(12)：1726-1728.
[65]余衍亮,奚肇庆,张晓云,罗翌,刘清泉,张念志,孙伯青,孙菊光,杜梁枫,郑艳,张丽,耿连艺,张肠.上感颗粒对急性上呼吸道感染患者的退热疗效分析[J].中医杂志.2011,52(6)：486-488.
[66]杨红.流行性感冒的分子流行病学研究进展[J].甘肃科技纵横.2003,32(5)：127,118.