天津市85例新型冠状病毒肺炎出院患者中医体质类型和临床特征分析

Analysis of traditional Chinese medicine constitution types and clinical characteristics of 85 discharged patients with COVID-19 in Tianjin

关键词:  新型冠状病毒肺炎  中医体质  T淋巴细胞亚群  肺部计算机断层扫描  康复

Key words:  COVID-19  TCM constitution  T lymphocyte subsets  lung CT  rehabilitation

摘要:

[目的] 采集天津市新型冠状病毒肺炎出院患者体检和中医体质辨识资料，分析其临床特征和中医体质类型，为进一步开展新型冠状病毒肺炎患者中医康复工作提供参考。[方法] 采用横断面研究方法，纳入85例天津市新型冠状病毒肺炎出院康复12～17个月患者为研究对象，进行抗体检查、血常规、生化指标、T淋巴细胞亚群、心脏彩超、肝胆胰脾彩超、泌尿系彩超、肺部计算机断层扫描（CT）、中医体质辨识等检查并对结果进行分析。[结果] 85例恢复期患者IgG（+）61人（占71.76%），T淋巴细胞亚群中淋巴细胞绝对数目（CD45⁺Lym）降低70例（82.36%），总T淋巴细胞绝对数目（CD3⁺）降低60例（70.59%），辅助/诱导T淋巴细胞绝对数目（CD3⁺CD4⁺）降低57例（67.06%），抑制/细胞毒T淋巴细胞绝对数目（CD3⁺CD8⁺）降低40例（47.06%）。肺部CT异常表现为肺纹理增多者78例，肺部结节影者24例，纵隔淋巴结影者9例，磨玻璃影者3例，肺纤维化者3例，肺气肿3例。中医体质辨识主体质类型中以平和质多见（47.62%），其次为血瘀质（17.85%）、气虚质（15.48%）和湿热质（8.33%）。[结论] 新型冠状病毒肺炎患者在出院康复12~17个月后仍部分存在免疫功能下降、肺部慢性炎症反应等后遗症状，中医体质虽整体趋于平和质，但瘀血质、气虚质和湿热质仍兼见其中，提示中医药可从体质类型对新型冠状病毒肺炎患者进行长期康复并需加强随访。

Abstract:

[Objective] To collect the physical examination and traditional Chinese medicine(TCM) constitution identification data of discharged patients with COVID-19 in Tianjin,analyze their clinical characteristics and TCM constitution types,and provide reference for further TCM rehabilitation of patients with COVID-19.[Methods] A cross-sectional study was carried out in 85 patients with COVID-19 in Tianjin who were discharged from hospital for 12 to 17 months. Antibody examination,blood routine examination,biochemical indexes,T lymphocyte subsets,echocardiography,liver,gallbladder,pancreas,spleen,urinary system ultrasound,lung CT,and TCM constitution identification were performed and the results were analyzed.[Results] There were 61 patients (71.76%) with IgG(+) in 85 convalescent patients. Among T lymphocyte subsets,CD45⁺ Lym decreased in 70 cases (82.36%),CD3+ decreased in 60 cases (70.59%),CD3⁺CD4⁺ decreased in 57 cases (67.06%),and CD3⁺CD8⁺ decreased in 40 cases (47.06%). The abnormal manifestations of lung CT included 78 cases of increased lung texture,24 cases of pulmonary nodules,9 cases of mediastinal lymph node shadow,3 cases of ground glass shadow,3 cases of pulmonary fibrosis,and 3 cases of emphysema. The main constitution types of TCM constitution identification are balanced constitution(47.62%),followed by blood stasis constitution (17.85%),qi deficiency constitution (15.48%) and dampness-heat constitution (8.33%).[Conclusion] There are still some sequelae such as decreased immune function and chronic pulmonary inflammatory response in patients with COVID-19 after 12 to 17 months of discharge rehabilitation. Although the overall TCM constitution type tends to be balanced constitution,blood stasis,qi deficiency and dampness heat constitution still coexist,suggesting that traditional Chinese medicine can carry out long-term rehabilitation for patients with COVID-19 from the TCM constitution type and need to strengthen follow-up.