天津市746例新型冠状病毒感染患者“长新冠”特征和中医证候学特点分析

Characteristics and traditional Chinese medicine syndrome of “long-COVID” of 746 COVID-19 patients in Tianjin

关键词:  新型冠状病毒感染  奥密克戎  “长新冠”  中医证候  康复

Key words:  COVID-19  Omicron  long-COVID  traditional Chinese medicine syndrome  rehabilitation

摘要:

[目的] 研究天津市新型冠状病毒感染患者出院后“长新冠”发生情况和临床特点，以及中医证候学特征，为恢复期患者的康复治疗提供参考。[方法] 以2022年1—3月感染奥密克戎的746例患者为研究对象，分别于出院后3、6个月进行随访调查，于出院3个月时系统查体，进行血常规、生化指标、胸部计算机断层扫描（CT）等检查。[结果] 746例患者中符合“长新冠”定义的有58例（7.8%），“长新冠”症状主要表现为乏力、易疲劳、记忆力减退、入睡困难或多梦易醒、活动后气短等；实验室检查基本趋于正常；36例胸部CT检查显示：肺纹理增多25例，无明显临床意义；索条影11例，肺纤维化2例，提示为陈旧性损伤；肺气肿2例，为基础病；肺结节9例，磨玻璃影1例，提示炎症可能。中医证候学调查发现，最常见的病位证素为脾、心、肺和肾，最常见的病性证素为气虚、阴虚、湿、热。[结论] 奥密克戎感染患者在出院后“长新冠”发生率、肺部影像学损伤较既往毒株发生率低，但乏力、记忆力减退、睡眠障碍等症状需引起关注，中医证候学表现为以气阴两虚证为主，兼有湿（热）、气滞、血瘀诸证。

Abstract:

[Objective] To study the occurrence，clinical characteristics and the syndrome of traditional Chinese medicine（TCM） of COVID-19 patients in Tianjin after discharge，so as to provide evidence for the rehabilitation treatment of convalescent patients. [Methods] A total of 746 patients infected with Omicron between January and March in 2022 were followed up 3 and 6 months after discharge，and they were systematically examined at 3 months after the discharge，for blood routine，biochemical indexes，chest computed tomography （CT）. [Results] Among the 746 patients，58（7.8%） met the definition of long-COVID. The symptoms of long-COVID mainly manifested as fatigue，memory loss，difficulty to fall asleep or wake up from dreams，shortness of breath after activity，etc. Laboratory tests were basically normal. Chest CT examination of 36 people showed that 25 cases of showed increased lung texture，without obvious clinical significance；11 cases of fibrous stripes and 2 cases of pulmonary fibrosis，suggesting old injury；2 cases of emphysema which was underlying disease；9 cases of lung nodules and 1 case of ground-glass opacities，suggesting possible inflammation. The investigation of TCM syndrome found that the most common syndrome elements are spleen，heart，lung and kidney，the most common disease symptoms qi deficiency，yin deficiency，humidity，and heat. [Conclusion] The incidence of long-COVID and lung imaging damage in patients with Omicron infection after discharge is lower than that of previous strains，but the symptoms such as fatigue，memory loss，and sleep disorders still need attention. Qi and yin deficiency，accompanied with humidity（heat），qi stasis and blood stagnation is the most common TCM syndrome.