499例甲型流行性感冒轻症中医证候分析

Traditional Chinese medicine syndrome analysis of 499 cases of mild influenza A

关键词:  甲型流行性感冒  中医证候  潜在类别分析  Logistic回归分析

Key words:  influenza A  syndrome of traditional Chinese medicine  latent category analysis  logistic regression analysis

摘要:

[目的] 采用潜在类别分析探讨甲型流行性感冒轻症中医证候。[方法] 收集甲型流感轻症患者四诊信息，采用SPSS 25.0和Mplus 8.3软件，对描述性数据进行频次分析，通过因子分析提取甲型流感轻症相关性较大的条目，再对其进行潜在类别分析，总结主要中医证候，并对可能影响中医证候分布的因素进行Logistic回归分析。[结果] 共纳入499例患者，症状频次由高到低依次为咳嗽、肌肉酸痛、乏力、咽红、头重痛等，通过因子分析提取出22个甲流轻症相关性大的症状条目，经潜在类别分析得出4类中医证候表现组合，分别为风寒束表证（25.1%）、风热犯卫夹湿证（44.5%）、表寒里热证（20%）、风热犯卫证（10.4%），Logistic回归分析显示以风热犯卫夹湿证为参照，病程≤1 d表现为风寒束表证的可能性是病程＞2天的1.955倍（OR=1.955，95%CI=1.024～3.732，P=0.042），就诊前未用药表现为风寒束表证、表寒里热证的可能性分别是就诊前使用抗病毒药物的0.267倍（OR=0.267，95%CI=0.087～0.822，P=0.021）和0.281倍（OR=0.281，95%CI=0.081～0.975，P=0.046）。[结论] 甲型流感轻症多数为风热犯卫夹湿证，其次为风寒束表证、表寒里热证、风热犯卫证；病程短以风寒束表证为主，未用抗病毒药物以风热犯卫夹湿证为主。

Abstract:

[Objective] To explore the Chinese medicine evidence for mild influenza A illness using latent class analysis.[Methods] Information on four consultations of patients with mild influenza A was collected,and SPSS 25.0 and Mplus 8.3 software were used to analyze the frequency of descriptive data,extract the items with greater relevance to mild influenza A by factor analysis,and then perform potential category analysis to summarize the main Chinese medicine symptoms,and perform logistic regression analysis on the factors that might affect the distribution of Chinese medicine symptoms.[Results] A total of 499 patients were included,and the frequency of symptoms,in descending order,were cough,muscle pain,fatigue,red throat,and severe headache,etc.. Twenty-two symptomatic items of high relevance to the mild symptoms of influenza A were extracted by factor analysis,and four types of traditional Chinese medicine symptom manifestation combinations were derived from the analysis of potential categories,namely,the wind-cool bundle of surface symptoms(25.1%),the wind-heat offending the wei and dampness symptoms(44.5%),the surface cold and internal heat symptoms(20%)(10.4%)[1]. Logistic regression analysis showed that with the wind-heat offending the guard and entrapping dampness syndrome as the reference,the likelihood of manifesting the wind-cold bundled surface syndrome for a disease duration of ≤ 1 day was 1.955 times higher than that of a disease duration of >2 days(OR=1.955,95%CI=1.024-3.732,P=0.042),and that the likelihood of manifesting the wind-cold bundled surface syndrome and the epidemiological-cold and internal-heat syndrome without the use of medication prior to the visit was higher than that of using antidotes prior to the visit,respectively were 0.267 times more likely(OR=0.267,95%CI=0.087-0.822,P=0.021) and 0.281 times more likely(OR=0.281,95%CI=0.081-0.975,P=0.046),respectively than those who had used antiviral medication prior to the consultation.[Conclusion] Most of the mild cases of influenza A were wind-heat against the guard and dampness syndrome,followed by wind-cold bundle surface syndrome,surface-cold and internal-heat syndrome,and wind-heat against the guard. The short course of disease is mainly due to exterior syndrome of wind-cold bundle,and the syndrome of wind-heat invading wei and dampness is the main one without antiviral drugs.