摘要
目的系统评价2019新型冠状病毒肺炎(新冠肺炎)中医证候发生率,为规范新冠肺炎中医辨证提供依据。方法计算机检索中国知网、中华医学期刊网、PubMed、Embase数据库自建库至2020年3月31日发表的有关新冠肺炎中医证候的横断面调查和病例系列研究,由2名研究员独立筛选文献,提取中医证候等相关数据,并依据JBI循证卫生保健中心推荐的质量评估工具进行文献质量评价,应用Stata 14.0软件对中医证候进行单组率Meta分析。结果最终纳入横断面研究13篇、病例系列研究5篇,共计2139例患者。对横断面调查研究的分析显示,在混杂因素的识别、控制及分析方法准确性上风险偏倚较高,在结局指标测量的信度和效度方面描述不清楚;对病例系列研究的分析显示,整体风险偏倚较小,但缺乏评估纳入患者全面性的描述。对纳入的18篇文献中病位与病性证素一致的中医证候进行合并,共整理出新冠肺炎中医证候33种,其中发生数≥50例、发生率≥10%以及有统计学意义〔指95%可信区间(95%CI)不跨越无意义线0〕的中医证候有10种,分别是寒湿阻肺证(469例、发生率28.2%、95%CI为5.9%~50.6%)、湿热蕴肺证(247例、发生率32.1%、95%CI为10.7%~53.6%)、疫毒闭肺证(228例、发生率28.9%、95%CI为12.5%~45.2%)、肺脾气虚证(202例、发生率22.1%、95%CI为9.5%~34.7%)、湿毒郁肺证(180例、发生率41.2%、95%CI为18.4%~64.1%)、湿阻肺脾证(81例、发生率56.3%、95%CI为48.1%~64.4%)、邪热壅肺证(76例、发生率31.1%、95%CI为25.3%~36.9%)、湿阻肺胃证(70例、发生率13.4%、95%CI为10.4%~16.3%)、热毒闭肺证(55例、发生率16.9%、95%CI为8.3%~25.5%)、气阴两虚证(53例、发生率13.7%、95%CI为2.7%~24.8%)。亚组分析显示,横断面研究符合上述条件的中医证候有6种,分别为寒湿阻肺证(200例、发生率20.9%、95%CI为12.6%~29.2%)、湿热蕴肺证(221例、发生率41.8%、95%CI为9.4%~74.2%)、湿毒郁肺证(120例、发生率41.4%、95%CI为8.6%~74.3%)、肺脾气虚证(115例、发生率19.2%、95%CI为6.8%~31.7%)、邪热壅肺证(76例、发生率31.1%、95%CI为25.3%~36.9%)和气阴两虚证(53例、发生率13.7%、95%CI为2.7%~24.8%);病例系列研究有3种,分别为疫毒闭肺证(133例、发生率44.0%、95%CI为24.5%~63.4%)、肺脾气虚证(87例、发生率38.7%、95%CI为32.3%~45.0%)、湿毒郁肺证(60例、发生率40.6%、95%CI为29.3%~52.0%)。结论2019新冠肺炎中医证候分布较广泛、复杂,主要中医证候有寒湿阻肺证、湿热蕴肺证、疫毒闭肺证、肺脾气虚证、湿毒郁肺证、湿阻肺脾证、邪热壅肺证、湿阻肺胃证、热毒闭肺证和气阴两虚证10种,可为新冠肺炎中医辨证规范提供参考。
Objective To systematically evaluate the incidence of coronavirus disease 2019(COVID-19)syndrome in traditional Chinese medicine(TCM),and to provide a basis for the standard of COVID-19 syndrome differentiation.Methods CNKI,China Medical Journal Network,PubMed and Embase databases were searched by computer,and TCM syndrome data of COVID-19 cross-sectional surveys and case series were collected from the establishment of the database to March 31st in 2020.Two researchers independently screened the literature,extracted relevant data such as TCM syndromes,and evaluated the quality of the literature according to the quality assessment tool recommended by the JBI Evidence-Based Health Care Center.Stata 14.0 software was used to perform a single-group Meta-analysis of TCM syndromes.Results Thirteen cross-sectional studies and 5 case series studies were included,with a total of 2139 patients.The analysis of the cross-sectional studies showed that the risk bias was higher in the identification,control and accuracy of the confounding factors,and the description of the reliability and validity of the outcome indicators was unclear.The analysis of the case series studies showed that the overall risk bias was small,but there was a lack of a comprehensive description of the assessment when selecting patients.A total of 33 TCM syndromes of COVID-19 were sorted out by combining the TCM syndromes with the same disease position and pathogenic syndrome in the included 18 literatures,and there were 10 types of TCM syndromes of which the number of occurrences was≥50,the incidence rate was≥10%,and had statistical significance[indicated that 95%confidence interval(95%CI)didn't cross the meaningless line 0],including cold dampness syndrome(469 cases,incidence rate was 28.2%,95%CI was 5.9%-50.6%),damp heat syndrome(247 cases,incidence rate was 32.1%,95%CI was 10.7%-53.6%),epidemic closed lung syndrome(228 cases,incidence rate was 28.9%,95%CI was 12.5%-45.2%),pulmonary and spleen Qi deficiency syndrome(202 cases,incidence rate was 22.1%,95%CI was 9.5%-34.7%),dampness stagnation lung syndrome(180 cases,incidence rate was 41.2%,95%CI was 18.4%-64.1%),dampness obstructing lung and spleen syndrome(81 cases,incidence rate was 56.3%,95%CI was 48.1%-64.4%),evil heat syndrome lung syndrome(76 cases,incidence rate was 31.1%,95%CI was 25.3%-36.9%),dampness-blocking lung and stomach syndrome(70 cases,incidence rate was 13.4%,95%CI was 10.4%-16.3%),heat poisoning lung closure syndrome(55 cases,incidence rate was 16.9%,95%CI was 8.3%-25.5%),and Qi-Yin deficiency syndrome(53 cases,incidence rate was 13.7%,95%CI was 2.7%-24.8%).Subgroup analysis showed that there were 6 types of TCM syndromes that met the above conditions in cross-sectional studies,namely cold and damp lung syndrome(200 cases,incidence rate was 20.9%,95%CI was 12.6%-29.2%),damp heat syndrome(221 cases,incidence rate was 41.8%,95%CI was 9.4%-74.2%),dampness-disease lung syndrome(120 cases,incidence rate was 41.4%,95%CI was 8.6%-74.3%),lung and spleen Qi deficiency syndrome(115 cases,incidence rate was 19.2%,95%CI was 6.8%-31.7%),heat-fever lung syndrome(76 cases,incidence rate was 31.1%,95%CI was 25.3%-36.9%)and Qi-Yin deficiency syndrome(53 cases,incidence rate was 13.7%,95%CI was 2.7%-24.8%).There were 3 kinds of TCM syndromes in case series studies,which were virus closed lung syndrome(133 cases,incidence rate was 44.0%,95%CI was 24.5%-63.4%),lung and spleen Qi deficiency syndrome(87 cases,incidence rate was 38.7%,95%CI was 32.3%-45.0%),and dampness and depression lung syndrome(60 cases,incidence rate was 40.6%,95%CI was 29.3%-52.0%).Conclusions The TCM syndromes of COVID-19 syndrome were widely distributed and complex.The main TCM syndromes were cold dampness syndrome,damp heat syndrome,epidemic closed lung syndrome,pulmonary and spleen Qi deficiency syndrome,dampness stagnation lung syndrome,dampness obstructing lung and spleen syndrome,evil heat syndrome lung syndrome,dampness-blocking lung and stomach syndrome,heat poisoning lung closure syndrome,Qi-Yin deficiency syndrome,which can provide reference for the standard of TCM syndrome differentiation of COVID-19.
作者
李宣霖
刘文瑞
何雯青
谢洋
李建生
Li Xuanlin;Liu Wenrui;He Wenqing;Xie Yang;Li Jiansheng(Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan&Education Ministry of P.R.China/Henan Key Laboratory of Chinese Medicine for Respiratory Disease,Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China;Department of Respiratory Diseases,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第6期664-670,共7页
Chinese Critical Care Medicine
基金
河南省新型冠状病毒防控应急攻关项目(201100310400,201100310500)
河南省中原学者科学家工作室项目(2018-204)
河南省高校科技创新人才支持计划项目(19HASTIT008)。
关键词
新型冠状病毒肺炎
中医
证候
单组率
META分析
Coronavirus disease 2019
Traditional Chinese medicine
Syndrome
Single-group rate
Meta-analysis
