摘要
目的:分析儿童肺炎的中医证型分布和病情分级情况,并探讨其与临床资料等相关危险因素的相关性。方法:收集安徽省儿童医院收治的430例肺炎患儿的临床资料,包括性别、年龄、既往呼吸道疾病病史、中医证型、肺炎病情分级、咳嗽时长、发热时长、发热峰值、病原体感染情况、呼吸道症状评估、胃肠道症状评估、实验室指标[白细胞计数(white blood cell,WBC)、中性粒细胞计数、血小板计数(platelet,PLT)、C反应蛋白(C reactive protein,CPR)和降钙素原(procalcitonin,PCT)、全身免疫炎症指数(systemic immune-inflammation index,SII)]等,统计肺炎患儿的证型分布和病情分级情况,并分析其与临床资料之间的相关性。结果:430例肺炎患儿中风热闭肺证192例、痰热闭肺证170例、毒热闭肺证33例、湿热闭肺证13例、肺脾气虚证12例;轻症361例、重症69例;单一感染335例、混合感染95例。各证型患儿单一感染率均高于混合感染率,仅风热闭肺证、痰热闭肺证、肺脾气虚证比较,差异具有统计学意义(P<0.05)。风热闭肺证、痰热闭肺证患儿轻症比例高于重症,毒热闭肺证、湿热闭肺证患儿重症比例高于轻症,差异均有统计学意义(P<0.05);肺脾气虚证患儿肺炎病情分级比较,差异无统计学意义(P>0.05)。不同肺炎病情分级患儿在性别、年龄段和既往呼吸道病史方面比较,差异无统计学意义(P>0.05)。不同肺炎病情分级患儿在病原体感染方面比较,差异有统计学意义(P<0.05)。不同中医证型患儿WBC、SII、CRP、PCT及呼吸道症状积分、胃肠道症状积分、发热峰值及发热、咳嗽时长比较,差异均有统计学意义(P<0.05)。不同肺炎病情分级患儿WBC、CRP、LDH比较,差异均无统计学意义(P>0.05);SII、PCT及呼吸道症状积分≥34分、胃肠道症状积分≥8分、咳嗽≥11 d、发热≥7 d、咳嗽≥11 d、热峰≥39.1℃比较,差异均有统计学意义(P<0.05)。Logistic回归分析显示,发热≥7 d、SII>1000×10^(9)·L^(-1)、胃肠道症状积分≥8分、混合感染、湿热闭肺证及毒热闭肺证是重症肺炎的独立危险因素(P<0.05)。结论:430肺炎患儿中,轻症和风热闭肺证最多,毒热闭肺证和湿热闭肺证与重症肺炎密切相关,混合感染、发热时长、SII升高和胃肠道症状是重症肺炎的重要危险因素。
Objective:To analyze the distribution of TCM syndrome types and disease severity in children with pneumonia,and to explore their correlations with related risk factors such as clinical data,etc.,in order to provide references for clinical syndrome differentiation and treatment.Methods:Clinical data from 430 children with pneumonia admitted to Anhui Provincial Children′s Hospital were collected,including gender,age,history of previous respiratory diseases,TCM syndrome type,pneumonia severity classification,duration of cough,duration of fever,peak fever temperature,pathogen infection status,respiratory symptom score,gastrointestinal symptom score,and laboratory indicators[including white blood cell count(WBC),neutrophil count,platelet count(PLT),C-reactive protein(CRP),and procalcitonin(PCT)].The distribution of TCM syndrome types and disease severity among the children with pneumonia was counted,the correlations with clinical data were statistically analyzed,and risk factors related to the classification of pneumonia severity were also investigated.Results:Among 430 children with pneumonia,the TCM syndrome type distribution was as follows:192 cases of wind-heat obstructing the lung syndrome,170 cases of phlegm-heat obstructing the lung syndrome,33 cases of toxic-heat obstructing the lung syndrome,13 cases of dampness-heat obstructing the lung syndrome,and 12 cases of lung-spleen qi deficiency syndrome.Regarding disease severity,361 cases were mild and 69 were severe.In terms of infection,335 cases had single infections and 95 had mixed infections.The rate of single infection was higher than that of mixed infection across all TCM syndrome types,and the differences were statistically significant between wind-heat obstructing the lung syndrome,phlegm-heat obstructing the lung syndrome,and lung-spleen qi deficiency syndrome(P<0.05).The proportion of mild cases was higher than severe cases among children with wind-heat obstructing the lung syndrome and phlegm-heat obstructing the lung syndrome,whereas the proportion of severe cases was higher than mild cases among those with toxic-heat obstructing the lung syndrome and dampness-heat obstructing the lung syndrome,with statistically significant differences(P<0.05).No statistically significant difference was found in pneumonia severity classification for children with lung-spleen qi deficiency syndrome(P>0.05).There were no statistically significant differences in gender,age group,or history of previous respiratory diseases among children with different pneumonia severity classifications(P>0.05).However,a statistically significant difference was observed in pathogen infection among children with different pneumonia severity classifications(P<0.05).Statistically significant differences were found among children with different TCM syndrome types in terms of WBC,SII,CRP,PCT,respiratory symptom scores,gastrointestinal symptom scores,peak fever temperature,and durations of fever and cough(P<0.05).No statistically significant differences were observed in WBC,CRP,or LDH among children with different pneumonia severity classifications(P>0.05).However,statistically significant differences were found for SII,PCT,respiratory symptom scores≥34,gastrointestinal symptom scores≥8,cough duration≥11 days,fever duration≥7 days,and peak fever temperature≥39.1℃(P<0.05).Logistic regression analysis revealed that fever duration≥7 days,SII>1,000×10^(9)·L^(-1),gastrointestinal symptom scores≥8,mixed infections,dampness-heat obstructing the lung syndrome,and toxic-heat obstructing the lung syndrome were independent risk factors for severe pneumonia(P<0.05).Conclusion:Among 430 children with pneumonia,mild cases and wind-heat obstructing the lung syndrome were the most common types.Toxic-heat obstructing the lung syndrome and dampness-heat obstructing the lung syndrome were closely associated with severe pneumonia.Mixed infections,prolonged fever duration,elevated SII,and gastrointestinal symptoms were major risk factors for severe pneumonia.
作者
徐萍
周陶成
XU Ping;ZHOU Taocheng(Anhui Provincial Children's Hospital,Hefei,Anhui,China,230041)
出处
《河南中医》
2026年第3期437-443,共7页
Henan Traditional Chinese Medicine
基金
安徽省中医药传承创新发展研究项目(2022ZYZD03)。
关键词
儿童肺炎
风热闭肺证
痰热闭肺证
毒热闭肺证
湿热闭肺证
中医证型
病原体
childhood pneumonia
wind-heat obstructing the lung syndrome
phlegm-heat obstructing the lung syndrome
toxic-heat obstructing the lung syndrome
dampness-heat obstructing the lung syndrome
Chinese medicine syndrome types
pathogen
