1. 上海市公共卫生临床中心结核科,上海,201508
2. 上海中医药大学交叉科学研究院,上海,201203
3. 上海中医药大学附属曙光医院传统中医科,上海,201203
4. 上海市公共卫生临床中心中医科,上海,201508
5. 上海市公共卫生临床中心呼吸科,上海,201508
6. 上海中医药大学附属市中医医院消化科,上海,200071
7. 上海市公共卫生临床中心感染与免疫科,上海,201508
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夏露, 吴欢, 刘平, 等. 中西医结合治疗新型冠状病毒肺炎100例疗效及肝损伤情况分析[J]. 上海中医药杂志, 2020,54(7):23-28.
XIA Lu, WU Huan, LIU Ping, et al. Analysis on clinical efficacy and liver injury of 100 cases of COVID-19 treated by integrated traditional Chinese and western medicine[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(7):23-28.
夏露, 吴欢, 刘平, 等. 中西医结合治疗新型冠状病毒肺炎100例疗效及肝损伤情况分析[J]. 上海中医药杂志, 2020,54(7):23-28. DOI: 10.16305/j.1007-1334.2020.07.095.
XIA Lu, WU Huan, LIU Ping, et al. Analysis on clinical efficacy and liver injury of 100 cases of COVID-19 treated by integrated traditional Chinese and western medicine[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(7):23-28. DOI: 10.16305/j.1007-1334.2020.07.095.
目的:回顾性分析100例上海地区新型冠状病毒肺炎(简称“新冠肺炎”)患者中西医结合治疗后的临床疗效及肝损伤情况。 方法:收集2020年1月22日至2020年2月10日上海市公共卫生临床中心收治的100例新冠肺炎患者的出入院临床资料及治疗方案信息,观察舌象、脉象、中医证候及肝损伤情况、临床结局与转归,比较临床症状、炎症及免疫相关指标的变化情况。 结果:①本研究中新冠肺炎患者的中医证型主要以热毒闭肺型、湿毒郁肺型、肺脾气虚型三型为主;实证明显偏多,虚证主要为肺脾气虚,气阴两虚偏少。②入院时无任何症状者有43例(占43.0%);服用中药汤剂以后,52例有症状患者的发热、咳嗽、咳痰、纳差、腹泻等主要症状均有不同程度改善。③中药汤剂治疗前与治疗1周后比较,患者的血清白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)等炎症指标及CD4+等免疫指标差异有统计学意义,均得到明显改善(P<0.05)。④中药汤剂治疗前,共有16例患者已存在轻度肝损伤;将服中药治疗前及治疗1周后的肝功能指标进行比较,发现治疗后其中有2例患者的肝功能恢复正常,其余14例仍存在肝损伤、但均为轻度,且治疗前后肝功能各项指标差异无统计学意义(P>0.05);其余84例患者在中药汤剂治疗前及治疗1周后肝功能各项指标均在正常范围内。⑤本研究中,共有81例(81.0%)患者病愈出院,19例(19.0%)患者仍在治疗中,病死率为0%。出院患者的平均住院时间为(16.0±5.8)d。5例重型患者中有3例病愈出院,剩余2例病情转轻,未向危重型发展,危重症转化率为0%。⑥81例出院患者中,仅有5例(6.2%)患者胸部CT提示肺炎感染病灶完全吸收,剩余76例(93.8%)患者胸部CT仍提示存在不同程度的异常病变。 结论:中西医结合治疗,特别是辨证应用中药汤剂治疗可明显减轻新冠肺炎患者的发热、咳嗽、纳差、腹泻等主要临床症状,改善体内炎症反应及免疫失调,降低病死率及危重症转化率,且不会造成药物性肝损伤。
Objective:To retrospectively analyze the clinical efficacy and liver injury of 100 cases of coronavirus disease 2019 (hereinafter referred to as COVID-19) treated by integrated traditional Chinese and western medicine in Shanghai. MethodsWe collected the clinical data and treatment plan of 100 cases of COVID-19 admitted to Shanghai Public Health Clinical Center from January 22,2020 to February 10,2020, observed the tongue image, pulse condition, TCM syndromes, liver injury indexes, clinical outcome and prognosis, and compared the changes of clinical symptoms, inflammation and immune related indexes. Results:①In this study, COVID-19 cases presented 3 main traditional Chinese medicine (TCM) syndromes:heat toxin blocking the lung, damp toxin stagnating the lung and qi deficiency of the lung and spleen. There were more cases of excess syndrome than cases of deficiency syndrome, and cases of the lung-spleen qi deficiency syndrome were more than cases of the dual deficiency of qi and yin syndrome. ② There were 43 asymptomatic cases (43.0%) at the time of admission. After taking TCM decoction, the main symptoms of 52 symptomatic cases, such as fever, cough, expectoration, poor appetite and diarrhea, were improved to varying degrees. ③There were significant differences in serum leukocyte count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and immune index (CD4,+,) before and after 1 week of TCM decoction treatment (P,<,0.05). ④A total of 16 cases had mild liver injury before the treatment of TCM decoction. By comparing the liver function indexes before and after 1 week of TCM treatment, we found that the liver function of 2 cases recovered to normal after treatment while the other 14 cases still had mild liver injury, and there was no significant difference in liver function indexes before and after treatment (P,>,0.05). The liver function indexes of the other 84 cases were within the normal range before and after 1 week of TCM decoction treatment. ⑤In this study, 81 cases (81.0%) recovered and were discharged from hospital and 19 cases (19.0%) were still under treatment with a mortality rate of 0%. The average hospitalization duration of discharged patients was (16.0±5. 8) days. Of 5 severe cases of COVID-19,3 cases recovered from the disease and were discharged from hospital. The remaining 2 cases turned to mild type and did not develop to critical type. The conversion rate of critical case was 0%. ⑥Of 81 cases discharged from hospital, only 5 cases (6.2%) showed complete absorption of pneumonia infection, and the remaining 76 cases (93.8%) showed abnormal lesions of different degrees on chest CT. Conclusion:The integrated treatment of traditional Chinese and western medicine, especially the application of TCM decoction based on syndrome differentiation, can obviously reduce the main clinical symptoms of patients with COVID-19 such as fever, cough, poor appetite and diarrhea, etc., improve inflammatory reactions and immune imbalance of the body, reduce mortality and critical case conversion rate, and will not cause drug-induced liver injury.
新型冠状病毒肺炎新型冠状病毒中药中西医结合治疗药物性肝损伤无症状感染者结局与转归回顾性分析
COVID-19SARS-CoV-2Chinese herbal medicineintegrated traditional Chinese and western medicine treatmentdrug-induced liver injuryasymptomatic infectionoutcome and prognosisretrospective analysis
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