湖北省2132例新型冠状病毒感染的真实世界临床研究_黄超群.pdf

中华中医药杂志(原中国医药学报)2023年2月第38卷第2期 CJTCMP,February 2023,Vol.38,No.2 896 湖北省2 132例新型冠状病毒感染的 真实世界临床研究黄超群1,2,3,4，吕文亮4,5，李昊4，高清华4,6，肖勇4,7，杨旻4,6，杨海军4,6，刘林4,5，曾兰4,5，孙易娜4,5，孙玉洁4,5，孙勤国8，魏力9，何东初10，李绪贵11，曾勇12，费新应13，曾江琴4,5，张思依4,5，向阳4,5，徐晓惠4,5，王仁礼4,5（1湖北省中医院，武汉 430061；2湖北中医药大学附属医院，武汉 430061；3湖北省中医药研究院，武汉 430074；4湖北中医药大学疫病研究所，武汉 430061；5湖北中医药大学中医临床学院，武汉 430061；6湖北中医药大学基础医学院，武汉 430061；7湖北中医药大学信息工程 学院，武汉 430061；8武汉市第三医院，武汉 430060；9武汉市中西医结合医院，武汉 430022；10中国人民解放军中部战区总医院，武汉 430070；11湖北 六七二中西医结合骨科医院，武汉 430079；12黄冈市中医医院，黄冈 438000；13黄石市中医医院，黄石 435000）摘要：目的：观察湖北省定点医院中医药治疗新型冠状病毒感染（COVID-19）普通型、重型患者的临床疗效。方法：此项为多中心、回顾性队列研究，收集了2019年12月27日2020年3月28日湖北省8家定点医院中采用中医药、中西医结合或西医治疗的普通型、重型COVID-19患者共2 132例临床资料，分析病死率、临床结局、肺部影像改善、核酸转阴时间、实验室指标，并对比分析中医组、中西医组、西医组疗效。结果：2 132例患者以普通型为主，重型者以老年人（60岁）居多。普通型患者首发症状前5位依次为咳嗽、乏力、发热、咳痰、纳差，重型患者依次为咳嗽、乏力、发热、咳痰、憋闷或喘促。普通型患者头痛、肌肉或关节疼痛、纳差、腹泻、恶心或呕吐、腹痛占比高于重型者（P0.05）。重型患者中接受中西医结合治疗的患者病死率（5.0%，26/523）低于西医组（12.5%，5/40）（P0.05）。普通型患者的有效率中医组为95.16%（118/124），中西医组为91.79%（1 218/1 327），均显著优于西医组的73.68%（56/76）（P0.05）；重型患者的有效率中医组为100.00%（42/42），中西医组为92.93%（486/523），均显著优于西医组的82.50%（33/40）（P0.05）。中西医组重型患者核酸转阴天数为10 d较普通型患者的12 d短（P0.05）。普通型患者中西医组的淋巴细胞计数增长幅度显著高于西医组（P0.01）；与西医组比较，中西医组、中医组可降低普通型患者中性粒细胞/淋巴细胞比值（P0.01）；与西医组比较，中西医组可显著降低重型患者直接胆红素及谷草转氨酶水平，增加白蛋白水平（P0.05）。结论：中医药治疗COVID-19普通型、重型患者显出其优势，中西医结合模式能降低重型COVID-19患者病死率，对治疗COVID-19具有价值，对疫情防治具有一定指导意义。关键词：新型冠状病毒感染；定点医院；中西医结合；临床疗效；真实世界；回顾性队列研究基金资助：国家重点研发计划（No.2020YFC0845300），湖北省科学技术厅重点研发计划项目（No.2020 BCB015）2 132 cases of Corna Virus Disease 2019 in Hubei province:A real-world studyHUANG Chao-qun1,2,3,4,LYU Wen-liang4,5,LI Hao4,GAO Qing-hua4,6,XIAO Yong4,7,YANG Min4,6,YANG Hai-jun4,6,LIU Lin4,5,ZENG Lan4,5，SUN Yi-na4,5,SUN Yu-jie4,5,SUN Qin-guo8，WEI Li9,HE Dong-chu10,LI Xu-gui11，ZENG Yong12,FEI Xin-ying13，ZENG Jiang-qin4,5,ZHANG Si-yi4,5,XIANG Yang4,5，XU Xiao-hui4,5,WANG Ren-li4,5 临床报道 通信作者：吕文亮，湖北省武汉市武昌区昙华林188号湖北中医药大学，邮编：430061，电话：027-68890188E-mail:内文2.indd 8962023/2/28 10:36:52中华中医药杂志(原中国医药学报)2023年2月第38卷第2期 CJTCMP,February 2023,Vol.38,No.2 897（1Hubei Provincial Hospital of Traditional Chinese Medicine,Wuhan 430061,China;2Affiliated Hospital of Hubei University of Traditional Chinese Medicine,Wuhan 430061,China;3Hubei Academy of Traditional Chinese Medicine,Wuhan 430074,China;4Institute of Epidemic Research,Hubei University of Chinese Medicine,Wuhan 430061,China;5Clinical College of Traditional Chinese Medicine,Hubei University of Chinese Medicine,Wuhan 430061,China;6Basic Medical College School of Traditional Chinese Medicine,Hubei University of Chinese Medicine,Wuhan 430061,China;7College of Information Engineering,Hubei University of Chinese Medicine,Wuhan 430061,China;8Wuhan Third Hospital,Wuhan 430060,China;9Wuhan Hospital of Traditional Chinese and Western Medicine,Wuhan 430022,China;10General Hospital of Central Theater of Chinese Peoples Liberation Army,Wuhan 430070,China;11Hubei 672 Orthopaedics Hospital of Integrated Chinese&Western Medicine,Wuhan 430079,China;12Huanggang Hospital of Traditional Chinese Medicine,Huanggang 438000,China;13Huangshi Hospital of Traditional Chinese Medicine,Huangshi 435000,China)Abstract:Objective:To observe the clinical effectiveness of traditional Chinese medicine(TCM)in the treatment of Corona Virus Disease 2019(COVID-19)common and severe type in designated hospitals of Hubei Province.Methods:This was a multi-center,retrospective,cohort study.A total of 2 132 common and severe COVID-19 patients treated with TCM,integrated Chinese and Western medicine(TCM-WM)or western medicine(WM)were collected from 8 designated hospitals in Hubei Province from December 27,2019 to March 28,2020.To analyze the fatality rate,clinical outcome,lung image improvement,nucleic acid negative conversion time and laboratory indicators,and compare the efficacy of the TCM group,the TCM-WM group and the WM group.Results:The majority of the 2 132 patients were common type,and most of the severe patients were the elderly(60 years old).The first five symptoms of common type were cough,fatigue,fever,sputum,poor tolerance,and severe type were cough,fatigue,fever,sputum,stiffness or shortness of breath in order.The proportion of headache,muscle or joint pain,fatigue,diarrhea,nausea or vomiting,and abdominal pain in normal type was higher than that in severe type(P0.05).The case fatality rate of severe patients in TCM-WM group(5.0%,26/253)was lower than that of WM group(12.5%,5/40)(P0.05).The effective rate of TCM group was 95.16%(118/124)and that of TCM-WM group was 91.79%(1 218/1 327),which was higher than that of 73.68%(56/76)in WM group(P0.05).The effective rate was 100.00%(42/42)in TCM group and 92.93%(486/523)in TCM-WM group,which was higher than that of 82.50%(33/40)in WM group(P0.05).The days of negative nucleic acid conversion in severe patients of TCM-WM group were 10 d in WM,which was shorter than 12 in normal patients(P0.05).The increase of lymphocyte count in TCM-WM group of common type patients was significantly higher than that in WM group(P0.01);Compared with WM group,TCM-W