摘要
目的基于潜在类别分析方法对新型冠状病毒肺炎(简称新冠肺炎)患者的中医初始症状及现症进行分类,探讨新冠肺炎的核心病机。方法采集2020年2-3月18家医院650例新冠肺炎患者的中医初始症状及中医现症,根据阳性率纳入相关指标,对纳入的中医临床症状的二分类信息进行潜在类别分析,识别其核心病机和中医证候诊断分类。具体分析过程包括概率参数化、参数估计与模型拟合、潜在分类与结果的中医理论解释。结果初始症状纳入分析的病例数为605例、症状指标23个,根据阳性率纳入初始症状指标17个,最终取3个类别的潜在类别模型。潜在类别1证候要素的病性为温(热)邪、痰湿和气虚,病位在肺;潜在类别2证候要素的病性为温(热)邪和气虚;潜在类别3证候要素的病性为温(热)邪、痰湿和气虚,病位为肺;综合分析,新冠肺炎发病时的主要证候要素病性为温(热)邪、痰湿、气虚,病位是卫表、肺。中医现症纳入分析的病例数为650例、症状指标55个,根据阳性率纳入现症指标43个,最终取4个类别的潜在类别模型。潜在类别1证候要素的病性为温(热)邪、湿邪、痰邪、气虚,病位主要在肺,分类命名为湿温(热)毒蕴、痰热郁肺;潜在类别2证候要素的病性为温(热)邪、湿邪、气虚,病位主要在脾,分类命名为湿温(热)毒蕴、脾失健运;潜在类别3证候要素的病性为湿邪、温(热)邪,病位主要在脾,分类命名为湿温(热)毒蕴、气阴两伤;潜在类别4证候要素的病性是温(热)邪、湿邪、气虚、阴虚,病位在脾、心,分类命名为湿温(热)毒蕴、心脾两虚。结论基于潜在类别分析方法,新冠肺炎发病初期的证候为湿温(热)毒袭卫表,继而犯肺,兼有肺气不足;其核心病机为湿温(热)毒蕴,兼见痰热郁肺、脾失健运、气阴两伤、心脾两虚。
Objective To analyze the initial symptoms and present traditional Chinese medicine(TCM)syndromes in patients with coronavirus disease 2019(COVID-19)through latent class analysis(LCA),and to explore the core pathogenesis.Methods The elements of initial symptoms and present TCM syndromes in 650 COVID-19 patients were collected from 18 hospitals between February and March,2020.Elements with high prevalence rate were included.The included elements as binary variables were analyzed to figure out the core pathogenesis of COVID-19 as well as TCM syndrome classification for diagnosis with LCA method.The specific analysis process included probability parameterization,parameter estimation and model fitting,latent class analysis,and interpretation of the results using TCM theory.Results Elements of initial TCM symptoms were collected in 605 patients with COVID-19;and 17 out of 23 initial symptoms were included for LCA model with 3 classes.Class 1 included the syndrome elements belonging to damp(heat)pathogen,phlegm-damp and qi deficiency,indicating that the disease location was at lung.The syndrome elements included in Class 2 showed that the nature of disease was warm(heat)pathogen and qi deficiency.Class 3 was composed of the syndrome elements of warm(heat)pathogen,phlegm damp and qi deficiency,and revealed that the disease location was at lung.In conclusion,the nature of initial COVID-19 was mainly warm(heat)pathogen,phlegm damp,and qi deficiency,and the location of disease was wei-exterior and lung.In terms of present syndromes of COVID-19 from 650 patients,43 out of 55 elements were included in LCA model with 4 classes.Class 1,named damp-warm(heat)toxin accumulation and phlegm-heat obstructing lung,included the elements of warm(heat)pathogen,damp pathogen,phlegm pathogen,and qi deficiency,and identified lung as the disease location.Class 2 included syndrome of damp-warm(heat)toxic accumulation and spleen failing to transport,of which the nature elements were warm(heat)pathogen,damp pathogen and qi deficiency,and the di
作者
陆炜青
钱刘兰
翟洪军
黄亚博
王一
林杰
程逸文
沈春锋
黄晓珊
庄鑫
陈启光
申春悌
LU Weiqing;QIAN Liulan;ZHAI Hongjun;HUANG Yabo;WANG Yi;LIN Jie;CHENG Yiwen;SHEN Chunfeng;HUANG Xiaoshan;ZHUANG Xin;CHEN Qiguang;SHEN Chunti(Changzhou Hospital of Traditional Chinese Medicine,Changzhou,213001;Changzhou NO.2 Peopled Hospital;Jinling Institute of Technology;Jiangsu Research Center for Chinese Medicine Development;Changzhou NO.3 People^s Hospital;Nanjing University of Chinese Medicine;School of Public Health,Southeast University)
出处
《中医杂志》
CSCD
北大核心
2021年第4期296-302,共7页
Journal of Traditional Chinese Medicine
关键词
新型冠状病毒肺炎
潜在类别分析
中医证候
证候要素
湿温毒疫
coronavirus disease 2019
latent class analysis
traditional Chinese medicine syndromes
syndrome elements
damp-warm epidemic toxin
