新型冠状病毒肺炎患者40例临床特点与舌象关系研究

目的研究新型冠状病毒肺炎(COVID-19)患者的临床特点与舌象表现的关系。方法观察40例COVID-19患者的症状、体征、实验室检查、影像学检查结果,并结合舌象进行分析。结果(1)舌象表现:40例患者中,舌质红者40例(100%),其中舌质暗红者19例(47.5%);少苔者5例(12.5%),苔白腻者27例(67.5%),苔黄腻者8例(20.0%)。(2)临床表现:40例患者中,发热27例(67.5%),其中低热(37.3~37.9℃)18例(45.0%)、中热(38~38.9℃)8例(20.0%)、高热(≥39℃)1例(2.5%);咳嗽25例(62.5%),乏力13例(32.5%),咽痛6例(15.0%),肌肉酸痛12例(30.0%),腹泻2例(5.0%)。舌红少苔者症状多轻微,仅有咳嗽、咽痛、乏力等症状,咽痛症状较舌苔厚腻者更为多见,差异有统计学意义(P<0.05);舌苔白腻、黄腻者则以咳嗽、发热的特征性临床表现为主,其中舌苔白腻者以低热为主,舌苔黄腻者发热多为38℃以上的中热或高热,差异有统计学意义(P<0.05)。(3)影像学表现:胸部X线片提示,40例患者中双侧肺部炎症患者13例(32.5%);单侧肺部炎症患者18例(45.0%),其中左肺炎症患者7例(17.5%),右肺炎症患者11例(27.5%);其余9例(22.5%)患者胸部X线片检查均未见明显异常。舌红少苔者影像学检查多无异常,胸部X片提示肺部炎症多为舌苔厚腻者,其中双肺炎症多见于舌红苔黄腻者,差异有统计学意义(P<0.05)(4)实验室检查:40例患者血白细胞计数为(5.17±1.55)×10^9/L,其中异常减低患者3例(7.5%);淋巴细胞计数为(1.39±0.75)×10^9/L,其中异常减低患者8例(20.0%),随着舌苔逐渐厚腻的变化,血白细胞计数逐渐升高,淋巴细胞计数逐渐下降,差异有统计学意义(P<0.05)。结论COVID-19患者舌红少苔多见于疾病早期病程较短者(1~2d),症状多轻微;伴随病程进展(病程≥3d),部分患者舌苔逐渐增多,表现为厚腻苔,症状以咳嗽、发热的特征性临床表现为主,反映了感染逐渐进展的情况,由此及时总结出COVID-19宜采用清热宣肺利湿、不可过用苦寒的治疗原则。

Analysis of the relationship between clinical features and tongue manifestations of 40 cases with corona virus disease 2019

Objective To investigate the relationship between the clinical features and tongue manifestations of corona virus disease 2019(COVID-19)cases.Methods The symptoms,signs,laboratory examinations and imaging examinations of 40 COVID-19 patients together with tongue manifestations were analyzed.Results(1)Tongue manifestations:among 40 cases,all cases(100%)had red tongue,among which 19 cases(47.5%)had dark red tongue.There were 5 cases(12.5%)with little tongue coating,27 cases(67.5%)with white and sticky tongue coating,and 8 cases(20.0%)with yellow and sticky tongue coating.(2)Clinical manifestations:among the 40 patients,27 cases(67.5%)had fever,among them,18 cases(45.0%)had low fever(37.3-37.9℃),8 cases(20.0%)had moderate fever(38-38.9℃),and 1 cases(2.5%)had high fever(≥39℃).There were 25 cases of cough(62.5%),13 cases of fatigue(32.5%),6 cases of pharyngeal pain(15.0%),12 cases of muscle pain(30.0%),and 2 cases of diarrhea(5.0%).Those with red tongue with little tongue coating were milder,with only cough,pharyngeal pain,fatigue and so on,and pharyngeal pain were more common in those with thick and greasy tongue coating,the difference was statistically significant(P<0.05).The patients with white greasy and yellow greasy coating on the tongue were mainly characterized by cough and fever,among which the patients with white greasy coating on the tongue were mainly characterized by low fever,while the patients with yellow greasy coating on the tongue mostly had medium and high fever above 38℃,the difference was statistically significant(P<0.05).(3)Imaging findings:chest X-ray showed that among 40 cases,13 cases had bilateral pulmonary inflammation(32.5%),18 cases(45.0%)had unilateral pulmonary inflammation,including 7 cases(17.5%)of left pneumonia and 11 cases(27.5%)of right pulmonary inflammation,the remaining 9 cases(22.5%)showed no significant abnormality on chest X-ray examination.Most of the patients with red tongue with little tongue coating showed no abnormality in the imaging examination,and the chest X-ray indicated that the pulmonary inflammation was mostly those with thick and greasy coating on the tongue,among which bilateral sides of pneumonia was more common in those with red tongue with yellow greasy coating,the difference was statistically significant(P<0.05).(4)Laboratory examination:the white blood cell count of 40 cases was(5.17±1.55)×10^9/L,among which 3 cases were abnormally decreased(7.5%).The lymphocyte count was(1.39±0.75)×10^9/L,among which 8 cases(20.0%)were abnormally decreased.With the change of thickness and stickiness of tongue coating,the number of white blood cells increased gradually,while the number of lymphocytes decreased gradually,the difference was statistically significant(P<0.05).Conclusion COVID-19 patients with red tongue and little coating were more seen at the early stage with short course of disease(1-2 d),and milder symptoms,along with the progression(course of 3 d or more),the tongue coating become more in some patients,characterized by thick greasy coating,and the clinical manifestations are manifested by cough and fever,reflecting the progress of the infection,therefore,to sum up the therapeutic principle for the COVID-19 cases is heat clearing,lung dispersing and removing dampness without overuse too bitter cold herbal drugs.