文章摘要
汤薪玉,黄伟强,包剑锋.从Delta到Omicron——中医药对新型冠状病毒肺炎的诊治思路初探[J].浙江中医药大学学报,2022,46(11):1211-1218.
从Delta到Omicron——中医药对新型冠状病毒肺炎的诊治思路初探
From Delta VOC to Omicron VOC: Preliminary Study on the Diagnosis and Treatment of COVID-19 by Traditional Chinese Medicine
DOI：10.16466/j.issn1005-5509.2022.11.005
中文关键词: 新型冠状病毒  Delta变异株  Omicron变异株  中医  病机  治则治法
英文关键词: SARS-COV-2  Delta VOC  Omicron VOC  Chinese medicine  pathogenesis  treatment strategy and method
基金项目:杭州市农业与社会发展科研项目(202004A0)；杭州市卫生科技计划重大项目(Z20220098)
作者单位
汤薪玉 浙江中医药大学第四临床医学院　杭州　310053 
黄伟强 浙江中医药大学第四临床医学院　杭州　310053 
包剑锋 浙江中医药大学附属杭州市西溪医院 
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中文摘要:
      [目的] 通过对杭州市新型冠状病毒Delta变异株及Omicron变异株的对比，探讨新型冠状病毒Omicron变异株感染者的中医临床特征。[方法] 采用回顾性研究方法，收集2021年6月11日至2022年2月5日浙江中医药大学附属杭州市西溪医院确诊的35例Delta变异株和152例Omicron变异株感染者的临床资料，比较其一般资料、临床症状、实验室指标、预后之间的差异，同时对40例Omicron变异株感染者入院时舌象情况分布，35例Delta变异株以及152例Omicron变异株感染者中西医结合治疗后的典型舌象情况进行观察，并附医案两则。[结果] 在一般资料方面，Delta变异株组感染者青中年占比更高(P＜0.05)，但Omicron变异株组感染者有低龄化趋势；Omicron变异株组感染者女性占比更大(P＜0.05)；Delta变异株组普通型占比较高，Omicron变异株组以轻型为主(P＜0.05)；初始起病Omicron变异株感染者不发热占比更高(P＜0.05)。在临床症状方面，咳嗽、咳痰、乏力、肌肉酸痛、鼻塞流涕、便溏、味嗅觉减退症状差异无统计学意义(P＞0.05)，而咽痛咽痒、头晕头痛症状Omicron变异株组感染者更突出(P＜0.05)。在实验室指标方面，Delta变异株组感染者免疫球蛋白M(immunoglobulin M，IgM)、白细胞计数、淋巴细胞计数、血小板计数、谷丙转氨酶(glutamic pyruvic transaminase，ALT)水平升高更明显(P＜0.05)。在预后方面，Omicron变异株感染者转阴时间更短，复阳人数更少。在舌象分布方面，Delta变异株感染者以淡红舌或红舌，薄黄或黄腻苔为主；Omicron变异株感染者多见齿痕舌或淡红舌，薄白或薄腻苔。中西医结合治疗后，Delta变异株感染者舌苔多由黄腻苔逐渐转为薄少苔，Omicron变异株感染者多由白腻苔逐渐转为薄白苔。所附医案两则，一则对于Omicron变异株无症状感染者投以新冠扶正透邪方，另一则对于Omicron变异株感染轻型患者投以新冠宣肺解毒汤，均收效甚佳。 [结论] Omicron变异株肺炎感染者有低龄化趋势，隐匿性更强，以轻型为主，初期发热症状不明显，临床表现多见上呼吸道感染症状，咽痛咽痒、头晕头痛表现更为突出，炎症反应较轻，鼻、咽、痰、大便平均转阴天数更短，复阳人数更少，多见淡红舌、齿痕舌，白腻苔，多由风邪裹挟“疫疠之气”致病，病位以卫表为主，其次在肺，具有传播快、致病性低、病因兼杂、协同致病的特点。
英文摘要:
      [Objective] To investigate the clinical characteristics of traditional Chinese medicine(TCM) of SARS-CoV-2 Omicron variants of concern(VOC) by comparing Delta and Omicron variant of coronavirus in Hangzhou. [Methods] A total of 35 patients infected with Delta VOC and 152 patients infected with Omicron VOC in Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University from June 11，2021 to February 5，2022 were collected. The differences of general demographics， clinical symptoms， laboratory examinations and prognosis were analyzed， and the distribution of tongue images of 40 patients infected with Omicron VOC at admission， 35 patients with Delta VOC and 152 patients with Omicron VOC after integrated traditional Chinese and western medicine treatment were observed， and two medical records were attached. [Results] In terms of general data， the proportion of young and middle-aged in the Delta VOC group was higher(P＜0.05)， but the Omicron VOC showed a trend of younger age； the proportion of women in the Omicron VOC group was higher(P＜0.05)； the proportion of common type in Delta VOC group was higher， while that in Omicron VOC group was mainly in light type(P＜0.05). When the two groups were initially infected， the proportion of Omicron VOC group without fever was higher(P＜0.05). In terms of clinical symptoms， there was no significant statistical difference in cough， expectoration， fatigue， muscle soreness， nasal obstruct and runny nose， loose stools， depletion of smell and taste symptoms(P＞0.05)， but sore throat， itching， dizziness and headache symptoms were more prominent in Omicron VOC group(P＜0.05). In terms of laboratory indexes， such as immunoglobulin M(IgM)， white blood cell count， lymphocyte count， platelet count and glutamic pyruvic transaminase(ALT) were more likely to increase in Delta VOC group(P＜0.05). In terms of prognosis， Omicron VOC had shorter days of negative conversion and fewer cases of reviving. In terms of tongue distribution， Delta VOC was mainly in light red tongue or red tongue， mostly thin yellow or yellow greasy moss coating， and Omicron VOC was mainly tooth-marked tongue or light red tongue， mostly thin moss or thin greasy moss coating. In terms of typical tongue changes after integrated traditional Chinese and western medicine treatment， the tongue coating of Delta VOC group was gradually transformed from yellow greasy to thin and small coating， and the tongue coating of Omicron VOC group was gradually transformed from white greasy to thin and white coating. In the two attached medical cases， the Fuzheng Touxie Decoction was applied to asymptomatic infected person， and the Xuanfei Jiedu Decoction was applied to light type， and they achieved good effects. [Conclusion] In the Omicron VOC group， there is a trend of younger age， stronger concealment， and light type is in majority， early fever symptoms are not obvious. In terms of clinical symptoms， upper respiratory tract infection is common， pharyngalgia， itching， dizziness， headache performance are more prominent， and the inflammatory reaction is mild. Nasal， pharyngeal， sputum， stool average negative days are shorter and fewer returners. Light red tongue， teeth-marked tongue and white and greasy fur is common. Omicron VOC is pathogenic by wind pathogen entrapping “epidemic pestilential Qi”， the disease location is mainly in exterior of Wei， and next in the lungs. It has the characteristics of fast transmission， low pathogenicity， complex etiology and synergistic pathogenicity.
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