36例新型冠状病毒肺炎(COVID-19)患者舌象观察

目的探究新型冠状病毒肺炎患者的舌象特征。方法收集36例新型冠状病毒肺炎患者的临床资料,采用数码相机对舌苔摄像,比较初期、中期、重症期及恢复期,比较普通型、重型与危重型舌象特征。结果 18例(50.00%)患者舌象见齿痕,28例(77.78%)患者舌苔腻。初期最常见舌象为舌淡红(33.33%)、舌红(33.33%)、舌苔白(厚)腻(83.33%)。中期舌象常见舌象为舌淡红(36.36%)、舌红(31.82%)、舌苔黄(厚)腻(72.73%)。重症期舌象为舌暗红,苔黄厚燥或舌红少苔。恢复期常见舌象为舌淡红(71.43%)、白(厚)腻(28.57%)。普通型最常见的舌象为舌淡红(48.28%)、苔黄(厚)腻(55.17%)、白(厚)腻(27.59%)。重型最常见舌象为舌红(60.00%)、苔白(厚)腻(40.00%),危重型舌象为舌暗红,苔黄厚燥或舌红少或无苔。结论本病舌象表现多为舌淡红或红,兼齿痕,苔白腻为主,随病程进展,兼见舌暗红、苔黄(厚)腻、黄燥、或少苔。     

外科手术创伤相关因素的现代中医舌象分析研究

目的:通过分析外科手术前后血生化指标与舌象指数变化之间的相关性探讨外科创伤因素对舌象变化的影响。方法:对25例外科腹腔镜胆囊切除术患者于手术前后分别运用ZBOX-1型中医舌象数字化分析仪采集并分析患者数字舌图像,得出腐腻指数和剥苔指数同时采集患者的临床血生化指标。观察手术前后舌象腐腻指数、剥苔指数及血生化指标的变化,运用逐步回归分析提取对传统中医舌象有明显影响的临床理化指标,并运用线性相关分析其可能的主要相关因素的相关系数。结果:外科手术后患者的舌象腐腻指数和剥苔指数均较术前升高(P=0.002,0.009);腐腻指数的中性粒细胞偏回归系数为0.625,血小板偏回归系数为0.025,其P值分别为0.000和0.001,剥苔指数的中性粒细胞偏回归系数为0.170,(P=0.013)结论:外科手术后患者的舌象腐腻和剥苔变化情况能较客观的反映手术创伤后炎性细胞的变化情况。     

社区获得性肺炎与SARS的对比分析

目的:研究社区获得性肺炎(CAP)与严重急性呼吸综合征(SARS)的不同特点。方法:比较2003年1月至2003年4月100例(广州市东山区)SARS患者和2001年1月至2003年1月100例CAP患者的临床症状、血象、放射学表现、转归等方面的特点,总结SARS的发病特点及病情发展规律。结果:①SARS患者出现38.5℃以上的发热、胸闷、头痛、肌痛症状的比例显著高于CAP患者(P<0.01);②SARS患者白细胞降低的比例显著高于CAP患者(p<0.01),白细胞升高的比例显著低于CAP患者(P<0.01);③SARS患者病死率显著高于CAP患者(P<0.01)④SARS患者抗体IgG显著高于CAP患者(P<0.01)。结论:SARS与CAP在临床症状、血象、胸片等方面都有不同特点,应注意区分,尽力作到早诊断、早隔离,避免SARS播散。     

肿瘤患者舌象特点及其影响因素

目的:观察肿瘤患者舌象特点及影响舌象的因素。方法:选择2014年1月—2014年6月北京中医药大学附属东直门医院血液肿瘤科门诊就诊的患者507例,在自然光下观察患者舌色、舌形、舌苔(苔质和苔色)及舌下络脉。结果:1舌色:暗舌类(淡暗舌、暗红色、紫暗舌)所占比例平均为77.7%,暗舌数量与年龄成正比(P<0.01)。化疗组紫暗舌比例明显高于非化疗组(P<0.05)。2舌形:齿痕舌(55.2%),胖大舌(50.9%),化疗组胖大舌比例较非化疗组多(P=0.046<0.05)。裂纹者(40.0%),男性组裂纹(49.1%)多于女性(33.4%)(P<0.01)。裂纹舌比例与年龄成正比(P=0.006<0.05)。化疗组瘀斑舌较非化疗组增多(P=0.004<0.05)。女性点刺舌概率高于男性(P=0.03<0.05)。3舌下静脉:舌下静脉迂曲者(61.9%),年龄越大,舌下静脉迂曲所占比例越大(P=0.005)。4舌苔:薄白苔占比例平均为35.1%;白腻苔占33.5%;剥脱兼腻苔以胃癌多见(21.1%)。结论:暗舌、白腻苔、齿痕、胖大舌及舌下脉络迂曲占到了相当的比例,表明脾虚湿盛、痰凝血瘀为肿瘤患者的基本病机。提示临床用药应注重温补脾肾、祛湿化痰及活血化瘀药物的应用。     

193例SARS患者舌象分析

目的观察SARS患者的舌象，为SARS舌诊提供客观依据。方法各医院指定专人分别采用600万像素富士数码相机、佳能数码相机、奥林巴斯数码相机均在上午9～10时自然光线单次摄影。经专家筛选后确定193舌象照片并结合90名SARS一线专家问卷调查结果，采用SPSS软件存储处理。结果(1)193例SARS患者照片中舌质淡红70例(36．27％)，舌质红60例(31．09％)，舌尖红25例(12．95％)，舌质暗红12例(6．22％)，舌质紫红11例(5．70％)，舌质绛6例(3．11％)，舌紫暗5例(2．59％)；(2)193例SARS患者照片中舌苔以白腻、薄白、灰黑苔、少苔、薄黄为主。舌苔白腻65例(36．68％)，舌苔薄白25例(12．95％)，灰黑苔23例(11．92％)，少苔20例(10．36％)，舌苔薄黄20例(10．36％)，舌苔黄厚腻15例(7．77％)，舌苔黄垢腻13例(6．74％)，舌苔黄腻10例(5．18％)舌苔黄燥5例(2．59％)；(3)193例SARS患者照片中SARS的舌体以边有齿痕、舌有裂纹和舌有瘀斑为主。舌边齿痕90例(46．63％)，舌有裂纹57例(29．53％)，舌有瘀斑46例(23．83％)。结合调查问卷结果SARS早期多在发病后1～5d左右，病机以热湿遏阻，卫气同病为特点，舌质主要表现为：舌淡红、舌红，苔薄白或薄黄微腻为主；中期多在发病后3～10d左右，病机以湿热蕴毒，正邪交争，邪阻少阳为特点，舌质主要表现为：舌暗红、紫红，苔白腻或黄厚腻为主；极期(高峰期)多在发病后7～14d左右，病机以湿热毒盛，耗气伤阴，淤血内阻为主要特点。舌质主要表现为：舌红绛，舌紫暗为主，苔白腻或黄腻；恢复期多在发病后10～14d以后，病机以正虚邪恋，易挟湿挟瘀为主要特点，舌象主要表现为：舌淡红，质嫩，边有齿痕，苔少或苔薄少津，或舌淡略暗，苔薄腻。结论SARS患者舌象和病情有一定相关性，研究SARS患者舌象对分析病情和判断预后有一定指导意义。     

SARS患者治疗前后血象的变化

目的探讨SARS(severeacuterespiratorysyndrome)患者综合治疗的血象变化,为治疗和防范提供指导意义。方法运用全自动血细胞检测仪CD3700,检测72例SARS患者治疗前后血象的变化,包括白细胞(WBC)、白细胞分类计数(DC)、红细胞(RBC)、血红蛋白(HB)等项目。结果SARS患者患病和治疗过程中观察发现,病人感染后经过2～12d潜伏期后发病,发病3～6d后,血象结果发生变化,出现明显WBC下降(P<0.01),中性粒细胞分类比例显著下降(P<0.01),淋巴细胞分类比例出现显著性增高(P<0.01),RBC、HB、以及RBC相关参数没有显著性变化(P>0.05);经抗菌、抗病毒类,并结合升白细胞治疗后,WBC有显著上升(P<0.01),WBC分类中,粒细胞比例增加,淋巴细胞比例降低,与治疗前有显著性差异(P<0.01)。结论SARS患者经综合治疗后的血象指标变化可以监测患病后病情的发展变化以及治疗效果观察,为临床诊断及预后效果等提供辅助指导意义。     

哮喘患者述情障碍及相关影响因素的研究

目的 探讨哮喘患者述情障碍及其相关因素.方法 采用多伦多述情障碍量表(TAS-26) , 艾森克人格问卷简式量表中国版(EPQ-RSC)、简明心境问卷-简式(POMS-SF)对52例哮喘患者进行了测查.结果 与常模比较,哮喘患者存有明显的述情障碍(t=2.15～5.29,P＜0.05～0.01).哮喘患者的TAS总分、Ⅰ、Ⅱ、Ⅲ及Ⅳ因子与E呈显著负相关(r=-0.372～-0.451,P＜0.01);Ⅲ因子与N呈显著负相关(r=-0.37,P＜0.01);TAS总分、Ⅰ、Ⅱ因子与N呈显著正相关(r=0.312～0.415,P＜0.01);Ⅱ和Ⅳ因子与P呈显著正相关(r=0.531～0.621,P＜0.01).TAS总分、I、Ⅱ及Ⅳ因子与POMS总分、TA、DD、AH、FI、及CB因子呈显著正相关(r=0.449～0.779,P＜0.01),TAS总分、I及Ⅱ因子与VA因子呈负相关(r=-0.418～-0.544,P＜0.05～0.01),Ⅳ因子与VA因子呈负相关(r=-0.320,P＜0.05).结论 哮喘患者普遍存在述情障碍, 且与个性特征及心境状况密切相关.     

125例基层医院老年社区获得性肺炎患者住院期间死亡影响因素分析

 目的  评价基层医院老年社区获得性肺炎(community acquired pneumonia,CAP)患者住院期间死亡相关影响因素。方法  收集2012年1月至2015年4月间上海市徐汇区大华医院呼吸内科住院治疗的老年CAP患者125例,按出院时生存情况分为死亡组(19例)和生存组(106例)。分析比较两组患者的一般资料(年龄、基础疾病合并情况、体质指数、血红蛋白水平、血清白蛋白水平、T细胞亚组)和肺炎严重度(PSI、CURB-65和APACHE Ⅱ评分),并进行统计学分析。结果  与生存组相比,死亡组年龄较大,体质指数、血红蛋白水平及血清白蛋白水平显著偏低,CD3+T细胞计数、CD4+T细胞计数及CD8+T细胞计数显著减少,肺炎严重度评分(PSI评分、CURB-65评分和APACHE Ⅱ评分)显著升高,差异均有统计学意义(P＜0.05),且与死亡显著相关(P＜0.01),基础疾病合并情况及CD4+/CD8+与死亡不相关(P>0.05)。老年CAP患者年龄与血红蛋白水平、血清白蛋白水平呈显著负相关,与PSI评分、CURB-65评分和APACHE Ⅱ评分显著正相关(P＜0.01),与CD3+T细胞计数和CD4+T细胞计数不相关。血红蛋白水平、血清白蛋白水平与PSI评分、CURB-65评分、APACHE Ⅱ评分显著负相关,血清白蛋白水平与CD3+T细胞计数及CD4+T细胞计数显著正相关(P＜0.01),血红蛋白水平与CD3+T细胞计数及CD4+T细胞计数正相关(P＜0.05)。CD3+T细胞计数和CD4+T细胞计数与PSI评分及APACHE Ⅱ评分显著负相关(P＜0.01),CD3+T细胞计数与CURB-65评分负相关(P＜0.05),CD4+T细胞计数与CURB-65评分不相关(P＞0.05)。体质指数与死亡负相关(P＜0.05)。结论  高龄、营养不良、免疫功能受损、肺炎病情重是老年CAP患者住院死亡的影响因素,应给予高度关注。积极抗感染等对症治疗,努力改善患者营养状况,调节免疫力等措施对降低老年CAP患者住院死亡率至关重要。       

慢性老年病患者生活满意度及影响因素

目的 探讨老年慢性病患者生活满意度及其影响因素.方法 选取60岁以上老年慢性病康复期患者92例,采用问卷调查方式,了解老年慢性病患者生活满意度的影响因素.结果 生活满意度与主观支持、社会支持呈显著正相关(P＜0.01);与客观支持、支持利用度无关.生活满意度与日常生活能力呈负相关(P＜0.05),与抑郁程度呈极显著负相关(P＜0.01).结论 社会支持、生活自理能力及情绪状态是影响老人生活满意度的主要因素.     

心包腔内置管间断抽液治疗恶性心包积液18例疗效观察

目的:探讨银屑病与系统性红斑狼疮(systemic lulups erythematosus,SLE)红细胞免疫调节功能的变化.方法:流式细胞仪检测红细胞表面CD58和CD59、血小板CD35及淋巴细胞CD2分子平均荧光强度.结果:银屑病患者红细胞表达CD58、CD59及血小板CD35分子明显高于正常对照组(P＜0.01);CD58与CD2之间呈显著负相关(r=-0.452 P＜0.05),CD58与CD59之间呈显著正相关(r=0.469,P＜0.05),血小板CD35与CD58之间呈显著正相关(r=0.503,P＜0.05);SLE患者的红细胞CD58、CD59及血小板CD35分子明显低于正常对照组(P＜0.01);CD58与CD59之间呈显著正相关(r=0.530,P＜0.05);CD58与CD2之间呈负相关(r=-0.443,P＜0.05);CD59与CD2之间呈负相关(r=-0.357,P＜0.05);血小板CD35与CD2之间呈显著负相关(r=-0.495,P＜0.05).结论:银屑病与SLE患者红细胞天然免疫调控淋巴细胞适应性免疫呈现紊乱.     

92例SARS患者舌象的分析

为了解严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者的中医证候特征、演变规律,舌象特点与X线胸片变化之间的关系,探索舌象在防治SARS中的作用,采用前瞻性方法对入院的92例SARS患者的临床表现、舌象照片、X线胸片等临床资料归纳总结和统计分析。结果患者的舌象出现芒剌与X线胸片的进展期和高峰期呈正相关,且与高峰期有显著性相关(P<0.05);舌体胖大、齿痕与痊愈期呈正相关,具有非常显著性相关(P<0.01);少苔或剥脱苔与吸收期、痊愈期和病程呈正相关,其中与吸收期和病程具有显著性相关(P<0.05)。提示虽然SARS患者的临床表现、舌象、X线胸片呈多样化,但放射学仍有独特改变,且舌象与X线胸片之间具有一定的相关性,舌象的动态追踪有助于及早发现病情变化,中医舌诊在SARS的诊疗中具有重要意义。     

Study on the correlation of tongue manifestation with fibrinogen and neutrophil in acute cerebral infarction patients

<正>Objective:To investigate the correlation of tongue manifestation with the fibrinogen level and the neutrophil count in blood of acute cerebral infarction patients.Methods:A total of 200 patients with first unilateral cerebral infarction in Neurology Department of Xuanwu Hospital from March,2008 to February,2009 were recruited in this study.The correlation of the tongue fur color and texture with the blood fibrinogen level and the neutrophil count was analyzed in these patients.Results:The level of fibrinogen and neutrophil count in thick fur group were significantly higher than that in thin fur group(P0.05).There was no statistical difference in the level of fibrinogen and neutrophil count found between moist fur and dry fur.Statistical significance existed in the level of fibrinogen between the greasy tongue fur group and non-greasy tongue fur group(P0.05).The level of fibrinogen and the neutrophil count were compared among different fur color groups,revealing that the level of fibrinogen in yellowish fur group was higher than that of white fur group and normal value with statistical significance(P0.05) with neutrophil count in yellowish fur group being significantly higher than that in white fur group.Conclusion:Our results suggested that the change of tongue manifestation was associated with the level of fibrinogen and the neutrophil count in the blood of cerebral infarction patients.     

Analysis and Comparison of the Tongue Picture of 34 Patients with Severe Acute Respiratory Syndrome

Objective: To explore the changes of tongue pictures in the developing process of disease in patients with severe acute respiratory syndrome (SARS), and to compare the tongue pictures of SARS patients with those of suspected SARS patients. Methods: Materials of tongue picture were dynamically collected from 34 SARS patients and 35 suspected SARS patients, and the difference and similarity between them were analyzed. Meanwhile, the changes in clinic symptoms and tongue picture after integrative medicinal treatment were observed. Results: Characteristics of tongue picture in SARS patients were changed along with the progress of the disease, showing that there existed a tendency of the pathogen invading from exterior to interior, from surface to the deep. Also the tongue pictures were varied due to the coexistence of dampness pathogen; the time of the early stage was generally 1 - 1.5 days, shorter than that of other stages. While in the patients with suspected SARS, the tongue picture was mostly red with     

160例慢性湿疹患者的舌象分析

[目的]探讨慢性湿疹患者舌象特点及其发生机制,为临床诊治慢性湿疹提供参考。[方法]选择符合诊断标准的慢性湿疹患者160例,根据中医辨证分为脾虚湿蕴型80例,血虚风燥型80例。另选择健康志愿者80例作为对照组。采用舌象采集仪和临床结合的方法进行舌象的采集分析。[结果]从舌色、舌形、苔色、苔质这4个方面对采集舌象进行分析。统计结果显示脾虚湿蕴型慢性湿疹患者的舌形、苔色及苔质和正常人比较差异均有统计学意义;血虚风燥型慢性湿疹患者的舌色、舌形、苔色及苔质和正常人比较差异均有统计学意义。两种证型慢性湿疹患者舌象之间比较显示,舌色、苔色之间差异有统计学意义。[结论]慢性湿疹患者的舌象和正常人相比差异有统计学意义,不同证型之间的舌象差异有统计学意义。由此得出舌诊信息的综合运用在慢性湿疹的诊断和中医证候的区分上具有一定的辅助作用。可以为慢性湿疹的诊断和辨证分型提供客观依据。     

不同舌苔胃癌患者血清炎症因子表达模式研究

目的探索不同舌苔胃癌患者的血清炎症因子的表达模式。方法临床收集134例不同舌苔的胃癌患者和93例不同舌苔的非胃癌人群,电化学发光免疫检测血清炎症因子水平,多因素关联分析舌苔类型和血清炎症因子的相关性。结果不同舌苔胃癌患者血清白细胞介素-17α(IL-17α)和肿瘤坏死因子-α(TNF-α)水平差异有统计学意义(P0.05)。苔色分析发现,黄苔和白苔胃癌患者血清IL-17α水平中值分别为3.062和3.982 ng/L,差异有统计学意义(P0.05),受试者工作特征曲线(ROC)分析显示血清IL-17α区分白苔与黄苔的灵敏度、特异性和计算线下区域面积(AUC)(95%CI)分别为72.7%、91.3%和0.639(0.539-0.739),截断值为6.033 ng/L,而且,类似的趋势在非胃癌人群中得到了验证。相关性分析显示,在同种舌苔胃癌患者内部,20种血清炎症因子显著正相关占主导地位,然而,在不同舌苔胃癌患者之间显著负相关占主导地位。结论血清IL-17α水平能够显著区分白苔和黄苔、白苔-黄苔、薄苔-厚苔可能反映了胃癌患者体内相反的炎症状态。     

A Pilot Study on the Correlation of Tongue Manifestation with the Site of Cerebral Infarction in Patients with Stroke

Objective：To discuss the correlation of tongue manifestation with the site of cerebral infarction in patients with acute cerebral infarction.Methods：From March 2008 to February 2009,200 cases of hospitalized patients with first unilateral cerebral infarction were chosen in the Department of Neurology,Xuanwu Hospital.The correlation of different tongue color,fur texture,fur color with the site of cerebral Infarction was analyzed.Results：The site of cerebral infarction in patients were compared between different tongue color by Chisquare test（P=0.314）,and further correspondence analysis demonstrated that there was correlation between red tongue and cortical-subcortical infarction group.The site of cerebral infarction in patients were compared between thick fur group and thin fur group,cortical-subcortical infarction occurred more frequently in the former（P=0.0008）.The site of cerebral infarction in patients were compared between dry fur group,moist fur group and smooth fur group,correspondence analysis demonstrated there was correlation between dry fur and cortical-subcortical group.The site of cerebral infarction in the patients were compared between white fur group,white-yellow fur group and yellow fur group（P=0.010）,and correspondence analysis demonstrated there was correlation between white fur and brainstem infarction;white-yellow fur has relationship with cortical infarction;subcortical infarction was weakly related with white-yellow fur;there was closer relationship between yellow fur and cortical-subcortical infarction.Conclusion：The change of tongue manifestation was associated with the site of cerebral infarction in patients,providing a new combining site for diagnosing cerebrovascular diseases by integrative medicine.     

人工饲养白化喜马拉雅旱獭血液生理生化指标测定

目的测定和比较人工饲养正常毛色与白化喜马拉雅旱獭的血液学指标,为喜马拉雅旱獭实验动物标准化提供科学依据。方法应用全自动血细胞仪和生化分析仪测定21只3岁龄健康、成年白化旱獭的血液生理生化指标。结果白化旱獭和正常毛色旱獭比较显示,除淋巴细胞百分率(t=2.154)和单核细胞百分率(t=1.984)差异有统计学意义外(P<0.05),其它血液生理生化指标差异均无统计学意义(P>0.05);白化旱獭雌性与雄性间比较,淋巴细胞百分率(t=2.693)、单核细胞百分率(t=2.796)、总胆红素(t=3.282)、白蛋白(t=2.784)和肌酐(t=3.174)水平的差异均有统计学意义(P<0.05)。结论毛色表型变异对喜马拉雅旱獭的血液生理生化水平没有直接影响;初步建立了健康成体白化喜马拉雅旱獭血液学生理生化指标参考值,为该动物实验动物化及其它应用性科学研究奠定基础。     

吸毒人员舌、脉象分布特征与中医证素的关联分析

目的：研究吸毒人员舌、脉象的分布情况及其与中医证素的关联。方法采集福州市公安戒毒所吸毒人员187例,其中海洛因53例,甲基苯丙胺128例,其他毒品6例。吸毒人员符合国际疾病分类(ICD-10)阿片类药物依赖诊断标准和苯丙胺类药物依赖诊断标准。结果吸毒人员最常见舌脉为：舌淡紫苔薄黄,脉沉弦滑;舌淡紫与证素肝、肾相关（P<0.05）,苔薄黄与证素血虚相关（P<0.05）,脉弦与证素脾、湿和气虚相关（P<0.05）,脉沉与证素痰和气滞相关（P<0.05）,脉滑与证素肾、脾及湿、热、血瘀相关（P<0.05）。结论1、吸毒人员最常见舌脉为：舌淡紫苔薄黄,脉沉弦滑,病位证素以肝、脾、肾为主,而病性证素以气虚、阳虚、气滞、血虚、阴虚、痰、湿为主;2、海洛因成瘾者与冰毒成瘾者舌象分布均为舌淡紫苔薄黄,而脉象分布,海洛因成瘾者以脉弦为主,冰毒成瘾者以脉沉为主。     

A Pilot Study on the Relationship between Tongue Manifestation and the Degree of Neurological Impairment in Patients with Acute Cerebral Infarction

Objective:To discuss the relationship between tongue manifestation and the degree of neurological impairment in the patients with acute cerebral infarction.Methods:Two hundred patients with first unilateral cerebral infarction were recruited.The relationship between different tongue manifestation and National Institute of Health Stroke Scale(NIHSS) were analyzed.Results:NIHSS scores in the patients from different tongue color groups were analyzed and further analysis demonstrated that the NIHSS score was higher in the patients with red or bluish-purple tongue than that of those with the pink(P<0.01).On tongue fur,the NIHSS score in the patients with thick fur was higher than that of those with the thin(P=0.003).NIHSS score in patients with slippery,moist or dry fur was significant different(P=0.003),Further analysis demonstrated that the NIHSS score was higher in the patients with dry fur than that of those with moist fur,and had statistical significance(P=0.01).The NIHSS score was higher in patients from greasy fur group than that of the non-greasy(P=0.002).There was significant difference of NHISS score in the patients with different fur color(P=0.000),and further analysis demonstrated that the NHISS score in white-yellow,yellow fur group were higher than that of the white(P=0.06 or 0.000).Conclusion:The changes of tongue manifestation might be associated with the degree of neurological impairment in the patients with acute cerebral infarction.