115例甲型流感病毒肺炎中医证素特征及分布规律研究

Study of Characteristics and Distribution Patterns of Traditional Chinese Medicine Syndrome Elements in 115 Cases of Influenza A Virus Pneumonia

摘要: 目的：研究甲型流感病毒肺炎患者中医证素的特征及分布规律。方法：采用横断面调查研究，收集115例甲型流感病毒肺炎患者的症状、体征、舌脉信息进行证素判定，运用构成比等方法，分析总结甲型流感病毒肺炎的证素特征及分布规律，并在此基础上利用Apriori算法发掘关联规则。结果：甲型流感病毒肺炎患者咳嗽、吐痰、舌赤、苔腻、苔黄、纳呆恶食、脉滑共计7个症状体征舌脉出现频率超过50%。病位证素中肺出现频率最高为95.65%，其次为表、胃。组合规律中单一病位证素最多为81例；其次为二病位证素组合21例，以肺表85.71%，肺胃14.29%为主。病性证素中痰出现频率最高为84.35%，其次是热、湿、阴虚、饮、气滞、阳亢、外风；病性证素以单一病性证素组合最多为20例，以痰75%、热25%为主；其次为三病性证素组合共18例，以热 + 痰 + 湿55.56%、热 + 痰 + 阴虚44.44%为主；再次为二病性证素组合共17例，以热 + 痰76.47%、痰 + 湿23.53%为主；四病性证素组合共12例，以热 + 痰 + 湿 + 饮41.67%、热 + 痰 + 湿 + 阴虚33.33%、热 + 痰 + 阴虚 + 阳亢25%为主；五病性证素组合共5例，以外风 + 热 + 痰 + 湿 + 阴虚为主。挖掘证素关联规则发现甲型流感病毒肺炎的证素关联组合主要集中在肺、表、胃、痰、湿、热、阴虚等证素之间的相互组合。结论：甲型流感病毒肺炎患者病位在肺，与表及胃密切相关；最常见的虚性证素为阴虚，实性证素为痰、湿、热。是以痰为标，热重湿轻为根本病机，兼有阴虚的基本组合；在此研究基础上提出津液代谢与甲型流感病毒病程及预后密切相关。

Abstract: Objective: To investigate the characteristics and distribution patterns of TCM syndrome elements in patients with influenza A virus pneumonia. Methods: A cross-sectional survey was conducted to collect symptoms, signs, tongue, and pulse information from 115 patients with influenza A virus pneumonia for syndrome element determination. Using methods such as proportion analysis, the study summarized the characteristics and distribution patterns of syndrome elements in influenza A virus pneumonia and further utilized the Apriori algorithm to discover association rules. Results: Among the 115 patients, seven symptoms, signs, and tongue-pulse features—coughing, expectoration, red tongue, greasy coating, yellow coating, poor appetite, and slippery pulse—occurred at frequencies exceeding 50%. In terms of disease location syndrome elements, the lung had the highest frequency (95.65%), followed by the exterior and the stomach. The combination pattern showed that single disease location syndrome elements were most common (81 cases), followed by two-location combinations (21 cases) primarily involving the lung-exterior (85.71%) and the lung-stomach (14.29%). For disease nature syndrome elements, phlegm had the highest frequency (84.35%), followed by heat, dampness, yin deficiency, fluid retention, qi stagnation, yang hyperactivity, and external wind. Single disease nature syndrome element combinations were most frequent (20 cases), mainly involving phlegm (75%) and heat (25%). Three-disease-nature combinations occurred in 18 cases, primarily involving heat-phlegm-dampness (55.56%) and heat-phlegm-yin deficiency (44.44%). Two-disease-nature combinations were observed in 17 cases, mainly involving heat-phlegm (76.47%) and phlegm-dampness (23.53%). Four-disease-nature combinations were found in 12 cases, primarily involving heat-phlegm-dampness-fluid retention (41.67%), heat-phlegm-dampness-yin deficiency (33.33%), and heat-phlegm-yin deficiency-yang hyperactivity (25%). Five-disease-nature combinations were noted in five cases, primarily involving external wind-heat-phlegm-dampness-yin deficiency. Association rule mining revealed that syndrome element combinations in influenza A virus pneumonia mainly involved interactions among the lung, the exterior, the stomach, phlegm, dampness, heat, and yin deficiency. Conclusion: The primary disease location in influenza A virus pneumonia is the lung, closely related to the exterior and the stomach. The most common deficiency syndrome element is yin deficiency, while the predominant excess syndrome elements are phlegm, dampness, and heat. The fundamental pathogenesis involves phlegm as the superficial factor, with heat being more prominent than dampness, and a basic combination also includes yin deficiency. Based on this research, it is proposed that fluid metabolism is closely related to the course and prognosis of influenza A virus infection.