【摘要】 目的通过回顾性分析,比较中西医结合治疗与单纯西医治疗新型冠状病毒肺炎(COVID-19)重型的疗效,寻找影响COVID-19重型患者预后的风险预测因子,评价中医药在COVID-19重型患者治疗中的意义并指导临床诊疗方案。方法利用可解释性机器学习方法回顾性分析华中科技大学同济医学院附属同济医院主院区、光谷院区及中法院区先后收治的共1 055例COVID-19重型患者的临床诊疗过程。根据治疗方案分为中西医结合-中药组(以下简称"中药组")、中西医结合-中成药组(以下简称"中成药组")和西药组。西药组仅基于COVID-19诊疗方案予以抗病毒、氧气支持及对症等常规治疗,中药组、中成药组分别在西医常规治疗基础上加中药汤剂、中药汤剂联合中成药治疗。比较3组患者的临床疗效指标(总住院天数、危重转化率、插管死亡率)及实验室相关指标。结果白蛋白与球蛋白比值、白细胞计数、淋巴细胞计数较低的患者,中药组或中成药组相较于西药组可降低插管死亡率。中药组或中成药组的插管死亡率、转危重率低于西药组;中药组、西药组的总住院天数低于中成药组。结论在西医常规治疗的基础上加用中药汤剂或中成药治疗COVID-19重型患者,可通过提升患者免疫功能,达到降低插管死亡率、改善预后的效果。更多还原

【Abstract】 Objective To compare the efficacy of integrated Chinese and Western medicine treatment and that of Western medicine treatment alone for severe cases of COVID-19, identify the risk predictors affecting the prognosis of patients with severe COVID-19, evaluate the significance of traditional Chinese medicine in the treatment of severe cases of COVID-19 and provide reference for clinical diagnosis and treatment. Methods Explainable machine learning was used to retrospectively analyze the clinical treatment process of 1 055 cases of severe COVID-19 admitted to the main hospital area, Optical Valley branch and Sino-French New City branch of Tongji Hospital in Wuhan.The cases were divided into integrated Chinese and Western medicine-Chinese herbal medicine(CW-CHM) group, integrated Chinese and Western medicine-Chinese patent medicine(CW-CPM) group and Western medicine(WM) group according to the treatment plan they followed.The WM group received such conventional treatment as antiviral treatment, oxygen support and symptomatic therapy based on the diagnosis and treatment protocol of novel coronavirus pneumonia, while the CW-CHM group and CW-CPM group were treated with herbal decoction and Chinese patent medicine combined with herbal decoction respectively in addition to the conventional treatment given to the WM group.Clinical efficacy indicators of the three groups were observed and compared, including total length of hospitalization, rate of cases that turned critical, intubation mortality, and laboratory-related indicators. Results Intubation mortality for patients with low A/G ratio, low white blood cell count and low lymphocyte count in the CHM group and CW-CPM group were significantly reduced compared with that in the WM group. The intubatione mortality rate and the rate of cases that turned critical in the CW-CHM group and CW-CPM group were lower than those in the WM group. The total hospitalization days of CW-CHM group and WM group were fewer than those of CW-CHM group. Conclusion The addition of Chinese medicine decoction or Chinese medicine decoction+ Chinese patent medicine to conventional WM treatment for severe COVID-19 cases may reduce the intubation mortality and improve the prognosis of the patients by improving their immune function.更多还原