新冠肺炎住院患者的中醫治療先驅性研究

Traditional Chinese Medicine Treatment to Hospitalized Patients with COVID-19: A Pilot Study

10.6516/TJTCM.202306_26(2).0001

王明仁(Ming-Jen Wang)；林家琳(Chia-Lin Lin)；林舜穀(Shun-Ku Lin)；陳朝宗(Chao-Tsung Chen)；廖韋程(Wei-cheng Liao)；翁詩涵(Shih-Han Weng)

新冠肺炎 ； 中醫 ； 住院治療 ； 重症照護 ； COVID-19 ； traditional Chinese medicine ； hospitalization ； intensive care

中醫藥研究論叢

26卷2期（2023 / 06 / 30）

1 - 14

繁體中文;英文

前言：隨著新冠肺炎在世界範圍快速傳播，造成全球醫療體系的極大衝擊。在2021年5月，台灣疫情由於多起境外移入案例與國內群聚案例突然急遽爆發，政府宣布全國進入三級警戒狀態。中醫也加入對抗新冠肺炎疫情的行列，積極開發相關的治療方案。本研究的目的是探討中醫治療對於中重症新冠肺炎住院患者的臨床治療成效。方法：本研究為單臂式介入研究法，我們招募於台北市立聯合醫院住院之新冠肺炎病患，患者除西醫常規治療以外，合併宣肺平喘、清熱解毒、化濁利濕為主要治療方向的中醫藥物，我們評估患者的臨床症狀、生命徵象、生化檢驗數值之以及病毒檢測轉陰天數作為分析指標。結果：本研究共納入10位中度及重度新冠肺炎住院患者。依照不同嚴重程度分級，重度病患在中醫治療後有71.4%（5/7）的患者C反應蛋白（C-reactive protein, CRP）上升，相反地，三位中度病患的CRP值均下降。若以患者開始接受中醫治療時的呼吸速率分組，小於每分鐘20次的患者在中醫治療後有83%（5/6）的患者CRP下降，其中位數與四分位距由29.2±50.6 mg/L下降到3.0±28.0 mg/L，且Wilcoxon test檢定有達到統計顯著差異；相反地，對於呼吸速度大於等於每分鐘20次的患者CRP數值均上升，中位數由4.3±24.2 mg/L上升到62.4±60.1 mg/L。對於與凝血功能和血栓形成相關的血小板數量，呼吸頻率較大的患者在中醫治療後由296.0±543.3×1000/μL下降到186.5±712.3×1000/μL；相反地，呼吸頻率較低的患者則由176.5±111.3×1000/μL上升到189.0±144.0×1000/μL。呼吸頻率較高的患者部份凝血活酶時間（activated partial thromboplastin time, aPTT）在中醫治療後由24.5±15.9秒上升到34.5±7.1秒，而呼吸頻率較低的患者在治療前後分別為27.6±14.6秒與27.9±8.6秒，幾乎沒有改變。結論：本研究呈現新冠肺炎中度與重度住院患者的中醫治療結果，我們發現新冠肺炎嚴重程度與治療前的呼吸速度可能是影響中醫治療成效的因素。

Background: With the pandemic of coronavirus disease rapidly spreading worldwide, it has caused a great impact on the global medical system. In May 2021, Taiwanese government announced that Taiwan had entered third-level alert state due to sudden outbreak of numerous cases of coronavirus disease 2019 (COVID-19) cases. Recent evidence implied Traditional Chinese medicine (TCM) as a potential treatment of COVID-19. Here, we conducted a pilot study to investigate the efficacy of TCM combined standard care in high-risk hospitalized patients with COVID-19. Methods: This single arm trial, recruiting patients with COVID-19 hospitalized in Taipei City Hospital Ren Ai Branch. In addition to standard therapy, all patients were given TCM formulas according to four diagnostic methods of Chinese Medicine. The primary outcome were clinical presentations, conversion time for COVID-19 viral assay and biochemical data. Results: Ten hospitalized patients with moderate or severe COVID-19 are enrolled in this study. According to the different severity levels of COVID-19, 71.4% (5/7) of severe patients had an increase in C-reactive protein (CRP) after TCM treatment, whereas all moderate patients had a decrease in CRP. 83% (5/6) of patients with a respiratory rate less than 20 breaths per minute had a reduction in CRP after TCM treatment, and the median and interquartile range decreased from 29.2± 50.6 mg/L to 3.0± 28.0 mg/L. The Wilcoxon test has reached statistical significance. Conversely, the CRP values increased for patients with respiratory rates greater than 20 breaths per minute, with a median increase from 4.3±24.2 mg/L to 62.4± 60.1 mg/L. The platelet count (PLT) of the patients with higher respiratory rate decreased from 296.0±543.3× 1000/μL to 186.5± 712.3× 1000/μL after TCM treatment; In contrast, the patients with lower respiratory rate increased from 176.5± 111.3× 1000/μL to 189.0± 144.0× 1000/μL. The activated partial thromboplastin time (aPTT) of patients with higher respiratory rate increased from 24.5± 15.9 sec to 34.5± 7.1 sec after TCM treatment, while the patients with lower respiratory rate were 27.6± 14.6 sec and 27.9± 8.6 sec before and after treatment respectively. Conclusion: We present the results of TCM treatment of moderately and severely hospitalized patients with COVID-19. The severity of new coronary pneumonia and the respiratory rate before treatment may influence the efficacy of TCM treatment.

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