2015年与2016年冬季北京地区流感样病例与气象因素关系的研究及流感确诊病例中医证候规律分析

摘要

目的 探讨2015年、2016年冬春季北京地区常见气候因素对流感样病例发病人数的影响以及流感病例中医证候特点.方法 采用横断面调查方法,收集2015年11月8日至2016年3月19日以及2016年11月14日至2017年2月28日就诊于北京4家医院门诊的流感样病例患者,分析其发生情况与同期日平均气温、日最高气温、日最低气温、日温差、日平均风速、日相对湿度、日照时数、日降水的相关性,并对相关因素进行主因素分析,得出主要影响因素;根据rtPCR结果对确诊的流感患者进行中医证型分析,通过比较不同病原之间的中医证型,得出2015年以及2016年冬季流感发病的主要中医证型.结果 2015年、2016年冬季北京地区共收集流感样病例2166例,其中阳性1209例(55.82％),甲流为主要流行病毒(93.3％),病原以H3N2为主(84.3％),H1N1、新H1N1并见;8个常见气象因素中日平均温度(r=-0.368,P＜0.05)、日最高温度(r=-0.293,P＜0.05)、日最低温度r=-0.377,P＜0.05)与流感发生情况成负相关,其中日平均温度对其影响最大,方差贡献率达87.2％;中医症状方面:流感首发证型中风热证占53.76％,风寒证29.28％,寒包火证占16.96％.不同病原中医证型间无明显差异.结论 2016年、2017年冬季流感发生情况主要受平均温度影响,平均温度越低发病率越高,病原以甲型H3N2为主,不同病原的中医证型间无明显区别,都以风热证主,属于中医学“风温病”范畴.%Objective:To explore the influence of common climatic factors on the incidence of flu like cases and the TCM syndrome characteristics of influenza cases in Beijing from the winter of 2015 to the spring of 2016.Methods:A cross-sectional survey was conducted to collect influenza like cases among outpatients in 4 hospitals in Beijing from November 8,2015 to March 19th-2016 and February 28th November 14,2016.The correlation between the occurrence and the daily mean temperature,daily maximum temperature,daily minimum temperature,daily temperature difference,daily mean wind speed,relative humidity,sunshine duration and daily precipitation were analyzed,and the main factors were analyzed,and the main influencing factors were obtained.According to the rtPCR results,the TCM syndromes of the confirmed influenza patients were analyzed.By comparing the TCM syndromes among different pathogens,the main TCM Syndromes of influenza in 2015 and 2016 were concluded.Results:In 2015 and 2016,2166 cases of influenza like cases were collected in the Beijing region,and 1209 cases(55.82％) were positive.H1N1 was the main influenza virus (93.3％).The pathogen was mainly (84.3％),H1N1 and new H1N1.In the 8 common meteorological factors,the mean daily temperature(r=-0.368,P＜0.05),the daily maximum temperature (r =-0.293,P ＜ 0.05),and the daily minimum temperature (r =-0.377,P ＜ 0.05)were negatively correlated with the occurrence of influenza,and the daily mean temperature had the greatest influence on the occurrence of influenza,and the variance contribution rate was 87.2％.The symptoms of traditional Chinese medicine:influenza first syndrome type-stroke heat syndrome accounted for 53.76％,wind cold syndrome 29.28％,and cold packet fire syndrome accounted for 16.96％.There was no obvious difference between the TCM syndrome types of different pathogens.Conclusion:The incidence of influenza in 2016 and 2017 is mainly affected by the average temperature.The lower the average temperature is,the higher the incidence is.The main cause is influenza A(H3N2).There is no obvious difference between TCM Syndromes of different pathogens.They all belong to the category of "wind warm disease" in TCM.