Objective

2

To explore the correlation between tongue manifestations and laboratory indicators in moderate cases of coronavirus disease 2019 （COVID-19）.

Methods

2

The tongue manifestations and laboratory indicators of 76 patients confirmed as moderate type of COVID-19 who were hospitalized in the cancer center of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 14th to February 28th， 2020 were collected. Tongue manifestations included tongue color and shape， tongue coating color and texture. Tongue color was divided into light red， light white， red， crimson and cyan purple； tongue shape included normal， enlarged （including teeth-marked tongue） and thin shape， and could be divided into non-cracked and cracked shape according to whether there was crack of tongue； regarding the coating texture， there was thin or thick， and moist or dry coating according to the thickness and mositure degree of the texture； the coating color was divided into white， yellow， gray and black. The laboratory indicators included blood routine examination， C-reactive protein （CRP）， plasma fibrinogen （FIB）， D-dimer （DD）， interleukin 2 （IL-2）， interleukin 4 （IL-4） ， interleukin 6 （IL-6）， interleukin 10 （IL-10）， tumor necrosis factor （TNF）， interferon-γ （IFN-γ）， total bilirubin （TBiL）， direct bilirubin （DBiL）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， albumin （ALB）， creatinine （Cr）， urea nitrogen （BUN）， and lactate dehydrogenase （LDH）. The correlation between tongue manifestations and laboratory indicators was analyzed.

Results

2

Among the 76 patients with moderate type of COVID-19， 38 cases had light red tongue and 38 cases had red tongue； there were 38 cases of normal-shaped tongue， 26 cases of enlarged tongue and 12 cases of thin tongue； the number of non-cracked and cracked tongue was 54 and 22 ， respectively； there were 42 cases of thin coating and 34 cases of thick coating， as well as 45 cases of moist coating and 31 cases of dry coating. White coating was found in 39 cases and yellow coating in 37 cases. The age of the dry coating group was higher than that of the moist coating group （

P

=0.049）. The CRP level was significantly higher in red tongue group than in light red group， in cracked tongue group than in non-cracked tongue group， in thick coating group than in thin coating group， in dry coating group than in moist coating group， as well as in yellow coating group than in white coating group （

P

＜0.05 or

P

＜0.01）. There were significant differences in the IL-6 level between different tongue shapes （

P

=0.029）， and patients with thin tongue had higher level of IL-6 than those with enlarged tongue （

P

=0.009）. Significantly lower level of IL-10 was found in patients with red tongue than those with light red tongue； the IL-10， IL-2， IL-4， and IFN-γ levels of the thick coating group were lower than those of the thin coating group； the patients with dry coating had decreased level of IL-10 than those with moist coating， and the IL-10 and IFN-γ levels were lower in the yellow coating patients compared to white coating patients （

P

＜0.05 or

P

＜0.01）. The DD， Cr and LDH levels were significantly higher in the cracked tongue patients than the non-cracked tongue patients （

P

＜0.05 or

P

＜0.01）.

Conclusion

2

The laboratory indicators varied among different tongue manifestations in patients with moderate type of COVID-19. The CRP level increases in patients with red tongue， thick， dry and yellow coating， while the IL-10 level decreases； increased IL-6 level is correlated with thin tongue， and the damage of cardiac and renal function is more severe in patients with cracked tongue.