基于数据挖掘分析卢秉久教授辨治代谢相关脂肪性肝病经验

Analysis of professor Lu Bingjiu′s experience in differentiation and treatment of metabolic associated fatty liver disease based on data mining

目的:基于真实世界的临床病例数据挖掘及分析卢秉久教授辨治代谢相关脂肪性肝病的发病特征与用药经验。方法:采集并记录电子病历以建立医案数据库;使用频次频率分析患者的一般资料(性别、年龄、体重指数、彩超及合并病情况)、中医证候要素(主诉症状、舌象及脉象)、中药药味及作用功效;采用Apriori算法对统计得出的高频药物进行关联分析并绘制网络图;运用聚类分析、复杂系统熵聚类、熵层析聚类分析等高级别数据挖掘方法对高频药物进行聚类分析,并以树状图将数据结果可视化展示;基于数据挖掘结果探索代谢相关脂肪性肝病的发病特点,挖掘处方用药规律,总结名家诊治经验。结果:共纳入329例病例,发病以中年人居多,93.01%的患者BMI超过正常水平。高脂血症、高血压病、2型糖尿病、心脑血管疾病及高尿酸血症为高频合并病。出现频次最高的舌脉要素分别为淡红舌、白腻苔及沉脉。纳入处方329首,涉及中药164种,高频药物共12味,以补虚药占比最高。关联分析得出18个核心药组,系统聚类得出6类新处方。结论:卢秉久教授认为代谢相关脂肪性肝病的病位在肝脾,主要表现为本虚标实,“浊瘀”是发病的关键病理因素,治疗应以“祛湿化浊、活血通脉”为总则,对重要兼证以“肝胃同调、肝心同治、气机畅达”等为指导思想。

Objective:To explore the characteristics and medication experience of Professor Lu Bingjiu in the treatment of metabolic-associated fatty liver disease based on real-world clinical case data mining.Methods:Electronic medical records were collected and recorded to establish a medical record database.The frequency frequency was used to analyze the general data(gender,age,body mass index,color Doppler ultrasound and combined diseases),TCM syndrome elements(chief symptoms,tongue and pulse),Chinese medicine flavor and effect.Apriori algorithm was used to analyze the association of high-frequency drugs and draw a network diagram.High-level data mining methods such as cluster analysis,complex system entropy clustering and entropy chromatography clustering analysis were used to cluster high-frequency drugs,and the data results were visualized by dendrogram.Based on the data mining results,the incidence characteristics of metabolic-associated fatty liver disease were explored,the rules of prescription medication were mined,and the diagnosis and treatment experience of famous experts were summarized.Results:A total of 329 cases were included in this study,with middle-aged people being the majority of the cases,and 93.01%of patients had BMI exceeding normal levels.Hyperlipidemia,hypertension,type 2 diabetes,cardiovascular and cerebrovascular diseases and hyperuricemia are high-frequency complications.The tongue pulse elements with the highest frequency of occurrence are light red tongue,white greasy fur,and sinking pulse.329 prescriptions were included,involving 164 types of traditional Chinese medicine and a total of 12 high-frequency drugs,with the highest proportion being tonifying drugs.Correlation analysis identified 18 core drug groups,and systematic clustering identified 6 new prescriptions.Conclusion:Professor Lu Bingjiu believes that the location of this disease is in the liver and spleen,mainly manifested as deficiency and excess."Turbidity and stasis"are the key pathological factors of the disease,and treatment should be based on the general principle of"dispelling dampness and turbidity,promoting blood circulation and unblocking the meridians".For important concurrent symptoms,the guiding ideology should be"liver stomach coordination,liver heart treatment,and smooth Qi circulation".