基于真实世界数据探讨中医药治疗非酒精性脂肪肝用药规律

Medication Rules of Chinese Medicine for Non-alcoholic Fatty Liver Disease Based on Real World Data Mining

目的:基于真实世界数据挖掘中医药治疗非酒精性脂肪肝用药规律研究。方法:收集2019年1月—2022年7月上海市宝山区中西医结合医院健康信息系统确诊的非酒精性脂肪肝的门诊患者的诊疗信息,建立Excel数据库,采用Excel 2017软件录入所有药物的四气、五味、归经及功效。应用R统计软件进行结果描述及数据分析,使用arules包的Apriori算法对处方进行关联规则分析。结果:本研究从收集的445例患者的1073首处方中最终筛选纳入处方140首,涉及中药265味;使用频次排名前5位的中药分别是柴胡、茯苓、黄芩、郁金、丹参;使用频次排名前5类的中药类别分别是补虚、利水渗湿、清热、活血化瘀和理气药;在15味高频药物中,苦、甘、辛药味最为常见,药性以温、平、微寒为主,归肝、脾、肺和胃经居多。经关联规则分析,药物组合中支持度最高的是柴胡-郁金、茯苓-白术,置信度排列前3的药物组合为地耳草-矮地茶、枳壳-柴胡、莪术-柴胡。聚类分析将中药分为5类,类1为柴胡、虎杖、厚朴、大黄、五味子、垂盆草、郁金、赤芍、枳壳、莪术、木香、连钱草、矮地茶和地耳草,类2为茯苓、白术,类3为当归、甘草、白芍、黄芩和茵陈,类4为丹参和山楂,类5为黄芪、半夏和陈皮。结论:治疗非酒精性脂肪肝多采用疏肝健脾、祛湿化痰、活血化瘀、清热解毒药物为主,性味多为温、平、微寒之品,使利湿不伤阴、活血不耗血,共奏痰化瘀散浊泄之效。

Objective:To study the medication rules of Chinese medicine for non-alcoholic fatty liver disease(NAFLD)based on real world data mining.Methods:The care information of outpatients with NAFLD diagnosed by the Hospital Information System of Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to July 2022 was collected,and an Excel database was established.With the software Excel 2017,the four natures,five flavors,channel entries and effects of all Chinese medicines were entered.R Statistical Software was used to describe the results and analyze the data.Apriori algorithm of arules package was used to analyze the association rules of prescriptions.Results:A total of 140 prescriptions were included in this study after screening 1073 prescriptions collected from 445 patients,which involved 265 Chinese medicinals;the top 5 Chinese medicinals in frequency were Bupleuri Radix,Poria,Scutellariae Radix,Curcumae Radix and Salviae Miltiorrhizae Radix et Rhizoma;the top 5 types of Chinese medicinals in frequency were for supplementing deficiency,promoting urination and percolating dampness,clearing heat,invigorating blood and dissolving stasis and rectifying qi;among 15 high-frequency Chinese medicinals,they were mainly bitter,sweet and acrid in flavor,and mainly warm,mild and slightly cold in nature with main channel entries to the liver,spleen,lung and stomach.According to the association rule analysis,the medicinal combinations with the highest degree of support were Bupleuri Radix-Curcumae Radix,and Poria-Atractylodis Macrocephalae Rhizoma;the top 3 medicinal combinations in the degree of confidence were Hyperici Japonici Herba-Ardisiae Japonicae Herba,Aurantii Fructus-Bupleuri Radix,and Curcumae Rhizoma-Aurantii Fructus.The Chinese medicinals were divided into 5 types by the cluster analysis:Type 1 included Aurantii Fructus,Polygoni Cuspidati Rhizoma,Cortex Magnoliae Officinalis,Rhei Radix et Rhizoma,Schisandrae Chinensis Fructus,Sedi Herba,Curcumae Radix,Paeoniae Rubra Radix,Aurantii Fructus,Curcumae Rhizoma,Aucklandiae Radix,Glechomae Herba,Ardisiae Japonicae Herba and Hyperici Japonici Herba;Type 2 included Poria and Atractylodis Macrocephalae Rhizoma;Type 3 included Angelicae Sinensis Radix,Glycyrrhizae Radix et Rhizoma,Paeoniae Radix Alba,Scutellariae Radix and Artemisiae Scopariae Herba;Type 4 included Salviae Miltiorrhizae Radix et Rhizoma and Crataegi Fructus;Type 5 included Astragali Radix,Pinelliae Rhizoma and Citri Reticulatae Pericarpium.Conclusion:The treatment of NAFLD usually adopts liver-soothing and spleen-fortifying,dampness-dispelling and phlegm-dissolving,blood-invigorating and stasis-dissolving,and heat-clearing and toxins-resolving Chinese medicines and they are mostly warm,mild and slightly cold in nature,which enables the dispelling of dampness not to damage yin,and the invigoration of blood not to consume blood.Thus,they work together to play a role in dissolving phlegm,dissipating stasis and discharging turbidity.