张炳厚治疗慢性肾小球肾炎用药规律聚类分析

Research on ZHANG Binghou' s Medication Experience in Treating Chronic Glomerulonephritis Based on Cluster Analysis

目的采用数据挖掘方法分析张炳厚治疗慢性肾小球肾炎(CGN)的治疗思路和用药规律。方法选择张炳厚专家门诊CGN患者80例、共计252诊次的处方资料,设计病例报告表、采集资料并建立数据库,统计药物使用频率并分析常用药物的功效和药性、药味、归经分布,量化常用药物的性味、归经后采用最长距离法进行分层聚类。结果 80例CGN患者共使用中药232味,4272频次。使用频率>10%的药物有33味,其中前五位分别为熟地黄、龟甲、石韦、土茯苓、炒白术。常用药物中补虚药、清热药、利水渗湿药为常用类别,药性中构成比最高的为平性(36.36%),药味中构成比最高的为甘味(78.79%),药物归经中构成比最高的为肾经(48.48%)。33味药物按药性聚为8类时临床意义清晰。结论张炳厚教授治疗CGN用药药性平寒、药味甘苦,以补肾健脾、清利湿热解毒为治疗大法,且补法、清法并重。

Objective To analyze ZHANG Binghou＇s medication experience in treating chronic glomerulonephritis （CGN） by data mining. Methods The prescribing information on 80 patients （252 visits） in specialist clinic of ZHANG Binghou was selected. The Case Report Form was designed, information was collected and the database was established. The frequency, effectiveness, medicinal property, flavors and channel entry of herbs were analyzed. The hierarchical cluster was performed with the longest-distance method after quantifying the nature, flavor and channel entry of commonly used herbs. Results Totally 232 herbs （4272 frequencies ） were used in 80 CGN patients. There were 33 herbs with a frequency higher than 10%. The top 5 herbs were Shudihuang （Radix Rehmanniae Praeparata, 熟地黄 ） , Guijia （Carapax et Plastrum Testudinis, 龟甲 ）, Shiwei （Folium Pyrrosiae, 石韦 ）, Tufuling （Rhizoma Smilacis Glabrae, 土茯苓 ） and Chaobaizhu （Atractylodis Macrocephalae Rhizoma Frictum,炒白术 ）. The deficiency-supplementing herbs, heat-clearing herbs, as well as water-disinhibiting and damp-percolating herbs were commonly used. The most frequently used herbs were with plain nature （36.36%）, sweet flavor （78.79%） and entry into kidney channel （48.48%）. The clinical significance was clear when 33 herbs were clustered into 8 categories according to their nature. Conclusion Prof. ZHANG Binghou often uses herbs with plain or cold nature and sweet or bitter flavor to treat CGN according to kidney-supplementing spleen-strengthening therapy and heat-clearing dampness-disinhibiting and detoxication therapy.