基于真实世界的3609例骨关节炎患者的中药处方模式分析

Analysis on Traditional Chinese Medicine Prescription Patterns in 3609 Patients with Osteoarthritis Based on The Real World

目的:中医药越来越广泛的应用于骨关节炎的治疗。本文基于真实世界,通过运用关联规则和聚类分析探索治疗骨关节炎的中药处方规律,以探讨中医药治疗骨关节炎的兼容性模式和规则。方法:基于医院信息系统、真实世界数据,收取安徽省中医院风湿科在2012年6月至2016年6月期间住院的骨关节炎患者,整理病历资料中的中药处方。根据所选药用公式和添加的信息组织建立一个数据库。关联规则使用SPSSModeler 14.2软件,聚类分析使用SPSS 22.0软件。根据中药的性、味、归经和功效进行分类。在分类的基础上,进行发生的频率计算和关联分析。并分析药物与免疫炎症指标的关联。结果:被选择的挖掘数据公式中能够说明的主要特征是:(1)在3 609个处方中,性温和性寒的、味甘和味苦的及归脾经草药使用最频繁;(2)中药活血化瘀类、补益类、利水渗湿类、清热类和祛风湿类是被频繁的使用;(3)关联度最高的前三个药对为:红花配伍桃仁(98.90%),蒲公英配伍白花蛇舌草(97.88%),茯苓配伍泽泻(92.63%);(4)中药与免疫炎症指标的关联:独活与陈皮关联于超氧化物歧化酶(SOD)指标上升,麦芽与丹参关联于超敏C反应蛋白(hs-CRP)、血沉(ESR)、补体C3、补体C4、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)指标下降;麦芽与茯苓关联于免疫球蛋白M(IgM)指标下降。结论:结果表明,骨关节炎与脾虚之间有密切的关系。这些处方中药功效以益气健脾、活血化瘀、健脾化湿、清热解毒为主,可能是治疗过程中的关键因素。同时,使用补虚药和健脾药也是处方的基础。

Traditional Chinese medicine（TCM） is widely used as a complementary approach for osteoarthritis treatment.This article is based on the real world. The implicit prescription patterns behind TCM formulae were examined by association rules mining and cluster analysis, so as to explore the Chinese medicinal compatibility patterns or rules in osteoarthritis treatment. This study was based on real-world data from the hospital information system（HIS）. Chinese medicinal prescriptions of hospitalized patients with osteoarthritis from June 2012 to June 2016 were collected from the Department of Rheumatism and Immunology, the First Affiliated Hospital of Anhui University of Chinese Medicine. TCM was listed according to the selected medicinal formulae and the added information was organized to establish a database.The frequency and association rules of prescription patterns were analyzed using the SPSS Modeler 14.2 Data Mining System. Cluster analysis of prescription patterns was also analyzed. An initial statistical analysis was carried out to categorize herbs according to their natures, flavors, channel tropisms and functions. Based on categorization, frequencies of occurrence were computed. At the same time, the relationship between TCM and immune and inflammatory markers was analyzed. The results showed that the main prescriptive features from the selected formulae of the mining data were that,（1） warm or cold herbs, sweet or bitter herbs, and with the channel tropism of spleen channel are the most frequently prescribed herbs in 3609 medicinal formulae;（2） herbs with blood-activating and stasis-resolving, restoring vital energy,water-eliminating and damp-removing, heat-clearing and or expelling wind-damp functions are frequently prescribed;（3） association rule analysis extracted three frequently used pairs of herbs, which are Hong Hua Tao Ren（98.90%）, Pu Gong Ying Bai Hua She She Cao（97.88%）, Fu Ling Ze Xie（92.63%）;（4） association rule between TCM and immune-inflammation index showed that the pair of Du Huo and Chen Pi was associated with increased superoxide dismutase（SOD） enzyme. The pair of Mai Ya and Dan Shen was associated with decreased high-sensitivity C-reactive protein（hs-CRP）, erythrocyte sedimentation rate（ESR）, complement component 3（C3）, complement component 4（C4）,immunoglobulin A（Ig A） and immunoglobulin G（Ig G）. The pair of Mai Ya and Fu Ling was associated with decreased immunoglobulin M（Ig M）. It was concluded that osteoarthritis was closely related to spleen deficiency. These prescriptions focus on herbs for qi-nourishing and spleen-invigorating, blood-activating and stasis-resolving, spleen-invigorating and dampness-eliminating, heat-clearing and detoxicating which seems to be the key element in the treatment process.Meanwhile, the use of restoring vital energy herbs and spleen-strengthening herbs also forms the basis of prescription patterns.