基于HIS4000份病历探讨从脾论治类风湿关节炎的配伍规律

Compatibility rules of rheumatoid arthritis treated from spleen based on HIS4000 medical records

目的:本文对医院信息系统(hospital information system,HIS)风湿病科临床数据中药背后隐含的方剂模式进行了研究,旨在探讨从脾论治类风湿关节炎的配伍模式或规律。方法:本研究以2012年5月-2016年12月在安徽中医药大学第一附属医院风湿病科住院治疗活动期类风湿关节炎患者为研究对象。使用office2010、复杂网络技术、IBM SPSS Clementine 14.2软件Apriori模块进行中药频数统计、核心处方分析、关联规则分析。结果:共有4 000份住院病历及3 643份中药处方被纳入研究,主要分析结果如下:(1)临床用药大致分为健脾化湿药、活血化瘀药、祛风湿药、清热药四大类,频次在60%以上的有茯苓、甘草、陈皮、丹参、薏苡仁、红花、山药、威灵仙、桃仁等,核心处方为:茯苓、甘草、陈皮、丹参、薏苡仁、红花、山药、威灵仙、桃仁、蒲公英;(2)药物关联分析得出:茯苓与白花蛇舌草、蒲公英、豨莶草、桃仁、威灵仙等健脾化湿药配伍活血化瘀药、祛风湿药、清热药等20对药物组合;(3)两组治疗前后指标差值比较,实验组Hs-CRP、RF、ESR、Ig A、Ig G、C3较对照组治疗后降低明显,差异有统计学意义(P<0.05或P<0.01);(4)药物与指标二项关联分析:姜半夏、豨莶草与Hs-CRP、ESR降低关联度较高,白术、丹参与RF降低关联度较高,山药、蒲公英与C3降低关联度较高,杜仲和威灵仙、红花与IGA、IGG降低关联度较高。三项关联分析:姜半夏、豨莶草分别与蒲公英、桃仁和Hs-CRP、ESR降低关联度较高,黄芪、丹参、甘草与RF降低关联度较高,山药、蒲公英、豨莶草与C3降低关联度较高,麦芽、蒲公英、威灵仙与IGA降低关联度较高,杜仲、红花、甘草与IGG降低关联度较高。结论:本研究解析了类风湿关节炎从脾论治的真实世界关系,以健脾化湿药为核心,与活血化瘀药、清热药、祛风湿药之间的配伍是组方的关键,可有效改善患者免疫、炎症等实验室指标。

Objective： Based on the hospital information system（hospital information system, HIS） were studied in rheumatology clinical medicine data hidden behind the prescription pattern, aims to explore the treatment of rheumatoid arthritis with patterns or rules from the spleen. Methods： This study from May 2012 to December 2016 in the treatment of active rheumatoid arthritis patients as the research object in the division of Rheumatology at the First Affiliated Hospital of Anhui TCM university. The use of Office 2010, the complex network technology and IBM Clementine 14.2 SPSS Apriori software module for Chinese medicine core prescription analysis, frequency statistics, association rule analysis.Results： a total of 4 000 copies of medical records and 3 643 prescriptions of traditional Chinese medicine were included in the study, the main results are as follows：（1） the clinical medication can be divided into jianpihuashi drugs, Huoxue Huayu drugs, dispelling dampness and heat drugs in four categories, more than 60% times the frequency of tuckahoe,liquorice, tangerine peel, coix seed, Salvia miltiorrhiza the kernel, safflower, Chinese yam, clematis root, peach kernel,core prescription： tuckahoe, liquorice, tangerine peel, Salvia miltiorrhiza, coix seed, safflower, Chinese yam, clematis root, peach kernel, dandelion;（2） drug association analysis： Poria and Oldenlandia, dandelion, Herba Siegesbeckiae,peach kernel, Chinese medicine jianpihuashi the compatibility of blood stasis, dispelling dampness and heat drugs for 20 drug combinations;（3） compare the index difference between the two groups before and after treatment, the experimental group Hs-CRP, RF, ESR, Ig A, Ig G and C3 compared with the control group decreased significantly after treatment, the difference was statistically significant（P〈0.05 or P〈0.01）;（4） the analysis of drug and two indicators of Relevance： Jiang Banxia, Herba Siegesbeckiae and Hs-CRP, ESR decreased the incidence is higher, white atractylodes rhizome, Salvia miltiorrhiza and RF reduce the high degree of relevance, yam, dandelion and C3 to reduce the high degree of relevance,Du Zhonghe, IGA, IGG and Honghua Weilingxian to reduce the high correlation. Analysis of the three Association： Jiang Banxia, Herba Siegesbeckiae respectively with Hs-CRP, ESR, dandelion, walnuts and reduce the high degree of relevance, astragalus, salvia, licorice and RF reduce the high degree of relevance, yam, dandelion, Herba Siegesbeckiae and C3 reduce the high degree of relevance, malt, dandelion, Radix Clematidis and IGA to reduce the high degree of relevance, eucommia, safflower, licorice and IGG reduce high correlation. Conclusion： This study on the treatment of rheumatoid arthritis from the real world to the spleen, spleen wet medicine as the core, and the compatibility between blood stasis, antipyretic, rheumatism medicine prescription is the key, which can effectively improve the patients＇ immune inflammation and other laboratory indexes.