基于HIS数据研究芙蓉膏外敷联合中药内服对类风湿关节炎患者免疫炎症的影响

Effects of Furong ointment external application combined with Chinese medicine oral administration on immune inflammation in rheumatoid arthritis patients explored by HIS data analysis

目的评价芙蓉膏外敷联合中药内服对类风湿关节炎患者免疫炎症指标的影响,旨在探讨中医药内外合治类风湿关节炎的配伍模式。方法收集安徽中医药大学第一附属医院信息系统(hospital information system,HIS)风湿病科2012年5月至2016年12月类风湿关节炎住院患者的病历资料,导入风湿病科临床数据库,利用SQL Server管理工具从数据库中将入选患者住院病历的全部数据进行提取、转换。依据是否使用芙蓉膏外敷将患者分为实验组(内外合治)和对照组(单纯内治),采用office 2010、SPSS 22.0、SPSS Clementine 14.2软件Apriori模块、ORACLE 10g工具等分析2组患者的中药使用情况、芙蓉膏与中药关联情况、免疫炎症指标的变化。结果 1)共计4 500例类风湿关节炎患者符合本研究要求,其中实验组2 250例,对照组2 250例。2组患者内服中药使用药物涉及400余味,实验组累计使用频次58 400次,对照组累计使用频次43 271次,均以茯苓、甘草、陈皮、薏苡仁、山药等健脾化湿药(利水渗湿药、理气药、补气药、化痰药、消食药),丹参、红花、桃仁等活血化瘀药,威灵仙、豨莶草等祛风湿药,蒲公英、白花蛇舌草等清热药等4类为主。2)2组RA患者治疗后RF、CCP-AB、Hs-CRP、ESR均较治疗前明显降低,差异有统计学意义(P<0.01)。2组治疗前后指标差值比较,实验组RF、CCP-AB、ESR、Hs-CRP较对照组治疗后降低明显,差异有统计学意义(P<0.01)。3)二项关联:芙蓉膏外敷联合忍冬藤、紫花地丁、姜半夏与RF、CCP-AB、ESR、Hs-CRP降低存在明显关联关系,置信度达50%以上。三项关联:芙蓉膏外敷联合姜半夏与白花蛇舌草、忍冬藤与白花蛇舌草、紫花地丁与豨莶草、姜半夏与泽泻和RF、CCP-AB、ESR、Hs-CRP降低存在明显关联关系,置信度达50%以上。多项关联:芙蓉膏与姜半夏、白花蛇舌草、蒲公英、威灵仙、薏苡仁、陈皮等4对组合,和RF、CCP-AB、ESR、Hs-CRP降低存在明显关联关系,置信度达55%以上。4)随机行走模型分析,实验组炎症指标RF、CCP-AB、ESR、Hs-CRP综合评价指标的正向递增率分别为0.439 9、0.355 6、0.479 9、0.537 4,综合评价指标记录次数分别为1 414、1 217、2 017、2 834。对照组炎症指标RF、CCP-AB、ESR、Hs-CRP综合评价指标的正向递增率分别为0.398 0、0.401 1、0.357 0、0.448 2,综合评价指标记录次数分别为1 623、900、1 115、1 805。结论芙蓉膏联合中药内服能明显改善活动期RA患者免疫炎症指标,芙蓉膏联合健脾化湿药、活血化瘀药、清热药组合配伍,与免疫炎症指标的改善存在明显关联关系。2组患者综合评价指标和接受的干预措施存在长程关联,芙蓉膏外敷联合中药内服患者炎症指标ESR、Hs-CRP的改善效果优于单纯使用中药内服。

The purpose of this study was to evaluate the effect of Hibiscus paste external application combined with traditional Chinese medicine（TCM） on the immune and inflammatory markers in patients with rheumatoid arthritis（RA）. Using SQL Server management tool, we extract and transform all the data of hospitalized medical records of patients selected from the information system database of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine. The patients were divided into experimental group（topical use of Furong ointment combined internal and external treatment） and control group（endotherapy only）. Then the clinical records of patients in the two groups were analyzed by Office 2010, SPSS 22, SPSS Clementine 14.2 Apriori software module and ORACLE10 g tools for evaluating Chinese medication, the association between lotus paste and traditional Chinese medicine,and immune inflammatory index. Data showed that 4 500 RA met the requirements of this study, including 2 250 in the experimental group and 2 250 in the control group. Total of over 400 kinds of traditional Chinese medicines were used in endotherapy of the two groups, and medication frequency of patients in experimental group accumulated to58 400 times, while the control group accumulated 43 271 times. The levels of RF, CCP-AB, Hs-CRP, ESR in patients of the two groups were significantly decreased after treatment（P〈0.01）, and the decrease of the indicators in experimental group was more significant than that in control group（P〈0.01）. The external application ointment combined with endotherapy of traditional Chinese drugs was associated with the decrease of RF, CCP-AB, ESR and Hs-CRP, and the confidence was more than 50%. Random walk model analysis showed that the positive rates of RF,CCP-AB, ESR and Hs-CRP in the experimental group were 0.439 9, 0.355 6, 0.479 9, 0.537 4, respectively, and the comprehensive evaluation times were 1 414, 1 217, 2 017 and 2 834, respectively. The positive rates of RF,CCP-AB, ESR and Hs-CRP in the control group were 0.398 0, 0.401 1, 0.357 0, 0.448 2, respectively, and the comprehensive evaluation times were 1 623, 900, 1 115 and 1 805, respectively. In conclusion, Furong ointment combined with oral administration of traditional Chinese drugs can significantly improve the immune and inflammatory indexes of patients with active RA, espercially for inflammatory indexes ESR and Hs-CRP.