基于真实世界数据分析的中医治疗便秘用药规律研究

Research on prescription rules of traditional Chinese medicine for constipation based on real-world data analysis

目的基于临床信息系统,采用数据挖掘方法从真实世界角度分析中医治疗便秘的用药规律。方法收集2015年2月至2019年2月上海中医药大学附属岳阳中西医结合医院健康信息系统中诊断为便秘的患者诊疗信息,建立Excel数据库。采用Microsoft Office Excel 2003软件对高频药物的频数、四气、五味、归经及功效进行描述性统计;借助SPSS Modeler 18.0软件中的Apriori算法对核心数据进行关联规则分析,并用web节点构建关联网状图;运用SPSS 16.0统计软件进行因子分析。结果(1)共纳入16416例接受中药饮片治疗的便秘病例,涉及中药731味。(2)使用频数排名前5位的药物依次为甘草、火麻仁、白术、枳实、厚朴;中医临床治疗便秘的用药以温、平、微寒之性为主,甘、苦药味为多;归经则以脾经为主,其次分别为胃经、大肠经、肺经。(3)在功效分类方面,使用频数排名前3位的依次为补气药、理气药、清热药。(4)关联规则分析结果显示,置信度最高的为厚朴-莱菔子-肉苁蓉-大腹皮(88.28%);共得到11条强关联药对,频数居前5位的药对依次为甘草-白术、甘草-火麻仁、枳实-火麻仁、白术-火麻仁、厚朴-火麻仁。(5)因子分析中共得到9个公因子,结合相关中医理论知识,提示中医临床治疗便秘的处方多由黄芪四君子汤、增液汤、五仁丸等经典名方化裁。结论中医临床治疗便秘以行气导滞、通腑下气为主要思路,整体以通、补、润三法为主,常用白术健脾益气、塞因塞用。

Objective To analyze the prescription rules of traditional Chinese medicine(TCM)in the treatment of constipation from the real-world perspective by mining the clinical information system.Methods The diagnosis and treatment information of patients diagnosed as constipation in the Health Information System of Yueyang Integrated Traditional Chinese and Western Medicine Hospital affiliated to Shanghai University of Traditional Chinese Medicine was collected from February 2015 to February 2019,and the Excel database was established.The frequency,four qi,five flavors,meridian tropism and efficacy of high frequency traditional Chinese herbal medicines(TCHMs)were analyzed with Microsoft Office Excel 2003 software;with SPSS Modeler 18.0 software the association rules of the core data were analyzed under Apriori algorithm to construct a network chart with web nodes.Factor analysis was also conducted with SPSS 16.0 statistical software.Results(1)A total of 16,416 constipated patients receiving TCM decoction treatment were included,which involved 731 kinds of TCHMs.(2)The top five TCHMs plants frequently used were Gancao(Radix Glycyrrhizae),Huomaren(Fructus Cannabis),Baizhu(Rhizoma Atractylodis Macrocephalae),Zhishi(Fructus Aurantii Immaturus),and Houpo(Cortex Magnoliae Officinalis).Clinically,TCHMs used for constipation treatment were mainly warm,neutral and slightly cold in property,sweet and bitter in taste,mostly entering the spleen meridian,followed by stomach meridian,large intestine meridian and lung meridian.(3)According to the efficacy classification,the top 3 TCHM categories in terms of use frequency were qi-invigorating TCHMs,qi-regulating TCHMs and heatclearing TCHM.(4)The results of association rule analysis showed that the TCHM combination with the highest confidence(88.28%)was Houpo(Cortex Magnoliae Officinalis)-Laifuzi(Semen Raphani)-Roucongrong(Herba Cistanches)-Dafupi(Pericarpium Arecae);A total of 11 strongly related TCHM pairs were obtained,and the top 5 TCHM pairs were Gancao(Radix Glycyrrhizae)-Baizhu(Rhizoma Atractylodis Macrocephalae),Gancao(Radix Glycyrrhizae)-Huomaren(Fructus Cannabis),Zhishi(Fructus Aurantii Immaturus)-Huomaren(Fructus Cannabis),Baizhu(Rhizoma Atractylodis Macrocephalae)-Huomaren(Fructus Cannabis),and Houpo(Cortex Magnoliae Officinalis)-Huomaren(Fructus Cannabis).(5)Combined with TCM theoretical knowledge,9 common factors obtained from factor analysis suggested that the prescriptions applied clinically to treat constipation were mostly modified based on classic prescriptions such as Huangqi Sijunzi Decoction,Zengye Decoction,Wuren Pill and so on.Conclusion The clinical treatment of constipation mainly adopts the idea of promoting qi circulation and resolving stagnation,dredging fu-organs and descending qi.The overall treatment methods include dredging,tonifying and moistening,and Baizhu(Rhizoma Atractylodis Macrocephalae)is commonly used to invigorate spleen and benefit qi,and to treat obstruction with tonics.