脾瘅郁热阶段医案用药规律数据挖掘——基于《脾瘅新论——代谢综合征的中医认识及治疗》

Data Mining of Medication Law of the Medical Cases of the Constraint Heat Stage of Pidan(脾瘅):Based on the Book New Discussion on Pi-dan(脾瘅)-Understanding and Treatment of Metabolic Syndrome in Traditional Chinese Medicine

目的采用关联规则方法分析《脾瘅新论——代谢综合征的中医认识及治疗》(以下简称《脾瘅新论》)中脾瘅郁热阶段医案的用药规律。方法收集《脾瘅新论——代谢综合征的中医认识及治疗》2004年1月—2016年12月脾瘅郁热阶段病例,采集医案中患者基本信息、临床症状体征、实验室检查、中西医诊断、治法、方药等。采用Epidata 3.1数据管理软件建立医案数据库,采用SPSS Modeler 14.2统计软件中提供的Apriori算法对药物与药物、药物与症状、药物与西医指标进行关联规则分析。结果共纳入医案79个,所涉证型27种,频次≥3的前三位有肝胃郁热,痰热互结、膏浊内蕴,中焦壅滞、膏浊积聚;治法20种,频次≥3的前三位有消膏降浊、辛开苦降,清热泻浊、行滞通络,清泄郁热、活血通络;处方79首,频次≥3的前三位有小陷胸汤加减、大柴胡汤加减、大黄黄连泻心汤加减;共用药物98味,药物总频次792次,频次≥15的前五位为黄连、黄芩、清半夏、生姜、生大黄。药物-药物关联规则按支持度≥15%,置信度=100%,各阶关联规则第一位分别为:干姜→黄连,瓜蒌仁+清半夏→黄连,生山楂+瓜蒌仁+清半夏→黄连;药物-症状关联规则按支持度≥5%,置信度=100%,各阶关联规则第一位分别为:黄连→脉沉滑,水蛭粉+干姜→失眠,水蛭粉+干姜+黄连→失眠,红曲+知母+清半夏+黄连→乏力;药物-西医指标关联规则按支持度≥5%,置信度=100%,各阶关联规则第一位分别为:黄连→餐后两小时血糖,苍术+黄连→糖化血红蛋白,赤芍+黄芩+黄连→糖化血红蛋白,苍术+天花粉+赤芍+干姜→糖化血红蛋白。结论脾瘅郁热阶段使用"态靶"辨证方法,药物组合以"小方"为特色,用药针对患者症状体征(症靶)及西医指标(标靶)。

Objective To analyze the medication law of medical records of Pi-dan constraint heat stage in the book New Discussion on Pi-dan(脾瘅): Understanding and Treatment of Metabolic Syndrome in Traditional Chinese Medicine(abbreviated as "New Discussion on Pi-dan"). Methods The medical cases recorded in the book New Discussion on Pi-dan which were at Pi-dan constraint heat stage from January 2004 to December 2016 were included, and data on patients′ basic information, clinical symptoms, laboratory examination, diagnosis of traditional Chinese and western medicine, treatment and prescription were collected. Epidata 3.1 software was used to establish the database of the medical records. The Apriori algorithm provided by SPSS Modeler 14.2 software was used to analyze association rules of drug-drug, drug-symptom and drug-western medicine indicators relationships. Results A total of 79 medical records were included involving 27 syndromes;the top three syndromes with frequency ≥3 times were liver-stomach constraint heat pattern, binding of phlegm and heat pattern, internal accumulation of ointment-turbidity pattern, middle jiao(焦) obstruction and stagnation pattern, and accumulations and gatherings of ointment-turbidity pattern. There were 20 treatment methods, of which the top three methods with frequency ≥3 times were dispersing ointment and directing turbidity downward, using acridity to open and bitterness to discharge, clearing heat and draining turbidity, moving stagnation and unblocking collaterals, clearing constraint heat, and invigorating blood and unblocking collaterals. There were 79 formulas, and the top three prescriptions with frequency ≥3 times included Modified Xiaoxianxiong Decoction(小陷胸汤加减), Modified Dachaihu Decoction(大柴胡汤加减) and Modified Dahuang Huanglian Xiexin Decoction(大黄黄连泻心汤加减). Ninety-eight common herbs were involved with a total frequency of 792 times. The five most frequently used herbs with frequency ≥15 times were Haunglian(Rhizoma Coptidis), Huangqin(Radix Scutellariae), Qing Banxia(Rhizoma Pinelliae Concisum), Shengjiang(Rhizoma Zingiberis Recens) and Sheng Dahuang(Radix et Rhizoma Rhei). According to the drug-drug association rules with support degree ≥15% and confidence degree =100%, the most important association at different stages were "Ganjiang(Rhizoma Zingiberis→Huanglian", "Gualouren(Semen Trichosanthis) + Qing Banxia→Huanglian", and "Sheng Shanzha(Fructus Crataegi) + Gualouren + Qing Banxia→Huangliuan". According to the support degree ≥5% and confidence degree =100%, the most important drug-symptom association at different stages were "Huanglian-deep and slippery pulse", "Shuizhifen(Hirudo) + Ganjiang→insomnia", "Shuizhifen + Ganjiang + Huanglian→insomnia ", and "Hongqu(Fermentum Rubrum) + Zhimu(Rhizoma Anemarrhenae) + Qing Banxia + Huanglian→fatigue". According to the support degree ≥5% and confidence degree =100%, the important drug & western medicine indicator association rules were "Huanglian→2 h-PG", "Cangzhu(Rhizoma Atractylodis) + Huanglian→glycosylated hemoglobin", "Chishao(Radix Paeoniae Rubra) + Haungqin + Huanglian→glycosylated hemoglobin", and "Cangzhu + Tianhuafen(Radix Trichosanthis) + Chishao + Ganjiang→glycosylated hemoglobin". Conclusion The syndrome differentiation method of "state and target" is used in the Pi-dan constraint heat stage. The drug combination is characterized by "minor formula" target to patients′ symptoms and signs(symptom target) and western medicine indicators(indicator target).