基于数据挖掘探讨中医药治疗急性心力衰竭的用药规律

Based on Data Mining to Explore the Medication Rules of Traditional Chinese Medicine in the Treatment of Acute Heart Failure

目的采用数据挖掘分析中医药治疗急性心力衰竭(AHF)的用药特点及组方规律。方法检索中国知网(CNKI)、万方数据知识服务平台(Wanfang)、维普中文期刊(VIP)、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library数据库自建库至2021年4月所有中医药治疗AHF的随机对照临床研究文献。筛选文献和提取资料后,应用Excel 2010、IBM SPSS Modeler 18.0、IBM SPSS Statistics 21.0对方药进行频数统计、关联规则分析及系统聚类分析。结果共纳入方剂67首,涉及中药103味,共计使用频次702次。AHF的病因构成以冠心病和肺源性心脏病为主,主要证型为阳虚水泛证、气虚血瘀证、心肾阳虚证;中药使用频次较高的药物有黄芪、附子、甘草、丹参、茯苓等;药物功效以补虚药、活血化瘀药和利水渗湿药为主;药性以温为主;药味以甘为主,兼有苦、辛;药物归经使用频次较高的为脾经、心经和肺经;关联规则分析得到“泽泻-猪苓”“茯苓-白术-附子”与“桂枝-丹参-茯苓-黄芪”等常用药对组合,聚类分析得到4个新方组合,主要用于阳虚喘脱证、阳虚水饮证、气阴两虚血瘀证及气虚血瘀水饮证的治疗。结论AHF的基本病机为本虚标实,以虚为主,治法以益气温阳为主,兼活血、利水、养阴、平喘、固脱等,挖掘出五苓散、真武汤及芪参益气滴丸的组方等治疗AHF的常用基础方。

Objective To analyze the medication characteristics and prescription rules of traditional Chinese medicine in the treatment of acute heart failure(AHF)by using data mining.Methods Randomized controlled clinical studies on the treatment of AHF with traditional Chinese medicine were searched from the inception of CNKI,Wanfang,VIP,CBM,PubMed and Cochrane Library to April 2021.After literature screening and data extraction,Excel 2010,IBM SPSS Modeler 18.0 and IBM SPSS Statistics 21.0 were used to perform frequency statistics,association rule analysis and system cluster analysis.Results A total of 67 prescriptions and 103 kinds of traditional Chinese medicine were included,and the frequency of use was 702 times.The etiology of AHF is mainly coronary heart disease and pulmonary heart disease,and the main syndromes are yang deficiency and flooding syndrome,qi deficiency and blood stasis syndrome,and heart-kidney yang deficiency syndrome.The traditional Chinese medicine used frequently included Astragali Radix,Aconiti Lateralis Radix Praeparata,Glycyrrhizae Radix et Rhizoma,Salviae miltiorrhizae Radix et Rhizoma,Poria,etc.The drug efficacy is mainly to replenish deficiency,promote blood circulation and remove blood stasis,eliminate dampness and promote diuresis.The main medicinal properties were warm,and the main medicinal taste was sweet,with both bitter and plenum.The most frequently used drugs belonged to spleen meridians,heart meridians and lung meridians.According to association rule analysis,common drug combinations,such as“Alismatis Rhizoma-Polyporus”“Poria-Atractylodes macrocephala Koidz-Aconiti Lateralsi Radix Praeparata”and“Cinnamoni Ramulus-Salviae miltiorrhizae Radix et Rhizoma-Poria-Astragali Radix”were obtained,and four new prescription combinations were obtained by cluster analysis,which were mainly used for the treatment of yang deficiency and asthma withdrawal,yang deficiency and water-drinking syndrome,blood stasis syndrome of qi and yin deficiency,and blood stasis syndrome of qi deficiency and blood-stasis water-drinking syndrome.Conclusion The basic pathogenesis of AHF is deficiency in origin and excess in superficiality,and the deficiency is its characteristic.The treatment methods is to benefit air temperature and yang,promote blood circulation,improve water,nourish yin,relieve asthma,solid removal,etc.The common basic prescriptions of Wuling powder,Zhenwu decoction and Qishen Yiqi dropping pills for the treatment of AHF have been dug out.