基于数据挖掘分析癌因性疲乏用药规律及中医辨治思路

Study on Medication Regularity and Traditional Chinese Medicine Thought of Syndrome Differentiation in Treating Cancer-related Fatigue Based on Data Mining

目的:应用数据挖掘方法对中医治疗癌因性疲乏(cancer-related fatigue,CRF)随机对照研究中的核心辨治思路及用药规律进行总结。方法:搜集中国知网、万方数据库、维普中文科技期刊数据库从建库至2019年12月30日收录的中医药干预CRF的随机对照试验,并筛选出记录完整的方剂。采用Excel建立数据库并录入古今医案云平台(V2.2.2),通过中药及中医证候频次分析、药对分析、关联规则分析、聚类分析、复杂网络分析等方法进行数据挖掘。结果:最终纳入76项研究,处方76首,CRF中医证型30个,中药总数149味,总用药频次818次。中医证型频次前2位由高到低分别为脾气虚证(22.45%)、气血两虚证(20.40%);治法以益气健脾(24.21%)、补气养血(21.05%)为主。中药频次前4位的高频单药为白术(7.09%)、甘草(6.11%)、茯苓(5.99%)、黄芪(5.74%);四气以温、平为主,五味以甘、苦为主,药多归于脾、肺二经;关联分析得出关联规则6条;高频药对前3位为白术-茯苓、白术-黄芪、白术-当归;复杂网络分析显示白术与其余中药配伍关联最多;中药聚类分析得出聚类组合4组。结论:临床辨治CRF的用药原则为以补为宗,不拘于补;气血同调,理气为先;脾肾双补,兼调心肝;攻补兼施,审时抗癌。

Objective:To summarize the core ideas of syndrome differentiation and treatment and medication regularity of traditional Chinese medicine(TCM) treatment for cancer-related fatigue(CRF) in randomized controlled studies by using data mining method.Methods :Randomized controlled trials of TCM intervention on CRF were collected from CNKI,Wanfang Database and VIP Chinese Science and Technology Journal Database from the establishment of the database to December 30th,2019,and the well-documented prescriptions were screened out. Excel was used to establish the database,which was inputed into Cloud Platform of Ancient and Modern Medical Records(V2.2.2). The platform were used to carry out data mining through Chinese medicine and TCM syndrome frequency analysis,drug pair analysis,association rule analysis,cluster analysis,complex network analysis and so on. Results:Finally,76 studies were included,including 76 prescriptions,30 CRF TCM syndrome types,149 Chinese medicines,and 818 frequency of medication. The top 2 syndromes in frequency from high to low were spleen qi deficiency syndrome(22.45%),qi and blood deficiency syndrome(20.40%). The main treatment methods were supplementing qi and strengthening spleen(24.21%) and supplementing qi and nourishing blood(21.05%). The top 4 high-frequency single medicinals in TCM frequency were Baizhu(Atractylodis Macrocephalae Rhizoma)(7.09%),Gancao(Glycyrrhizae Lycyrrhizae Radix Et Rhizoma)(6.11%),Fuling(Poria)(5.99%),Huangqi(Astragali Radix)(5.74%). The four qi were mainly warm and flat,and the five flavors were mainly sweet and bitter. Most Chinese medicines returned to the two meridians of spleen and lung. Total 6 association rules were obtained from association analysis. The top three high-frequency drug pair were Baizhu-Fuling,Baizhu-Huangqi and Baizhu-Danggui(Angelicae Sinensis Radix). Complex network analysis showed that Baizhu was most associated with the compatibility of other Chinese medicine. Four cluster combinations were obtained by TCM clustering analysis. Conclusions:The medication principles of syndrome differentiation and treatment in clinical treatment of CRF is taking supplementation as the principle of treatment and it is not limited to supplementation,qi and blood are regulated at the same time,regulating qi is given priority in addition to tonifying both the spleen and kidney,and regulating heart and liver,tonification and purgation in combination is made to fight cancer.