冠心病热相关证临床用药规律分析

Analysis of Clinical Medication Law of Heat Related Syndromes of Coronary Heart Disease in the Recent Ten Years

目的分析近十年冠心病热相关证临床用药规律,为冠心病相关证的临床治疗提供借鉴。方法系统检索2011-2021年国内外主要医学数据库发表的冠心病热相关证的临床观察文献,提取方剂名称、证候名称、药物组成,统计药物使用频率、药物类别,对高频药物进行关联规则分析,通过“古今医案云平台”进行系统聚类,利用Gephi和Liquorice软件进行药物复杂网络可视化分析。结果最终纳入75篇合格文献,涉及到的热相关证的构成比大小排序:热(29.03%)>痰(28.23%)>瘀(20.97%)>毒(8.87%)。排在前3位的复合证为:痰热瘀阻证、痰热互结证、热瘀痰阻证;药物总频次为631次,共计109种药物,其中44种药物使用频率≥5%,使用频率前6位分别为丹参(64.00%)、黄连(57.33%)、半夏(42.67%)、川芎(28.00%)、茯苓(28.00%)、赤芍(28.00%)。清热类药物使用频次较高的依次为黄连(57.33%)、黄芩(25.33%)、金银花(20.00%)。药物功效类别共涉及16种,清热药(17.59%)、补虚药(16.67%)、活血化瘀药(16.67%)、理气药(10.19%)使用频率较高。关联组合使用较多的药对为黄连→丹参、半夏→黄连、半夏→丹参;药物聚类分析总共得到7组药物组合。而在药物的复杂网络分析中,丹参是全局网络的核心,与黄连、半夏、川芎、茯苓、赤芍、瓜蒌等药物的连线较粗,表示药物之间组合度较高。结论冠心病热相关证的治疗以清热解毒、散结养脉、活血化瘀为核心治法,辅以补气化痰。丹参、黄连、半夏、瓜蒌、茯苓等配伍在冠心病热相关证的治疗中最常用,小陷胸汤、四妙勇安汤、桂枝茯苓丸、十味温胆汤合定志丸、生脉饮为常用方剂组合,该研究可为冠心病热相关证的临床用药提供参考。

Objective To analyze the clinical medication law of heat related syndromes of coronary heart disease in recent ten years,so as to provide reference for the clinical treatment of related syndromes of coronary heart disease.Methods The clinical observation literatures of heat related syndromes of coronary heart disease published in major medical databases at home and abroad from 2011 to 2021 were systematically searched,the prescription names,syndrome names and drug compositions were extracted,the drug use frequencies and drug categories were counted,the association rules of high-frequency drugs were analyzed,and the systematic clustering was carried out through the“Ancient and Modern Medical Records Cloud Platform”,Gephi and Liquorice softwares were used for visual analysis of drug complex network.Results The study finally included 75 eligible articles,and those involved heat related syndromes were:heat(29.03%)>phlegm(28.23%)>stasis(20.97%)>toxin(8.87%).The top three composite syndromes were as follows:phlegm heat and stasis syndrome;phlegm heat interaction syndrome;heat and stasis phlegm syndrome.The total frequency of drugs was 631 times,and a total of 109 drugs were identified,of which 44 drugs were used at frequencies≥5%;and the top 6 most frequently used were Salviae miltiorrhizae radix et rhizoma(64.00%),Coptidis rhizoma(57.33%),Pinelliae rhizoma(42.67%),Chuanxiong rhizoma(28.00%),Poria(28.00%),and Paeoniae radix rubra(28.00%).The most frequently used fever-clearing drugs were in the order of Coptidis rhizoma(57.33%),Scutellariae radix(25.33%),and Lonicerae japonicae flos(20.00%).A total of 16 drugs were involved in the drug efficacy categories,with more frequently used of heat-clearing drugs(17.59%),deficiency-tonifying drugs(16.67%),blood circulation-promoting and blood stasis-removing drugs(16.67%)and qiregulating drugs(10.19%).The most association combinations are Coptidis rhizoma→Salviae miltiorrhizae radix et rhizoma,Pinelliae rhizoma→Coptidis rhizoma,Pinelliae rhizoma→Salviae miltiorrhizae radix et rhizome.Seven drug combinations were obtained by drug clustering analysis.In the complex network analysis of drugs,Salviae miltiorrhizae radix et rhizoma is the core of the global network.Its connection lines with Coptidis rhizoma,Pinelliae rhizoma,Chuanxiong rhizoma,Poria,Paeoniae radix rubra,Trichosanthis fructus and other drugs are thicker,indicating higher degrees of combination between drugs.Conclusion The core treatment of heat related syndromes of coronary heart disease is"clearing heat and detoxification,dispersing knot and nourishing blood,promoting blood circulation and removing blood stasis",supplemented by supplementing qi and resolving phlegm.Salviae miltiorrhizae radix et rhizome,Coptidis rhizome,Pinelliae rhizome,Trichosanthis fructus,Poria and other compatibilities are most commonly used in the treatment of heat related syndromes of coronary heart diseases.Xiaoxianxiong Decoction,Simiaoyong’an Decoction,Guizhi Fuling Pill,Shiwei Wendan Decoction combined with Dingzhi Pill,and Shengmai Decoction,are the common prescription combinations.This study provides reference for the clinical medication of heat related syndromes of coronary heart disease.