基于脉络学说指导和医案数据挖掘的心血管事件链证治规律分析

Vessel-collateral Theory Guided Rules of Syndrome and Treatment of Cardiovascular Event Chain Based on Medical Record Data Mining and Analysis

目的:以脉络学说为指导,基于医案数据挖掘分析结果探讨心血管事件链证治规律。方法:采用多源数据库类研究,系统检索PubMed、中国知识基础设施工程(CNKI)、万方数据知识服务平台(Wanfang Data)、维普网(VIP)、中国生物医学文献服务系统(SinoMed)中代谢综合征、冠心病心绞痛、心肌梗死介入后、心肌梗死后心律失常及心肌梗死后心力衰竭相关医案,检索时限设置为数据库建库至2022年1月。提取医案中患者姓名、年龄、性别、症状、舌象、脉象、药物、病位等字段,基于脉络学说指导进行药物功效分类及证候分类判定,运用频数解构、系统聚类分析、FP-Growth关联分析等数据挖掘方法分析心血管事件链证治规律。结果:心血管事件链上述5个关键病理环节中均出现营卫失常相关的证候表现;营卫“由络以通,交会生化”异常所继发的湿、痰、瘀、水在上述5个关键病理环节所占比重有所差异,相应用药组合所占频次也不相同。结论:营卫失常为心血管事件链发病的始动因素并贯穿全过程,脉络末端营卫“由络以通、交会生化”异常可导致气血津液精输布代谢障碍,津聚为湿,湿凝为痰,血滞为瘀,瘀血化水,成为促进心血管事件链发展加重的内在驱动因素,导致“凝-壅-塞-不通”传变规律,构成了心血管事件链5个关键病理环节发展演变的核心病机。

Objective:To explore the rules of syndrome and treatment of cardiovascular event chain based on the results of data mining of medical records under the guidance of vessel-collateral theory.Method:Multi-source database research method was used to retrieve the medical records related to metabolic syndrome,angina pectoris of coronary heart disease,post-intervention of myocardial infarction,arrhythmia after myocardial infarction and heart failure after myocardial infarction between database inception and January 2022from PubMed,China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(Wanfang Data),VIP and China Biomedical Literature Service System(SinoMed).The fields of name,age,gender,symptoms,tongue image,pulse image,drug and disease location were extracted from these medical records,and drug efficacy classification and syndrome classification were determined based on vessel-collateral theory.The rules of syndrome and treatment of cardiovascular event chain were analyzed by data mining methods such as frequency deconstruction,systematic cluster analysis and FP-Growth association analysis.Result:The above five key pathological links in the chain of cardiovascular event chain all showed symptoms related to the disorder of Yingwei.The proportion of dampness,phlegm,blood stasis and water secondary to the disorder of Yingwei in the above five key pathological links was different,and the frequency of corresponding drug combinations was also different.Conclusion:The disorder of Yingwei is the initiating factor of cardiovascular event chain and runs through the whole process.The abnormality of Yingwei at the terminal of vessel-collateral may lead to the disorder of Qi,blood,body fluid and essence transportation and metabolism.Body fluid accumulates into dampness,dampness accumulates into phlegm,blood stagnation accumulates into blood stasis,blood stasis accumulates into water,which becomes an internal driving factor to promote the development and aggravation of cardiovascular event chain.It leads to the transmission law of Ning-Yong-SaiButong,which constitutes the core pathogenesis of the development and evolution of the five key pathological links of cardiovascular event chain.