基于真实世界数据研究芍药甘草汤加减对抗结核药物性肝损伤辨治规律

Study on syndrome differentiation and treatment of anti-tuberculosis drug induced liver injury with Shaoyao Gancao Decoction based on real world data

目的 采用真实世界方法分析芍药甘草汤加减治疗抗结核药物性肝损伤(ATB-DILI)的中医辨证特点及临床用药特征。方法 挖掘分析武汉市肺科医院2020年8月—2021年8月诊断为ATB-DILI且使用芍药甘草汤加减的患者真实世界数据,总结归纳其辨治特点及用药规律。结果 纳入病案66例,处方199张,证型11种,主要症状10种。涉及212味中药,性味以甘温、苦寒,归肝、肺、脾经药物为主,功效以补虚、清热等为主。关联分析得到3 294条关联规则,高频中药聚类分析得到3类核心药物组合。结论 ATB-DILI的真实世界特征为:肝脾两虚证最为常见,其次为肝胆湿热证、肝气不足证等,临床谴方用药既要补脾益气、疏肝清热又要祛湿、化痰,在芍药甘草汤基础上对症加减,标本兼治。

Objective To analyze the clinical dialectical and medication characteristics of Shaoyao Gancao Decoction in treatment of anti-tuberculosis drug induced liver injury(ATB-DILI). Methods Mined andanalyzed the data of patients who were diagnosed with ATB-DILI and used Shaoyao Gancao Decoction from August 2020 to August 2021 in Wuhan Pulmonary Hospital, and summarized the characteristics of the diagnosis, the treatment and the rule of medication. Results This study included 66 medical records, 199prescriptions, 11 types of syndromes, and 10 main symptoms. Involved 212 traditional Chinese medicines(TCM), their tropism of taste: sweet and warm, bitter and cold. In the liver, lung, and spleen, and the effects of the TCM pieces were tonic and heat-clearing.3 294 association rules were obtained through association analysis, and three core drug combinations were got through highfrequency cluster analysis. Conclusion The most common syndrome was liver and spleen asthenia, followed by damp-heat in liver and gallbladder, insufficient liver qi, etc. Medication should not only invigorate the spleen and replenish qi, soothe the liver and clear heat, but also clear damp and reduce phlegm. On the basis of Shaoyao Gancao Decoction, added or subtracted other TCM pieces,treated diseases both symptoms and root causes.