基于隐结构模型和关联规则探讨急性胰腺炎的用药规律

To explore the medication rule of acute pancreatitis based on latent structure model and association rules

目的 探讨中医药治疗急性胰腺炎的用药规律及中医证型,为临床治疗急性胰腺炎提供中医辨证思路和依据。方法 计算机检索中国知网(CNKI)数据库等中文数据库,检索从建库至今(2021年9月)关于急性胰腺炎临床治疗的文献,筛选后,将文献中的方剂录入Excel,规范中药名,用SPSS Modeler18.0将频率大于4%的中药用Apriori算法建立模点,得到药物之间的关联规则。基于Lantern5.0软件对频率大于4%的中药进行隐树模型学习,得到隐类变量及显变量,对模型进行诠释。结果 纳入文献157篇,方剂182首,涉及165味中药,频率大于4%的中药共39味,频次最高的是前五位是大黄(90.66%)、柴胡(69.23%)、黄芩(59.89%)、枳实(50.00%)、芒硝(48.90%)。关联规则分析共40条强关联规则,其中二项7条,三项24条,四项9条,置信度最高的为二项中大黄→芒硝,三项中厚朴+芒硝→大黄,枳实+芒硝→大黄,延胡索+芒硝→大黄,黄芩+芒硝→大黄,柴胡+芒硝→大黄,四项中柴胡+黄芩+芒硝→大黄。隐结构模型分析包含7个隐变量,Y0、Y1……Y6,分别代表方剂大承气汤、大柴胡汤、膈下逐瘀汤、茵陈蒿汤、清胰汤、柴胡疏肝散、泻心汤。结论 急性胰腺炎的治疗以通腑泻下药为主,根据病情加减泻下药、理气药、活血药、清热解毒药、清热燥湿药、利湿退黄药。通过以方测证,推测急性胰腺炎代表证候为瘀血阻滞证、腑实热结证、阳明热结证、肝胆湿热证、肝火旺盛证、肝郁气滞证、邪热壅滞证,可见证候以实证居多。

Objective To explore the medication rule and syndrome type of Traditional Chinese Medicine(TCM) in the treatment of acute pancreatitis(AP),and to provide the thought and basis of TCM syndrome differentiation for clinicatreatment of AP.Methods Computer retrieval of CNKI database and other Chinese databases,retrieval of literature on clinical treatment of AP from the establishment of the database to the present(September 2021),after screening,the prescriptions in the literature were input into Excel,after standardizating the name of TCM,SPSS Modeler18.0 was used to establish model points with Apriori algorithm for TCM with frequency greater than 4%,and the association rules between drugs were obtained.Lantern5.0 was used to learn the latent tree model for Chinese medicines with a frequency greater than 4%,and the latent variables and manifest variables were obtained,and the model was interpreted.Results 157 references were included,182 prescriptions were included,involving 165 Chinese medicines,39 of which were more than 4% in frequency.The top five Chinese medicines with the highest frequency were Rhubarb(90.66%),Bupleurum(69.23%),Scutellaria baicaleae(59.89%),Immaturus aurantii(50.00%),and Herabilite(48.90%).A total of 40 strong association rules were analyzed.Among them,there were 7 binomial items,24 trinomial items and 9 quadrinomial items,with the highest confidence of binomial Rhubarb→ Mirabilite,trinomial magnolia officinalis+Mirabilite→ Rhubarb,Immaturus aurantii+Mirabilite→ Rhubarb,Scutellaria baicalensis+Mirabilite→ Rhubarb,Scutellaria baicaleae+Mirabilite→ Rhubarb,bupleurum+Mirabilite→ Rhubarb,and quadrinomial Bupleurum+Scutellaria baicalensis+Mirabilite→ Rhubarb.The latent structure model analysis contains 7 latent variables,Y0,Y1……Y6 respectively represents the prescription Dachengqi Decoction,Big Bupleurum decoction,Gexia Zhuyu Decoction,Yinchen Artemisia decoction,Qingyi Decoction,Bupleurum Liver-relieving powder and Purging heart Decoction.Conclusion The diagnosis and treatment of AP,mainly to tongfu purging drugs,according to the condition of the reduction of purging drugs,qi drugs,drugs to promote blood circulation,heat antitoxin,heat dryness drugs,dampness and yellowing medicine.The representative syndromes are presumed to be blood stasis block syndrome,fu-solid heat syndrome,Yang-ming heat syndrome,damp-heat syndrome of liver and gallbladder,exuberant liver fire syndrome,stagnation of liver stagnation and qi syndrome,and obstruction of evil heat syndrome.