基于文献挖掘探讨针刺治疗甲状腺结节的用穴特点及核心组合

Discussion on the characteristics and core combination of acupoint functions in the treatment of thyroid nodules based on literature mining

目的通过检索针刺治疗甲状腺结节相关文献,总结针刺治疗甲状腺结节的选穴规律,为进一步的临床方案优化提供参考。方法基于文献涉及的多中心患者样本建立针刺治疗甲状腺结节腧穴处方数据库;设置最小置信度为0.5,最小支持度为0.1,以提升度作为主要排序标准,运用Apriori算法获取针刺治疗甲状腺结节腧穴以及经络配伍强关联规则,二阶穴位和经络强关联规则用网络图展示,三阶、四阶穴位强关联规则用列表展示;采用层次聚类法分别对穴位和经络进行聚类分析,应用R语言包“ggtree”在RStudio软件中绘制圆形聚类树状图可视化聚类结果。结果(1)最终纳入47篇文献,涉及1880例甲状腺结节患者,共记录55种取穴组合,使用频次前五的腧穴为天突、内关、合谷、阿是穴、足三里,主要归足阳明胃经、任脉;(2)按提升度排序,排名前三的二阶强关联规则为大杼—曲骨、大杼—天柱、曲骨—天柱,三阶关联规则排名前三的为天柱—曲骨—大杼、内关—大杼—曲骨、内关—天柱—大杼,提升度最高的四阶关联规则为内关—天柱—曲骨—大杼;(3)聚类分析显示,大杼、天柱、曲骨、内关为一类常用核心组合,合谷、天突、水突、列缺、足三里以合谷为主穴聚为一类常用穴位组合。结论针刺治疗甲状腺结节重视使用阳经和循行经过颈部的经脉,强调局部取穴配合远端取穴,局部核心取穴为阿是穴、天突、大杼、天柱,远端核心取穴为内关、曲骨。基于多中心、大样本的分析结果具有一定推广价值,从而为进一步的临床方案优化提供参考。

Objective To summarize the rules of acupoint selection in acupuncture treatment of thyroid nodules by searching the relevant literature on acupuncture treatment of thyroid nodules,so as to provide references for further optimization of clinical scheme.Methods The prescription database of acupoints for acupuncture treatment of thyroid nodules was established based on multi center patient samples involved in the literature;set the minimum confidence as 0.5 and the minimum support as 0.1.Take the promotion degree as the main ranking standard,and use the Apriori algorithm to obtain the strong association rules of acupuncture treatment of thyroid nodule acupoints and meridian compatibility.The strong association rules of second-order acupoints and meridians are displayed by network diagram,and the strong association rules of third-order and fourth-order acupoints are displayed by list;the hierarchical clustering method is used to cluster the acupoints and meridians respectively,and the R language package“ggtree”is used to draw a circular clustering tree in Rstudio software to visualize the clustering results.Results(1)Finally,47 articles were included,involving 1880 patients with thyroid nodules.A total of 55 acupoint combinations were recorded.The top five acupoints used frequently were Tiantu,Neiguan,Hegu,Ashixue and Zusanli,mainly belonging to Yangming Stomach Channel of Foot and Ren channel.(2)According to the order of degree of promotion,the second-order strong association rules of the top three are Dazhu-Qugu,Dazhu-Tianzhu and Qugu-Tianzhu.Tianzhu-Qugu-Dazhu,Neiguan-Tianzhu-Dazhu,Neiguan-Tianzhu-Dazhu are the top three,and Neiguan-Tianzhu-Qugu-Dazhu is the fourth-order association rules with the highest degree of promotion.(3)Cluster analysis also shows that Dazhu,Tianzhu,Qugu and Neiguan are a kind of commonly used core combinations,while Hegu,Tiantu,Shuitu,Lieque and Zusanli are a kind of common acupoint combinations with Hegu as the main acupoint.Conclusion Acupuncture treatment of thyroid nodules attaches importance to the use of Yang meridian and meridians passing through the neck,emphasizing local acupoint selection combined with the distal acupoint selection,local core acupoint Ashixue,Tiantu,Dazhu,Tianzhu,and distal core acupoint Neiguan and Qugu.The analysis results based on multi-center and large samples have a certain popularizing value,so as to provide references for further optimization of clinical regimens.