基于贝叶斯网络与关联规则探讨下肢动脉硬化闭塞症的中医临床疗效评价条目

Traditional Chinese Medicine Efficacy Evaluation Items for Lower Extremity Arteriosclerosis Obliterans Based on Bayesian Network and Association Rule

目的初步形成下肢动脉硬化闭塞症(ASO)中医证候相关的疗效评价条目池,为ASO证候疗效评价提供参考,为建立病证结合的中医临床疗效评价体系提供思路。方法通过检索中国知网、维普中文科技期刊数据库、万方期刊数据库内2012年1月1日至2022年8月31日公开发表的ASO临床疗效观察的期刊文献,整理归纳中医证候、症状、体征等疗效评价条目,建立数据库。通过关联规则发掘中医证候与评价条目的强关联组合,运用贝叶斯网络分析中医证候与评价条目的因果关系。将同时满足关联规则及贝叶斯网络模型条件的条目进行组合,初步形成ASO中医疗效评价条目池。结果共纳入文献127篇,7种辨证分型,分别为血脉瘀阻证(52次,36.62%)、寒凝血瘀证(33次,23.24%)、气虚血瘀证(23次,16.20%)、阴虚血瘀证(15次,10.56%)、热毒炽盛证(9次,6.34%)、湿热毒盛证(5次,3.52%)、痰瘀阻络证(5次,3.52%)。对前三种证型进行数据挖掘,临床疗效评价症状及体征条目共11种。初步形成ASO三种证型的中医临床疗效评价条目池。1)血脉瘀阻证,主要条目为疼痛(贡献度0.85);次要条目为皮色(贡献度0.80)、肤温(贡献度0.78)、间歇性跛行(贡献度0.90)。2)寒凝血瘀证,主要条目为疼痛(贡献度0.67);次要条目为肤温(贡献度0.71)、间歇性跛行(贡献度0.94)。3)气虚血瘀证,主要条目为疼痛(贡献度0.87);次要条目为皮色(贡献度0.60)、肤温(贡献度0.69)、间歇性跛行(贡献度0.85)。结论所建立的ASO条目池可为证候或症状改善的临床疗效评价提供参考,为进一步建立起规范科学的ASO中医临床疗效评价体奠定了基础。

Objective To preliminarily form an traditional Chinese medicine(TCM)efficacy evaluation item pool for lower extremity arteriosclerosis obliterans(ASO),thereby providing reference for syndrome evaluation of ASO and the establishment of TCM efficacy evaluation system integrating disease and syndromes.Methods Data⁃bases including CNKI,CQVIP and Wanfang were searched from January 1st,2012 to August 31st,2022 for literature related to ASO efficacy evaluation.Items involving TCM syndromes,symptoms and signs were summarized to estab⁃lish database.The association rules were used to discover strong association combinations between TCM syndromes and evaluation items,and Bayesian networks were used to analyze their causal relationships.The items that satisfied both the association rules and Bayesian network model conditions were combined to form a preliminary TCM efficacy evaluation item pool for ASO.Results A total of 127 papers were included involving seven TCM syndromes,which were blood vessels obstruction(52,36.62%),cold congealing and blood stasis(33,23.24%),qi deficiency with blood stasis(23,16.20%),yin deficiency and blood stasis(15,10.56%),intense heat-toxin(9,6.34%),exuber⁃ant damp-heat toxin(5,3.52%)and phlegm-stasis obstructing the collaterals(5,3.52%).Data on the first three syndromes were mined,and 11 symptoms and signs items for efficacy evaluation were obtained.The preliminary TCM efficacy evaluation item pool for ASO were formed.For blood vessels obstruction syndrome,the primary item was pain(contribution degrees 0.85),and the secondary items were skin color,skin temperature and intermittent claudication(contribution degrees:0.80,0.78,0.90 respectively).For cold congealing and blood stasis syndrome,the main items was pain(contribution degrees 0.67),while the secondary items included skin temperature and intermittent claudication(contribution degrees 0.71 and 0.94 respectively).Regarding qi deficiency and blood stasis syndrome,the primary item was pain(contribution degrees:0.87),and the secondary items were skin color,skin temperatur and intermittent claudication(contribution degrees:0.60,0.69,0.85 respectively).Conclusion The established item pool provides reference for efficacy evaluation on syndromes or symptoms in ASO,which lays foundation for fur⁃ther establishing a standardized scientific TCM efficacy evaluation system of ASO.