基于真实世界数据挖掘中医药治疗不同证型系统性红斑狼疮肺间质病变的用药规律研究

Study on the Medication Patterns of Traditional Chinese Medicine in theTreatment of Pulmonary Interstitial Lesions in Systemic Lupus Erythematosuswith Different Syndrome Types Based on Real-World Data Mining

目的 基于真实世界临床数据探讨不同证型系统性红斑狼疮肺间质病变中药组方用药规律。方法 收集2017年1月至2021年12月门诊及住院患者资料,对患者的基本信息、中医证型、药物四气五味归经进行频次频率统计;对前4高频证型的药物进行关联规则分析、聚类分析及证型-药物复杂网络分析。结果 共纳入146例患者、369首处方。经频次统计发现最常见证型是湿热痹阻证、气阴两虚证、肝肾亏虚证、阴虚内热证;共涉及298味中药,出现药物频次5 629次,高频药物有29味,排名前5位分别是茯苓、当归、黄芪、炙甘草、白芍;药物四气以温、寒、平为主,五味以甘、苦、辛为主,归经以肺、脾、肝、肾为主,功效分类以补虚药、清热药、利水渗湿药为主;高频证型关联规则、系统聚类及复杂网络分析得到湿热痹阻证、气阴两虚证、肝肾亏虚证、阴虚内热证核心药物组合分别为四妙丸加减与木防己汤加减、补肺汤加减、独活寄生汤加减、六味地黄丸加减。结论 中药治疗系统性红斑狼疮肺间质病变多以清热祛湿、活血通痹、益气养阴、补肺脾肾为治则,得出的组方规律对临床治疗具有一定的参考价值,同时为新药开发提供思路。

Objective To explore the medication rules of traditional Chinese medicine(TCM)in the treatment of different syndrome types of systemic lupus erythematosus interstitial lung disease based on real world data mining.Methods The data of outpatients and inpatients from January 2017 to December 2021 were collected.Conduct frequency statistics on the patient's basic information,traditional Chinese medicine syndrome types,and the meridian tropism of the four Qi and five flavors of drugs.Perform association rule analysis,cluster analysis,and syndrome drug complex network analysis on the top 4 high-frequency syndrome types of drugs.Results A total of 369 prescriptions were included in 146 patients.The frequency statistics showed that the most common syndromes were dampness-heat impediment syndrome,deficiency of both Qi and Yin,deficiency of liver and kidney,and internal heat due to Yin deficiency.A total of 298 Chinese medicinals were involved,with the drug occurrence frequency of 5629 times,and high-frequency drugs of 29 kinds,with Poria,Radix Angelicae Sinensis,Radix Astragali seu Hedysari,Radix Glycyrrhizae Preparata and Radix Paeoniae Alba in the top 5 places respectively.The four Qi of the drugs were mainly warm,cold and mild,and the five flavors were mainly sweet,bitter and pungent,and the meridian tropism was mainly composed of lung,spleen,liver and kidney.The efficacy of the drugs was mainly classified as deficiency-tonifying drugs,heat-clearing drugs,and diuretic and dampness-infiltrating drugs.The core drug combinations obtained from association rules,systematic clustering and complex network analysis of the different syndrome types were modified Simiao pill and modified Mufangji decoction,modified Bufei decoction,modified Duhuo Jisheng decoction,and modified Liuwei Dihuang pill.Conclusion In the treatment of systemic lupus erythematosus pulmonary interstitial lesions with TCM,the therapeutic principles were mainly clear heat and remove dampness,activate blood and relieve impediment,replenish Qi and nourish Yin,supplement lung,spleen and kidney.The formula rules have certain reference value for clinical treatment and provide ideas for new drug development.