回顾性研究中医治疗男性不育症用药规律及作用机制

Retrospective Study of Chinese Medicine Treatment of Male Infertility Law and Mechanism of Action

目的基于临床信息系统,采用数据挖掘方法从真实世界角度分析中医治疗男性不育症用药规律及高频药对的作用机制。方法基于回顾性研究的方法,选择某院2020年1月~2021年12月信息系统诊断为“男性不育症”或“不育”的中医门诊处方,建立Excel数据库并进行描述性统计,对核心数据进行关联规则分析,并借助网络药理学方法分析高频药对发挥作用的潜在机制。结果共纳入1528例病例,涉及中药273味,以温性为主,甘味为多,以肝经为主;关联规则分析结果显示,置信度最高的组合为泽泻、牡丹皮、茯苓(97.62%)。通过TCMSP、GeneCards、STRING 11.0、MetScape等数据库筛选高频药对主要化合物35个,相应作用靶点147个,与男性不育症的共同靶点78个,KEGG富集分析筛选得到222条信号通路(P<0.01),主要涉及癌症的途径、化学致癌-受体激活、脂质和动脉粥样硬化信号通路等。结论中医临床治疗男性不育症补肾益精法、补脾益气养血法、利湿泄浊为主要思路,高频药对发挥“利湿泄浊”作用具有多组分、多靶点、多途径等特点。

OBJECTIVE To analyze the medication rule and mechanism of high-frequency drug pairs in TCM treatment of male infertility from the perspective of real world by data mining method,based on clinical information system.METHODS Based on the method of retrospective study,the information system diagnosis of "male infertility" or "sterile" outpatient prescriptions of TCM in a hospitalin from January 2020 to 2021 Decemberwere chose to create the Excel database and descriptive statistics,association rule analysis of core data,with the analysis of network pharmacology method,high frequency potential mechanism to play a role.RESULTS A total of 1 528 cases were included,involving 273 kinds of TCM,mainly warm,mostly sweet and mainly liver meridian.Association rule analysis showed that the combinations with the highest confidence were Rhizoma Salix,Cortex Moutan and Poria Cocos(97.62%).35main compounds,147 corresponding targets and 78 common targets with male infertility were screened by TCMSP,GeneCards,STRING 11.0,MetScape and other databases.222 signaling pathways were obtained by KEGG enrichment analysis(P<0.01).They mainly involved pathwaysfor cancer,chemical carcinogenesis-receptor activation,lipid and atherosclerosis,etc.CONCLUSION In the clinical treatment of male infertility,the methods of tonifying kidney and essence,tonifying spleen,nourishing qi and nourishing blood,removing dampness and clearing away turbidnessare the main ideas.The high-frequency drugs have the characteristics of multi-component,multi-target and multi-approach to play the role of "removing dampness and clearing away turbidness".