基于关联规则及熵聚类分析135例气虚血瘀型缺血性中风老年患者的处方用药规律

The medication rules of prescriptions in treating 135 elderly patients with ischemic stroke of the Qi deficiency and blood stasis type based on association rules and entropy clustering

目的:应用数据挖掘方法分析气虚血瘀型缺血性中风老年患者的中药处方用药规律。方法:搜集2017年6月-2022年6月山东中医药大学附属医院老年医学科收治的气虚血瘀型缺血性中风老年患者的中药处方,使用中医传承辅助平台V2.5进行深入分析。结果:筛选出符合要求的方剂135首,共计226味中药,累计使用频次2 615次,使用频次靠前的药物以补气药及活血化瘀药为主,其中使用频次≥40的中药共21味,包括甘草、黄芪、白术、茯苓、川芎等药物,性味以温性、甘味为主,主要归脾经;经Apriori关联规则分析得出支持度个数为“45”的药物组合23个及置信度为“0.8”的关联规则14条;经改进的互信息法的药物间关联度分析得出关联系数在0.03以上的药对37对;经复杂系统熵聚类分析得到药物核心组合10个;经无监督熵层次聚类分析得到新处方5个。结论:老年患者脾气虚衰,易生痰湿,痰湿阻滞又困遏脾气,日久则痰湿愈重、脾胃愈虚。故治疗气虚血瘀型缺血性中风,除选用补气药及活血化瘀药以益气活血外,还应配以祛湿化痰药以健运脾气,往往能达到更理想的治疗效果。

Objective:To analyze the prescription medication rules of elderly patients with ischemic stroke of the Qi(气)deficiency and blood stasis type.Methods:The TCM prescription for the elderly ischemic stroke patients with Qi deficiency and blood stasis in the Geriatrics Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from June 2017 to June 2022 was collected for an in-depth analysis by traditional Chinese medicine inheritance support system V2.5.Results:A total of 135 prescriptions that met the requirements were screened out,including 226 Chinese medicinal materials,with a cumulative frequency of 2615 times.The drugs with the highest frequency were mainly used for invigorating Qi,and promoting blood circulation to remove blood stasis.Among them,there were 21 Chinese medicinal materials with a frequency of more than 40 times,including Gancao(Radix Glycyrrhizae),Huangqi(Radix Astragali),Baizhu(Rhizoma Atractylodis Macrocephalae),Fuling(Poria cocos),Chuanxiong(Rhizoma Chuanxiong),etc..The main medicinal properties and medicinal tastes were warm property and sweet taste,and the active ingredients of the drug were mainly absorbed by spleen meridian.Apriori association rule analysis showed that there were 23 drug combinations with support degree of 45 and 14 association rules with confidence degree of 0.8.After the correlation degree analysis of medicines by improved mutual information method,there were 37 medicine pairs with correlation coefficient above 0.03.A total of 10 groups of core medicine combinations were obtained by complex system entropy cluster analysis.After unsupervised entropy hierarchical clustering analysis,five new prescriptions were obtained.Conclusion:Elderly patients with spleen Qi deficiency are prone to have phlegm dampness in the body,and the blockage of phlegm and dampness leads to the blockage of spleen Qi.As time goes on,phlegm and dampness become heavier,and spleen and stomach become more deficient.Therefore,in the treatment of ischemic stroke with Qi deficiency and blood stasis,in addition to the selection of Qi tonifying medicines and blood stasis medicines to invigorate Qi and blood.It should also be combined with dampness and phlegm dissolving medicines to strengthen spleen Qi,which can often achieve a more ideal treatment effect.