近30年中医药治疗阻塞性睡眠呼吸暂停低通气综合征的用药规律分析

Analysis of medication rule in the treatment of obstructive sleep apnea hypopnea syndrome with traditional Chinese medicine in the past 30 years

目的应用数据挖掘技术探究中医治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的用药规律及组方特点,期待为临床遣方用药及新方组合提供参考和依据。方法检索中国知网、万方、维普及中国生物医学文献服务系统四大数据库1990年1月1日至2021年10月1日发表的中医治疗OSAHS的所有文献。运用Microsoft Excel 2019,IBM SPSS Modeler 18.0,IBM SPSS Statistics 26.0,Gephi 0.9.2等数据挖掘软件进行频数、关联规则、系统聚类及复杂网络分析等。结果共纳入135篇合格文献,包含154首方剂、202味中药。半夏(8.96%)、茯苓(8.96%)、甘草(8.86%)、陈皮(7.57%)、石菖蒲(6.37%)等25味中药为高频药物,多以性温(47.65%)、味辛(32.51%)为主,主要归为肺(23.07%)、脾(21.74%)、心(16.47%)经,使用率较高的药物以补虚药(23.78%)、化痰止咳平喘药(20.78%)、活血化瘀药(16.9%)、理气药(12.74)、利水渗湿药(8.96%)、开窍药(6.37%)为主;得到以痰瘀互结证为首的28种证型分布,以脾、肺、咽喉、鼻窍为主的病位证素13个及以痰、血瘀、气虚、湿邪、热邪为主的病性证素11个;获得茯苓→白术+陈皮+半夏、石菖蒲→郁金+川芎等30条常用配伍组合,挖掘出5个核心方药组合及针对核心证素的8味公共药物。结论中医药治疗OSAHS以扶正祛邪为主,益气补肺健脾、行气活血化瘀、清热化痰开窍、理气燥湿化痰是临证遣方用药的基本原则,辨证予以解表、温阳、滋阴、安神、平肝熄风等。核心方剂为六君子汤、补阳还五汤、涤痰汤加减。该研究可为新药研发及新方组成提供思路和借鉴。

Objective To explore the rules and characteristics of prescriptions for the treatment of OSAHS in traditional Chinese medicine with data mining technology,and to provide references and basis for clinical prescriptions and new prescription combinations.Methods All literatures on the treatment of OSAHS included in CNKI,Wanfang,Weipu and China Biomedical Literature Service System from January 1,1990 to October 1,2021 were searched.Microsoft Excel 2019,IBM SPSS Modeler 18.0,IBM SPSS Statistics 26.0,Gephi 0.9.2 and other data mining software were used for frequency and association rules,system clustering and complex network analysis,etc.Results A total of 135 qualified documents were included,including 154 prescriptions and 202 traditional Chinese medicines.Pinellia(8.96%),Poria(8.96%),Licorice(8.86%),Tangerine Peel(7.57%),Grass leaved sweetflag(6.37%)and other 25 traditional Chinese medicines were high-frequency medicines.Xin(32.51%)was mainly attributed to lung(23.07%),spleen(21.74%),heart(16.47%)meridian.The most commonly used drugs were tonic(23.78%),phlegm,cough and asthma(20.78%),promoting blood circulation and removing stasis(16.9%),prescriptions for regulating qi flow(12.74%),damp-draining diuretic(8.96%),and resuscitation drugs(6.37%).The distribution of 28 syndrome types led by phlegm and blood stasis syndrome,13 disease location syndrome elements dominated by spleen,lung,throat and nasal orifices,and 11 disease nature syndrome elements dominated by phlegm,blood stasis,qi deficiency,dampness and heat evil were obtained.A total of 30 commonly used compatibility combinations such as Poria cocos→Atractylodes macrocephala+Pericarpium Citri Reticulatae+Pinellia ternata,Acorus tatarinowii Schott→Curcumae Radix+Ligusticum chuanxiong were obtained,and 5 core prescription combinations and 8 public drugs for core syndrome elements were excavated.Conclusions Traditional Chinese medicine treatment of OSAHS is mainly based on strengthening the body resistance and eliminating pathogenic factors.The basic principles of clinical prescription are replenishing qi,tonifying lung and invigorating spleen,promoting qi,activating blood and removing blood stasis,clearing heat,resolving phlegm and opening orifices,regulating qi,drying dampness and resolving phlegm.Syndrome differentiation should be used to relieve the exterior,warm yang,nourish yin,calm the mind,calm the liver and extinguish the wind.The core prescriptions are Liujunzi decoction,Buyang Huanwu decoction and Ditan decoction.This study can provide ideas and references for new drug research and development and new prescription composition.