基于数据挖掘探讨国医大师张琪治疗儿童肾病综合征激素撤减期用药规律

Exploration on Medication Law of TCM Master Zhang Qi in the Treatment of Children with Nephrotic Syndrome During Hormone Withdrawal Period Based on Data Mining

目的采用数据挖掘方法对国医大师张琪教授治疗儿童肾病综合征激素撤减期的用药规律进行分析,传承其学术思想。方法收集2008年1月-2018年12月黑龙江省中医医院张琪教授门诊的儿童肾病综合征激素撤减期患者病案,利用Excel2019建立数据档案,基于中医传承计算平台3.5,运用频次统计、关联规则、聚类分析等数据挖掘方法,探讨张琪教授用药规律。结果共筛选纳入中药处方271首,涉及中药194味,药物总频次为4610。高频药物包括甘草、黄芪、莲子、麦冬、地骨皮、茯苓、太子参、柴胡、金银花等。药性以寒、平居多,药味以甘、苦、辛为主,归经以肺经、脾经、肾经居多。药物功效统计中补虚类、清热类、利水渗湿类使用频次较高。关联规则分析得出高频药物组合模式184组;支持度为60%时,包含核心药物组合为黄芪、太子参、莲子、麦冬、地骨皮、茯苓、甘草;聚类分析得到6类新方组合。结论儿童肾病综合征激素撤减期以肺、脾、肾三脏虚弱为本,多见气阴两虚证,张琪教授治疗本病以调理肺脾肾之气为要,清补兼施,随证治以清利湿热、理气和胃、利水渗湿之品,以调整阴阳平衡为期。

Objective To analyze the medication laws of children with nephrotic syndrome during hormone withdrawal period treated by TCM master Zhang Qi using data mining methods,inheriting his academic ideas.Methods The medical records of children with nephrotic syndrome during the hormone withdrawal period treated by Professor Zhang Qi at the Outpatient Department of Traditional Chinese Medicine of Heilongjiang Provincial Hospital from January 2008 to December 2018 were collected.A database was established using Excel 2019.Frequency statistics,association rules,and clustering analysis were employed among other data mining techniques to elucidate Professor Zhang Qi's medication principles based on the Traditional Chinese Medicine Inheritance Computing Platform 3.5.Results A total of 271 prescriptions were selected,encompassing 194 types of Chinese herbs,with a total drug frequency of 4610 instances.High-frequency herbs included Glycyrrhizae Radix et Rhizoma,Astragali Radix,Nelumbinis Semen,Ophiopogonis Radix,Lycii Cortex,Poria,Pseudostellariae Radix,Bupleuri Radix,Lonicerae Japonicae Flos,and others.The properties of the drugs were predominantly cold and neutral,with flavors mainly sweet,bitter and pungent,and they targeted the lung meridian,spleen meridian,and kidney meridian primarily.In terms of therapeutic efficacy,there was a higher frequency of usage for tonifying deficiencies,clearing heat,and resolving water and dampness.Through association rule analysis,a total of 184 groups of high-frequency herb combinations were identified.When the support rate was set at 60%,seven core herb combinations were included:Astragali Radix,Pseudostellariae Radix,Nelumbinis Semen,Ophiopogonis Radix,Lycii Cortex,Poria,Glycyrrhizae Radix et Rhizoma.Clustering analysis yielded 6 novel formula combinations.Conclusion The hormone withdrawal period for children with nephrotic syndrome is characterized by the weakness of the lung,spleen and kidney,commonly presenting as qi-yin deficiency syndrome.Professor Zhang Qi manages the condition by regulating the qi of the lung,spleen and kidney,and employs a treatment strategy that is both tonifying and supplementing.To balance yin and yang,medications are chosen to clear dampness and heat,regulate qi and the stomach,and promote the elimination of water and dampness.