基于真实世界研究数据挖掘吕文良教授治疗非酒精性脂肪性肝病中医用药规律研究

Analysis of the experience of Professor Lv Wenliang in the treatment of non-alcoholic fatty liver disease based on real-world research by data mining

目的:深入剖析吕文良教授治疗非酒精性脂肪性肝病(NAFLD)的临床用药规律。方法:基于真实世界研究数据收集和整理吕文良教授于2017年1月1日至2023年5月23日在中国中医科学院广安门医院门诊治疗NAFLD的处方1383份,采用Excel建立规范化、标准化临床资料数据库,借助SPSS Statistics 20.0、SPSS Modeler 18.0软件进行高频药物的关联规则分析、聚类分析。结果:共纳入处方1383首,涉及药物355味,其中频次排名前10的药物分别是:白芍、柴胡、茵陈、黄芪、荷叶、白术、茯苓、当归、甘草、垂盆草;药性多偏温、平、寒,药味以苦、甘、辛为主;主入肝、肺、胃、脾经;共产生“香附→当归、川楝子→香附、当归→香附、黄连→泽泻、苍术→泽泻”等12条药物配伍,聚类分析共得到“垂盆草、金钱草、茵陈、荷叶、鸡内金、姜黄、山药、薏苡仁”等3个聚类方。结论:吕教授认为“湿、热、瘀、痰、虚、郁”是NAFLD主要病理因素,以健脾疏肝、清利湿热活血为主要治则,在治法上强调攻补兼施、寒温并用、甘苦合用、气血同调、随症加减,讲求以平为期、以和为要。

Objective:Analyzing Clinical Medication Practices of Professor Lv Wenliang for Treating Non-Alcoholic Fatty Liver Disease(NAFLD).Methods:Based on real-world medical data,we collected and collated 1,383 prescriptions of Professor Lv Wenliang for the treatment of NAFLD in the outpatient clinic of Guang'anmen Hospital of the China Academy of Traditional Chinese Medicine(CATCM) from 1 January 2017 to 23 May 2023 and used Excel to establish a normalized and standardized database for the clinical information,and then with the help of SPSS Statistics 20.0 and SPSS Modeler 18.0 software for association rule analysis and cluster analysis of HF drugs.Results:A total of 1,383 prescriptions were included,involving 355 flavors of drugs,of which the top 10 drugs in terms of frequency were:Paeonia lactiflora,Radix Bupleurum Chinense,Herba Leonurus,Radix Astragali,Lotus leaf,Rhizoma Atractylodis Macrocephalae,Poria cocos,Radix Angelicae Sinensis,Glycyrrhiza Uralensis,and Herba Taraxacum Chinense,which are mostly warm,calm,and cold in nature,with bitter,sweet,and pungent flavors;they are mainly found in the meridians of the liver,lungs,stomach,and spleen.There were 12 drug combinations such as "Xiang Fu → Angelica sinensis,Neem Ziziphi → Xiang Fu,Huang Lian → Ze Xie,Cang Zhu → Ze Xie," and 3 cluster formulas such as "Tarragon grass,Qian Cao,Yin Chen,Lotus Leaf,Chicken Nei Jin,turmeric,Chinese yam,and Semen Coix lacryma" were obtained from the cluster analysis.Conclusion:Professor Lv believed that "dampness,heat,stasis,phlegm,deficiency,and depression" are the main pathological factors of NAFLD,and that the main treatment principle is to strengthen the spleen and dredge the liver,clear dampness,heat,and activate blood,and to emphasize the combination of attacking and tonifying,combining cold and warmth,combining sweetness and bitterness,regulating qi and blood,and adding and subtracting according to the symptom,and emphasizing the principle of peacefulness and the importance of harmony.