基于真实世界探讨海派名医顾乃芳治疗银屑病的用药规律

Discussion on the Medication Rules of GU Naifang,a Famous Doctor of Shanghai School,in the Treatment of Psoriasis Based on the Real World

目的:探讨海派名医顾乃芳教授治疗银屑病的用药规律。方法:收集和整理2021年1月1日至2024年1月1日上海市中医医院门诊病历系统中顾乃芳教授治疗银屑病患者的处方,建立中药治疗银屑病的数据库。运用Excel 2019统计处方中所用中药的味数、功效、频数、频率,并通过IBM SPSS Modeler 18.0软件进行药物关联规则分析,运用SPSS 26.0软件进行核心药物聚类分析。结果:(1)本次研究共纳入银屑病患者1000例,2038份处方,187味中药,药物使用总频数为37099,使用频数>1000的中药有15味,分别为牡丹皮、生地黄、赤芍、土茯苓、蜀羊泉、石见穿、龙葵、板蓝根、紫花地丁、茜草、白花蛇舌草、蛇莓、鹿衔草、丹参、莪术,累积频率66.31%。(2)中药功效统计分析显示,清热解毒药、清热凉血药、破血消癥药、滋阴药、化瘀止血药、祛风湿强筋骨药使用频数较多。(3)关联规则分析显示,共获得15个高频的两味中药组合和15个高频的三味中药组合,其中生地黄-赤芍为置信度最高的两味中药组合,白花蛇舌草-鹿衔草-蛇莓为置信度最高的三味中药组合。(4)聚类分析显示,共得到6个聚类处方,主要显示3类药物组合。第1类:生地黄、赤芍、牡丹皮、龙葵、蜀羊泉、石见穿、土茯苓、板蓝根、紫花地丁、茜草、半枝莲、石上柏、鹿衔草、白花蛇舌草、蛇莓、地榆;第2类:丹参、莪术、水蛭;第3类:天冬、麦冬、玉竹、石斛、芦根。结论:顾乃芳临床治疗银屑病,以清热解毒和清热凉血药物使用最多,在此基础上配伍活血、化瘀、滋阴等药物。

Objective:To explore the medication rules of Professor GU Naifang,a famous doctors of Shanghai school,in the treatment of psoriasis.Method:The prescriptions of Professor GU Naifang for treating psoriasis patients in the outpatient medical record system of Shanghai Traditional Chinese Medicine Hospital from January 1,2021 to January 1,2024 was collected and organized,and the database for traditional Chinese medicine treatment of psoriasis was established.Excel 2019 software was used to calculate the taste,efficacy,frequency,and frequency rat of traditional Chinese medicine used in prescriptions.IBM SPSS Modeler 18.0 software was used for drug association rule analysis,and SPSS 26.0 software was used for core drug cluster analysis.Result:(1)A total of 1000 psoriasis patients were included in this study,with 2038 prescriptions and 187 traditional Chinese medicines.The total frequency of drug used was 37099 times,and 15 traditional Chinese medicines with a frequency>1000 were used,including Mudanpi(Moutan Cortex),Shengdihuang(Rehmanniae Radix Exsiccata seu Recens),Chishao(Paeoniae Radix Rubra),Tufuling(Smilacis Glabrae Rhizoma),Shuyangquan(Solani Lyrati Herba),Shijianchuan(Salviae Chinensis Herba),Longkui(Solani Nigri Herba),Banlangen(Isatidis Radix),Zihuadiding(Violae Herba),Qiancao(Rubiae Radix),Baihuasheshecao(Oldenlandiae Diffusae Herba),Shemei(Duchesneae Herba),Luxiancao(Pyrolae Herba),Danshen(Salviae Miltiorrhizae Radix),and Ezhu(Curcumae Rhizoma),with a cumulative frequency of 66.31%.(2)Statistical analysis of the efficacy of traditional Chinese medicine showed that there were more frequently used medicines for clearing heat and detoxifying,clearing heat and cooling blood,breaking blood and eliminating symptoms,nourishing Yin,resolving blood stasis and stopping bleeding,and dispelling wind,dampness,and strengthening muscles and bones.(3)The results of association rule analysis showed that a total of 15 high-frequency combinations of two traditional Chinese medicines and 15 high-frequency combinations of three traditional Chinese medicines were obtained.Among them,Shengdihuang(Rehmanniae Radix Exsiccata seu Recens)-Chishao(Paeoniae Radix Rubra)had the highest confidence in the two traditional Chinese medicine combinations,and Baihuasheshecao(Oldenlandiae Diffusae Herba)-Luxiancao(Pyrolae Herba)-Shemei(Duchesneae Herba)had the highest confidence in the three traditional Chinese medicine combinations.(4)According to the clustering analysis results,a total of 6 clustering prescriptions were obtained,mainly displaying 3 types of drug combinations.Category 1:Shengdihuang(Rehmanniae Radix Exsiccata seu Recens),Chishao(Paeoniae Radix Rubra),Mudanpi(Moutan Cortex),Longkui(Solani Nigri Herba),Shuyangquan(Solani Lyrati Herba),Shijianchuan(Salviae Chinensis Herba),Tufuling(Smilacis Glabrae Rhizoma),Banlangen(Isatidis Radix),Zihuadiding(Violae Herba),Qiancao(Rubiae Radix),Banzhilian(Scutellariae Barbatae Herba),Shishangbai(Selaginellae Doederleinii Herba),Luxiancao(Pyrolae Herba),Baihuasheshecao(Oldenlandiae Diffusae Herba),Shemei(Duchesneae Herba),and Diyu(Sanguisorbae Radix).Category 2:Danshen(Salviae Miltiorrhizae Radix),Ezhu(Curcumae Rhizoma),and Shuizhi(Hirudo).Category 3:Tiandong(Asparagi Radix),Maidong(Ophiopogonis Radix),Yuzhu(Polygonati Odorati Rhizoma),Shihu(Dendrobii Herba),and Lugen(Phragmitis Rhizoma).Conclusion:In GU Naifang's clinical treatment of psoriasis,the drugs of clearing heat and detoxifying and clearing heat and cooling blood were mostly used,and on this basis,the drugs of promoting blood circulation,removing blood stasis and nourishing Yin were used.