基于真实世界数据探讨中医药治疗非酒精性脂肪肝用药规律
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R575.5

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上海市宝山区科学技术委员会项目(21-E-62);上海市宝山区医学重点学(专) 科建设项目(BSZK-2023-A08);山东省重点研 发计划项目(2021CXGC010509);国家中医药管理局中医肝胆病重点学科、慢性肝病虚损重点研究室和上海市中医临床重点实验室 项目(20DZ2272200);上海市临床重点专科建设项目(shslczdzk01201)


Medication Rules of Chinese Medicine for Non-alcoholic Fatty Liver Disease Based on Real World Data Mining
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    摘要:

    目的:基于真实世界数据挖掘中医药治疗非酒精性脂肪肝用药规律研究。方法:收集2019 年1 月— 2022 年7 月上海市宝山区中西医结合医院健康信息系统确诊的非酒精性脂肪肝的门诊患者的诊疗信息,建立 Excel 数据库,采用Excel 2017 软件录入所有药物的四气、五味、归经及功效。应用R 统计软件进行结果描 述及数据分析,使用arules 包的Apriori 算法对处方进行关联规则分析。结果:本研究从收集的445 例患者的 1073 首处方中最终筛选纳入处方140 首,涉及中药265 味;使用频次排名前5 位的中药分别是柴胡、茯苓、 黄芩、郁金、丹参;使用频次排名前5 类的中药类别分别是补虚、利水渗湿、清热、活血化瘀和理气药;在 15 味高频药物中,苦、甘、辛药味最为常见,药性以温、平、微寒为主,归肝、脾、肺和胃经居多。经关联 规则分析,药物组合中支持度最高的是柴胡-郁金、茯苓-白术,置信度排列前3 的药物组合为地耳草-矮地 茶、枳壳-柴胡、莪术-柴胡。聚类分析将中药分为5 类,类1 为柴胡、虎杖、厚朴、大黄、五味子、垂盆 草、郁金、赤芍、枳壳、莪术、木香、连钱草、矮地茶和地耳草,类2 为茯苓、白术,类3 为当归、甘草、白 芍、黄芩和茵陈,类4 为丹参和山楂,类5 为黄芪、半夏和陈皮。结论:治疗非酒精性脂肪肝多采用疏肝健 脾、祛湿化痰、活血化瘀、清热解毒药物为主,性味多为温、平、微寒之品,使利湿不伤阴、活血不耗血,共 奏痰化瘀散浊泄之效。

    Abstract:

    Abstract:Objective:To study the medication rules of Chinese medicine for non- alcoholic fatty liver disease (NAFLD) based on real world data mining. Methods:The care information of outpatients with NAFLD diagnosed by the Hospital Information System of Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to July 2022 was collected, and an Excel database was established. With the software Excel 2017,the four natures,five flavors,channel entries and effects of all Chinese medicines were entered. R Statistical Software was used to describe the results and analyze the data. Apriori algorithm of arules package was used to analyze the association rules of prescriptions. Results : A total of 140 prescriptions were included in this study after screening 1 073 prescriptions collected from 445 patients , which involved 265 Chinese medicinals ; the top 5 Chinese medicinals in frequency were Bupleuri Radix,Poria,Scutellariae Radix,Curcumae Radix and Salviae Miltiorrhizae Radix et Rhizoma; the top 5 types of Chinese medicinals in frequency were for supplementing deficiency, promoting urination and percolating dampness, clearing heat, invigorating blood and dissolving stasis and rectifying qi; among 15 high- frequency Chinese medicinals, they were mainly bitter, sweet and acrid in flavor, and mainly warm, mild and slightly cold in nature with main channel entries to the liver, spleen, lung and stomach. According to the association rule analysis, the medicinal combinations with the highest degree of support were Bupleuri Radix- Curcumae Radix, and Poria-Atractylodis Macrocephalae Rhizoma;the top 3 medicinal combinations in the degree of confidence were Hyperici Japonici Herba-Ardisiae Japonicae Herba,Aurantii Fructus-Bupleuri Radix,and Curcumae Rhizoma-Aurantii Fructus. The Chinese medicinals were divided into 5 types by the cluster analysis:Type 1 included Aurantii Fructus, Polygoni Cuspidati Rhizoma, Cortex Magnoliae Officinalis, Rhei Radix et Rhizoma,Schisandrae Chinensis Fructus,Sedi Herba,Curcumae Radix,Paeoniae Rubra Radix,Aurantii Fructus, Curcumae Rhizoma, Aucklandiae Radix, Glechomae Herba, Ardisiae Japonicae Herba and Hyperici Japonici Herba;Type 2 included Poria and Atractylodis Macrocephalae Rhizoma;Type 3 included Angelicae Sinensis Radix, Glycyrrhizae Radix et Rhizoma, Paeoniae Radix Alba, Scutellariae Radix and Artemisiae Scopariae Herba;Type 4 included Salviae Miltiorrhizae Radix et Rhizoma and Crataegi Fructus; Type 5 included Astragali Radix, Pinelliae Rhizoma and Citri Reticulatae Pericarpium. Conclusion: The treatment of NAFLD usually adopts liver- soothing and spleen- fortifying , dampness- dispelling and phlegm-dissolving , blood-invigorating and stasis-dissolving , and heat-clearing and toxins-resolving Chinese medicines and they are mostly warm, mild and slightly cold in nature, which enables the dispelling of dampness not to damage yin,and the invigoration of blood not to consume blood. Thus,they work together to play a role in dissolving phlegm,dissipating stasis and discharging turbidity.

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张顺宵,秦利,黄珊,杨超茅,张晟,张妍,陈月,孙明瑜.基于真实世界数据探讨中医药治疗非酒精性脂肪肝用药规律[J].新中医,2023,55(20):18-24

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  • 在线发布日期: 2023-10-27
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