基于数据挖掘研究沈一平治疗免疫性血小板减少症用药规律
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R558+.2

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浙江省中医药科技计划项目(2023ZF099);浙江省名老中医专家传承工作室建设项目(GZS2021022)


Medication Rules of SHEN Yiping Treating Immune Thrombocytopenia Based on Data Mining
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    摘要:

    目的:基于数据挖掘技术研究沈一平教授运用中医药治疗免疫性血小板减少症(ITP) 的用药规 律。方法:选取2002年1月1日—2022年10月25日就诊于浙江省中医院血液内科沈一平教授门诊并符合纳入 标准及排除标准的ITP患者,运用SPSS Modeler 18.0软件进行数据处理,进行药物频数分析、统计中西医疗效; 采用SPSS Modeler 18.0中的Apriori算法进行药物关联规则分析;用SPSS statistics聚类算法对核心药物进行聚类 分析。将分析结果请沈一平教授审阅并访谈。结果:共纳入处方2 575首,药物频数分析结果示,居前10位中 药分别为山药、太子参、无花果、薏苡仁、蒲公英、仙鹤草、防风、白术、黄芪、荆芥。药物归经频次从高到 低依次为肝、脾、肺、胃、肾、心、胆、大肠、膀胱、小肠、三焦、心包。药物四气频次从高到低依次为寒、 平、温、凉、热,其中,寒、平两种药物所占分别为34.48%、33.27%。药物五味频次以甘、苦、辛为主,酸、 涩、淡、咸次之。高频药物关联规则分析结果获得:核心药物组合以止血、清热、疏风、益气、健脾治法为 主。高频药物系统聚类分析,得到5个聚类结果:第1类为益气养阴止血药;第2类为清热疏风止血药;第3类 为清热凉血药;第4类为补肾填精、温阳益气药;第5类为滋水涵木、酸收止血药。结合访谈发现,沈一平教 授运用中医治疗ITP的思路随着时间而有改变,将其分为3个阶段进行观察,随着时间的变化:归肺经药物比 例有一定的上升,而归肝经、肾经药物比例较前下降;辛味药比例稍有下降;逐渐增加疏风药、清热药的使用 比例。结论:沈一平教授治疗ITP总体治则为健脾益气补肾。在此基础上,加强疏风固表,注意兼证,治病防 变,辨病、辨证论治,融合四气五味之理。

    Abstract:

    Abstract:Objective:To study the medication rules of Professor SHEN Yiping using Chinese medicine to treat immune thrombocytopenia (ITP) based on data mining technology. Methods: ITP patients who visited the Hematology Department of Zhejiang Provincial Hospital of Traditional Chinese Medicine and treated by Professor SHEN Yiping from January 1, 2002 to October 25, 2022 and met the inclusion and exclusion criteria were selected. SPSS Modeler 18.0 software was used for data processing, drug frequency analysis, and statistics on the effectiveness of Chinese medicine and western medicine. The Apriori algorithm in SPSS Modeler 18.0 was used for drug association rule analysis. Cluster analysis of core drugs was conducted by SPSS statistics clustering algorithm. The analysis results were reviewed by and interviewed with Professor SHEN Yiping. Results: A total of 2 575 prescriptions were included, and the frequency analysis results showed that the top 10 Chinese medicinals were Dioscoreae Rhizoma, Pseudostellariae Radix,Ficus carica,Coicis Semen,Taraxaci Herba,Agrimoniae Herba,Saposhnikoviae Radix,Atractylodis Macrocephalae Rhizoma,Astragali Radix,and Schizonepetae Herba. The frequency of channel entry of medicinals from high to low is in the following order: liver, spleen, lung, stomach, kidney, heart, gallbladder, large intestine, bladder, small intestine, sanjiao, and pericardium. The frequency of the four qi of medicinals in descending order is cold,neutral,warm,cool,and hot. Among them, cold and neutral medicines account for 34.48% and 33.27% respectively. The five flavors of medicinals are mainly sweet, bitter, and acrid, followed by sour, astringent, bland, and salty. The analysis results of high-frequency medicinals association rules showed that the core medicinals combination is mainly based on hemostasis,heat-clearing,wind-scattering,qi-tonifying,and spleenfortifying treatments. The clustering analysis of high frequency medicinals system generated five clustering results:the first category is qi-boosting,yin-nourishing and bleeding-stanching medicinals;the second type is heat-clearing, wind-scattering and bleeding-stanching medicinals; the third category is heatclearing and blood-cooling medicinals; the fourth category is kidney-tonifying and essencesupplementing, yang-warming and qi-tonifying medicinals; the fifth category is water-nourishing and wood-moistening, acid-alleviating and bleeding-stanching medicinals. Based on the interviews, it was found that Professor SHEN Yiping's approach to using Chinese medicine to treat ITP has changed over time. He divided it into three stages for observation, and over time, the proportion of medicinals targeting the lung channel entry were increased to a certain extent,and the proportion of medicinals targeting the liver channel and kidney channel entry were decreased when compared with those before; the proportion of acrid medicinals was slightly decreased; the usage proportion of wind-scattering and heat-clearing medicinals was gradually increased. Conclusion:Professor SHEN Yiping's overall treatment principle for ITP is to fortify the spleen,boost qi,and supplement the kidney. On this basis,it is necessary to scatter wind and consolidate the exterior, pay attention to both symptoms and signs, treat diseases and control development of existing disease, treat diseases based on disease differentiation and syndrome differentiation,and integrate the principles of the four qi and five flavors.

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董南希,吴迪炯,叶宝东,沈英英,指导:沈一平.基于数据挖掘研究沈一平治疗免疫性血小板减少症用药规律[J].新中医,2024,56(8):7-13

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  • 在线发布日期: 2024-04-23
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