摘要
目的:探索真实世界强直性脊柱炎(AS)中药组方用药规律,针对中医药治疗对患者免疫炎症指标关联规则分析,为AS的辨证论治提供依据。方法:对安徽中医药大学第一附属医院风湿科2012年6月至2016年6月AS住院患者的病历资料进行回顾性研究。对所用中药通过复杂网络图分析核心处方,SPSS 21.0和SPSS modeler14.2对中药性味归经频数、关联规则分析,并运用关联规则、随机行走模型评价中医药治疗对免疫炎症指标的影响。结果:(1)性寒、性温和性平的,味甘、味苦和味辛以及归脾胃肝经药物使用最频繁;(2)补益药、活血化瘀药、行气药、健脾化湿药、祛风湿药、清热药被频繁的使用,且之间相互关联;(3)红花配伍桃仁(98.15%),薏苡仁配伍茯苓(95.47%),甘草配伍狗脊(94.57%),甘草配伍威灵仙(94.48%),蒲公英配伍白花蛇舌草(94.40%)为关联度较高的五个药对;(4)山药分别与茯苓、牛膝、泽泻关联于C3、C4、hs-CRP下降,狗脊分别与白花蛇舌草、川芎、山药关联于Ig A、Ig G、Ig M下降,豨莶草与牛膝关联于ESR、WBC下降,狗脊与独活关联于SOD上升。(5)中药内外合治组炎症指标(ESR、hs-CRP)的行走正向增长率及改善系数均较单纯内治组高。结论:我院风湿科治疗AS以从脾论治为主,寒温并用,甘苦同施,肝脾同调,祛邪不忘扶正,标本兼治,中医药在改善免疫炎症指标上具有优势,且内外合治在改善炎症指标上优于单纯内治,可值得推广。
This study was aimed to explore traditional Chinese medicine（TCM） compatibility patterns or rules in the treatment of ankylosing spondylitis（AS） in the real world clinical situations. The effect of TCM treatment and immune inflammatory biomarkers were analyzed by association rules, which provided evidences for AS syndrome differentiation and treatment. Retrospective study was conducted on records of hospitalized AS patients at the Department of Rheumatism, the First Affiliated Hospital of Anhui University of Chinese Medicine from June 2012 to June 2016. The technology for complex networks was integrated to analyze the core prescription. The frequency and association rules of prescription patterns were analyzed using the SPSS 21.0 and SPSS modeler 14.2. The effect on immune inflammatory biomarkers was analyzed by association rules and random walk model. The results showed that,（1） warm, cold, and neutral herbs, sweet, bitter or pungent herbs, and with the channel tropism of spleen channel, stomach channel and liver channel are the most frequently prescribed herbs;（2） herbs with functions of tonifying and replenishing, blood-activating and stasis-resolving, qi-regulating, spleen-strengthening and dampness-resolving, wind-dampness dispelling, heatclearing are frequently prescribed, which are also interrelated and interacted on each other;（3） the top five pairs of couplet herbs with the highest confidence included Hong Hua paired with Tao Ren（98.15%）, Yi Yi Ren paired with Fu Ling（95.47%）, Gan Cao paired Gou Ji（94.57%）, Gan Cao paired with Wei Ling Xian（94.48%）, Pu Gong Ying paired Bai Hua She She Cao（94.40%）;（4） Shan Yao was highly related to decreased C3, C4 and hs-CRP when compatibility with Fu Ling, Niu Xi, Ze Xie; Gou Ji was highly related to decreased Ig A, Ig G and Ig M when compatibility with Bai Hua She She Cao, Chuan Xiong, Shan Yao. Xi Qian Cao was associated with Niu Xi when ESR and WBC decreased. Gou Ji and Du Huo were associated when SOD increased.（5） The group of internal medicine coordinated with external medicine has positive growth rate of walk and improvement index of inflammatory indexes（ESR, hs-CRP） compared to single internal medicine group. It was concluded that AS treatment in the Department of Rheumatism of our hospital was based on spleen. The treatment was focused on the regulation of cold and warm, sweet and bitter, liver and spleen. The treatment of AS is to eliminate evil factors and to reinforce healthy qi. TCM has advantages in the improvement of immune inflammatory indexes. The improvement of inflammatory indexes by the internal medicine coordinated with external medicine was better than the single use of internal medicine, which is worthy of further promotion.
出处
《世界科学技术-中医药现代化》
CSCD
2017年第12期1928-1934,共7页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
国家中医药管理局重点学科中医痹病学建设项目(国中医药发[2009]30号)
负责人:刘健
国家卫生计生委国家临床重点专科中医风湿病科建设项目(财社[2013]239号)
负责人:刘健
安徽省财政厅安徽省重点实验室建设项目:现代中医内科应用基础与开发研究安徽省重点实验室(1306c083035)
负责人:刘健
关键词
真实世界
强直性脊柱炎
关联规则
数据挖掘
中医药
Real world, ankylosing spondylitis, association rules, data mining, traditional Chinese medicine
作者简介
通讯作者：刘健，安徽界首，教授，主任医师，博士生导师，研究方向：中医药防治风湿病。
