基于POMDP的不稳定心绞痛中西医结合治疗方案优化研究  

Optimized Treatment Program for Unstable Angina by Integrative Medicine Based on Partially Observable Markov Decision Process

作　　者：冯妍[1] 徐浩[2] 刘凯[3] 周雪忠[3] 陈可冀[2] 

机构地区：[1]首都医科大学附属北京安贞医院全科医学科,北京100029 [2]中国中医科学院西苑医院心血管科,北京100091 [3]北京交通大学计算机与信息技术学院,北京100044

出　　处：《中国中西医结合杂志》2013年第7期878-882,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家中医药行业科研专项项目(No.201007001);北京市科技计划重大项目(No.D08050703020801)

摘　　要：目的初步优化中西医结合防治不稳定心绞痛(unstable angina,UA)的综合治疗方案。方法基于部分可观察的马尔科夫决策过程模型(Partially Observable Markov Decision Process,POMDP)的方法,选择气虚、血瘀、痰浊3个主要证侯要素,对UA住院患者的诊治情况进行深层次数据挖掘、分析,客观评价UA中西医结合的疗效。结果 UA气虚证、血瘀证、痰浊证患者的推荐治疗方案依次为:硝酸酯类+他汀类+氯吡格雷+血管紧张素Ⅱ受体阻滞剂+肝素类+黄芪+党参+茯苓+白术(ADR=0.85077869);硝酸酯类+阿司匹林+氯吡格雷+他汀类+肝素类+当归+红花+桃仁+赤芍(ADR=0.70773000);硝酸酯类+阿司匹林+他汀类+血管紧张素转换酶抑制剂+栝蒌+薤白+半夏+陈皮(ADR=0.72509600)。结论本研究基于POMDP优化了UA的治疗方案,可作为进一步规范和制定中西医结合治疗UA方案的参考。Objective To initially optimize comprehensive treatment program for treating and preventing unstable angina （UA） by integrative medicine （IM）. Methods Based on partially observable Markov decision process model （POMDP）, we chose 3 syndrome elements, i.e., qi deficiency, blood stasis, and phlegm turbidity from UA inpatients. The efficacy of treating UA by IM was objectively as- sessed by in-depth data mining and analyses. Results The treatment programs for UA patients of qi de- ficiency syndrome, blood stasis syndrome, and phlegm turbidity syndrome were recommended as fol- lows ： nitrates ＋ statins ＋ clopidogrel ＋ angiotensin l] receptor blockers ＋ heparins ＋Astragalus membra- naceus ＋Condonopsis ＋ poria and large-head atractylodes rhizome （ADR =0.85077869） ; nitrates ＋ as- pirin ＋ clopidogrel ＋ statins ＋ heparins ＋ Astragalus membranaceus ＋ safflower ＋ peach seed ＋ red peony root （ADR = 0.70773000 ） ; nitrates ＋ aspirin ＋ statins ＋ angiotensin-converting inhibitors ＋ snakegourd fruit ＋ onion bulb ＋ ternate pinellia ＋ tangerine peel （ADR = 0. 72509600 ）. Conclusion As a POMDP based optimized treatment programs for UA, it can be used as a reference for further standardization and formulation of UA program by integrative medicine.

关 键 词：部分可观察马尔科夫决策过程 不稳定心绞痛 治疗方案优化 

分 类 号：R541.4[医药卫生—心血管疾病]