基于银屑病疗效联系数几何特性的临床用药优选探讨  

Study on Clinical Drug Selection Scheme from Geometrical Characteristics Based on Connection Number of Clinical Efficacy of Psoriasis

作　　者：李斌[1,2] 华亮[1,2] 徐蓉 李欣[1,2] 赵克勤[3] LI Bin;HUA Liang;XU Rong;LI Xin;ZHAO Keqin(Yueyang Integrated Chinese and Western Medicine Hospital Affiliated to Shanghai University of TCM, Shanghai 200437, China;Skin Disease Institute, Shanghai Institute of TCM, Shanghai 201203, China;Zhuji Institute of Contact Numbers,Zhuji 311811 ,Zhejiang,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437 [2]上海市中医药研究院皮肤病研究所,上海201203 [3]诸暨市联系数学研究所,浙江诸暨311811

出　　处：《辽宁中医杂志》2018年第2期237-241,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81273764,81302971,81473682);上海市科委项目(16QA1403800);上海市卫计委中医药事业发展三年行动计划(16CR2035B)

摘　　要：目的：探讨银屑病中医辨证论治的阶段性治疗效果联系数中的几何信息对临床辨证用药的指导意义,为科学用药,提高疗效提供一个新的途径。方法：（1）把阶段性治疗结局中的痊愈率看成是相对确定的测度,作为联系数中的同部a;把有效率和好转率看成是带有不确定性的测度,作为联系数中的异部b＋c。把无效率也看成是相对确定的测度,作为联系数中的反部d;把a、b＋c、d看作是能够作成泛疗效三角形的三条边,根据欧式几何学中：三角形中任意两条边大于第三边的几何特性,检验银屑病血热证常用14味中药阶段性疗效是否能构成一个泛疗效三角形,能构成泛疗效三角形的称之为泛疗效稳定的,否则称之为泛疗效不稳定的。（2）仅考察痊愈率、显效率、好转率能否构成一个疗效三角形,能构成疗效三角形的中药称之为疗效稳定的,否则称之为疗效不稳定的。（3）对能够构成稳定疗效三角形的中药,计算各个稳定疗效三角形的面积,面积大的所对应的中药优先于面积小的稳定疗效三角形所对应的中药。结果：排在第1位的是白鲜皮,其次是土茯苓2,金银花3,生地4,牡丹皮与赤芍并列5-6,蚤休7,荆芥8。其余药在银屑病血热证中治疗效果各有较大程度的不确定性,这一结果与临床辨证论治吻合较好。结论：可以在银屑病血热证中医辨证论治处方选药中应用疗效联系数的几何信息,为明确优选用药提供决策支持。其他疾病的中医辨证论治和处方选药也可参考本文给出的思路和方法。Objective： It explores the staged therapeutic efficacy of psoriasis,expressed by the geometric features of contact numbers,which provides a new method for improving therapeutic efficacy. Methods：（1） It is looked as a relatively definite measure that the cure rate of the treatment effect as the in-phase（a） of the contact number; a uncertainty measure that the efficiency and improvement rate as the in-out-phase（b ＋ c） of the contact number; a relatively definite measure that the inefficiency rate as the out-phase（d） of the contact number. According to the Euclidean geometry,any two edges of a triangle were greater than the third. We verified whether the efficacy of 14 commonly-used herbs in blood-heat syndrome psoriasis could form this model.If herbs data was satisfied in this model,it is called stable curative effect triangle,otherwise it is called unstably curative effect triangle.（2） We investigated the recovery rate,effective rate and improvement rate of herb whether can constitute a therapeutic triangle. If it can constitute a therapeutic triangle,it shows that the herb curative effect is stable. Otherwise it is not stable.（3） The herb which can be used to form a therapeutic triangle is used to calculate the area of each therapeutic triangle,and the effect of the herb corresponding to the large area of the triangle is prior to that of the small area. Results： Effect of stability in the first row is Baixianpi,followed by Tufuling,Jinyinhua,Shengdi,Mudanpi,Chishao,Zaoxiu and Jingjie. The therapeutic efficacy of rest drug has a high degree of uncertainty in the treatment of blood-heat syndrome of psoriasis. This result is consistent with the clinical effect. Conclusion： Geometric features of contact numbers could provide decision support for the clear preferred medication in order to improve therapeutic efficacy of blood-heat syndrome psoriasis. Other diseases of TCM syndrome differentiation and treatment and prescription drugs can also refer to the ideas and methods given in thi

关 键 词：银屑病 清热凉血药 疗效联系数 几何特性 稳定性 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]