徐振晔教授中医药辨证论治大肠癌的临床数据挖掘  

Clinical Data Mining of Differentiation and Treatment of Colorectal Cancer with Traditional Chinese Medicine by Professor Xu Zhenye

作　　者：祝利民[1] 史海霞 徐振晔[1] Zhu Limin;Shi Haixia;Xu Zhenye(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Shanghai Ninth People's Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 201900,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]上海交通大学医学院附属第九人民医院,上海201900

出　　处：《世界科学技术-中医药现代化》2021年第6期1773-1783,共11页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：上海市科学技术委员会上海市自然科学基金面上项目(16ZR1437500):胃肠安方通过IP08降低肿瘤干细胞自噬抑制结肠癌复发转移的研究,负责人:祝利民。

摘　　要：目的通过数据挖掘软件及方法从多个维度系统整理徐振晔教授针对大肠癌的临证思维方法及用药规律,为中医药诊治大肠癌提供借鉴。方法采用回顾性临床研究的方法,选取2016年1月至2021年3月期间徐振晔教授门诊治疗的经病理或影像学诊断、至少有2次以上复诊且持续服药2个月及以上有临床症状减轻的大肠癌患者病案。在纳入病例前,将患者的基本信息、临床症状、辨证分型、涉及脏腑、病理因素、临床用药等进行数据预处理及统一、标准化和规范化。在EXCEL中输入所有处理好的病案数据,采用统计产品与服务解决方案25(Statistical Product and Service Solutions,SPSS25)作临床数据有关的频次及聚类分析;在此基础上,采取IBM数据挖掘平台SPSS Modeler 18对临床症状及处方作关联规则分析。结果本研究最终纳入87例患者,279张中药处方。从主要症状频次分析,就诊大肠癌患者中出现纳呆、乏力、大便溏、消瘦、夜寐不安、腹胀、腰酸以及口干占到前八位。出现频次较高的辨证分型为脾虚精亏。病理因素中湿和瘀最多,占50.179%和39.068%。相关脏腑中脾胃、肾、肠、肝最多,占96.774%和41.219%、24.373%、17.921%。纳入分析的279张处方中按照频次排序为黄芪、白术、鸡内金、白茯苓、白花蛇舌草、菝葜、预知子、黄精、野葡萄藤及绞股蓝。四味药排名前五的高置信度组合有黄精、菝葜、鸡内金、黄芪,黄精、白花蛇舌草、鸡内金、黄芪,黄精、鸡内金、白术、黄芪,黄精、鸡内金、白茯苓、黄芪,太子参、黄精、白茯苓以及白术。药物和症状经过聚类后分为六大类。结论徐振晔教授在大肠癌诊治中提倡健脾养精,佐以健脾化湿、化痰散结、疏肝理气、清热解毒、活血通络等法则综合运用的学术思想,为启发中医药对大肠癌的辨证论治拓展了新思路。Objective To study Professor Xu Zhenye’s clinical reasoning and choice of medication in colorectal cancer(CRC)treatment from different aspects using data mining tools and techniques as a reference for traditional Chinese medicine(TCM)-based CRC treatment.Methods A retrospective clinical study was performed on Professor Xu Zhenye’s patients who received his outpatient services during January 2016 and March 2021 and met the following inclusion criteria:1)diagnosed with CRC based on pathological and imaging findings;2)with at least two follow-ups after diagnosis,and continue taking the medicine for 2 months or more;3)showed improvements in clinical symptoms of CRC.Data preprocessing was performed before including any patients in the study to ensure that the demographic and clinical data such as basic information,clinical symptoms,differentiation of symptoms and signs for classification of syndromes,affected sites,pathological factors,and clinical medication were arranged in a uniform,standardized,and normalized fashion.Following that,relevant data were recorded in Excel spreadsheets.The software SPSS 25 was used for frequency and cluster analysis.The data mining workbench IBM SPSS Modeler 18 was employed to generate association rules from the clinical symptoms and medications for CRC treatment.Results A total of 87 CRC patients were included in this study.The eight symptoms most commonly seen in the CRC patients were torpid intake,lack of strength,loose stools,emaciation,restless sleep,abdominal distention,sore waist,and dry throat.The highest frequent syndrome-differentiation type was spleen vacuity and essence depletion.Dampness and stasis were the most important pathological factors in the CRC patients,present in 50.179%and 39.068%of all patients.Spleen and stomach,kidney,bowel,liver involvement was largely detected in the CRC patients,representing 96.774%,41.219%,24.373%and17.921%of all cases,respectively.Based on the analysis of 279 prescriptions,10 Chinese herbal medicines(CHMs)were most frequently prescri

关 键 词：徐振晔 辨证论治 中医药 大肠癌 数据挖掘 

分 类 号：R273[医药卫生—中西医结合]