基于真实世界数据探讨中医药治疗肝硬化食管胃静脉曲张破裂出血用药规律  

Exploring the medication patterns of Traditional Chinese Medicine in the treatment of esophagogastric variceal bleeding in liver cirrhosis based on real-world data

作　　者：王德昕 战俊邑 余金钟 刘成海[1] 刘平[1] 慕永平[1] WANG Dexin;ZHAN Junyi;YU Jinzhong;LIU Chenghai;LIU Ping;MU Yongping(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Institute of Liver Diseases,Shanghai University of Traditional Chinese Medicine,Key Laboratory of Liver and Kidney Disease of the Ministry of Education,Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai,Shanghai,201203,China)

机构地区：[1]上海中医药大学附属曙光医院、上海中医药大学肝病研究所、肝肾疾病病证教育部重点实验室、上海市中医临床重点实验室,上海201203

出　　处：《中国中西医结合消化杂志》2024年第3期203-207,213,共6页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：国家自然科学基金面上项目(No:81874390);上海市科委自然科学基金面上项目(No:21ZR1464100);上海市科委2022年度“科技创新行动计划”生物医药科技支撑专项(No:22S11901700);上海市临床重点专科建设项目(No:shslczdzk01201)

摘　　要：目的基于医院电子病例库分析总结真实世界的数据,采用数据挖掘的方法探讨中医药治疗肝硬化食管胃静脉曲张破裂出血(esophagogastric variceal bleeding,EGVB)的用药规律。方法收集2018年7月—2023年6月上海中医药大学附属曙光医院电子病例库确诊EGVB患者的诊疗信息,建立Excel数据库。运用Microsoft Excel 2019软件对患者的基本信息、高频药物的四气、五味、归经、功效进行频数频率统计;通过SPSS Modeler 18.0软件构建药物关联网状图和关联规则分析表;借助SPSS 29.0软件进行聚类分析和因子分析。结果最终纳入240例接受中药饮片治疗的EGVB患者,在612条处方信息中,涉及中药431种;使用频数排名前5位的中药分别是黄芪、茯苓、白术、当归、甘草;使用频数前5类的中药类别分别是补虚药、利水渗湿药、清热药、活血化瘀药、止血药;在30味高频药物中,以甘、苦药味最为常见;寒性药使用最多;归经以肝经、脾经、肺经、心经、胃经为主;关联规则分析结果显示,治疗EGVB的药物组合中主要为黄芪、泽泻、茯苓、黄芩等与其他药物的组合;因子分析共得到9个公因子;聚类分析得到7个处方。结论中医药治疗EGVB的主要治疗原则为补益虚损、清热泻火、化痰祛瘀、利水渗湿。Objective Analysing and summarising real-world data based on the hospital's electronic medical records(EMR)and using data mining methods to explore the medication patterns of Traditional Chinese Medicine(TCM)in the treatment of esophagogastric variceal bleeding(EGVB).Methods The diagnosis and treatment information of EGVB of EMR in Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine from July 2018 to June 2023 was collected,and an Excel database was established.Perform statistics on patient's basic information,Siqi,Wuwei,Meridian and efficacy;use Apriori algorithm in SPSS Modeler 18.0 software to analyze association rules,and use web nodes to construct a drug-pair association network diagram;use SPSS 29.0 statistical software to perform cluster analysis and factor analysis.Results This study finally included 240 patients with EGVB who were treated with decoction pieces of TCM.Among the 612 prescriptions information,431 types of Chinese herbal medicines were involved;the top 5 Chinese herbal medicines used in frequency were Astragalus,Poria,White art,Angelica,Licorice;the top 5 categories of Chinese herbal medicines in terms of frequency of use were deficiency tonic,diuretic and dampness-inducing medicines,heat-clearing medicines,medicines for activating blood circulation and removing blood stasis,and medicines for stopping bleeding;among the 30 high-frequency drugs,bitter and sweet are the most common;the drugs are cold in nature.The number of liver meridians,spleen meridians,lung meridians,heart meridians and stomach meridians are mostly;factor analysis yielded a total of 7 effective factors;cluster analysis yielded a total of 9 effective prescription.Conclusion TCM treatments of EGVB are tonifying deficiency loss,clearing heat and expelling fire,eliminating phlegm and removing blood stasis,and promoting water and dampness.

关 键 词：肝硬化 食管胃静脉曲张破裂出血 中医药 数据挖掘 关联规则 

分 类 号：R256.35[医药卫生—中医内科学]