基于PageRank算法及Mplus因子分析探讨杨霓芝教授诊治IgA肾病规律  

PageRank Algorithm and Factor Analysis Assists the Identification of Treatment Patterns of Chinese Herbal Medicine for Immunoglobulin A Nephropathy

作　　者：卢家言 张腊[2] 胡晓璇[2] 凌曦淘 于浩天 梁紫越 卢佐宸 侯海晶[2,4] 卢富华 杨霓芝[2] LU Jiayan;ZHANG La;HU Xiaoxuan;LING Xitao;YU Haotian;LIANG Ziyue;LU Zuochen;HOU Haijing;LU Fuhua;YANG Nizhi(The Second Clinical College,Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Guangdong Provincial Hospital of Chinese Medicine/The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China;School of Public Health and Medicine,Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Guangdong-Hong Kong-Macao Joint Lab on Chinese Medicine and Immune Disease Research,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广州510006 [2]广东省中医院/广州中医药大学第二附属医院,广州510120 [3]广州中医药大学公共卫生与管理学院,广州510006 [4]粤港澳中医药与免疫疾病研究联合实验室,广州510120

出　　处：《世界科学技术-中医药现代化》2024年第3期581-590,共10页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：广东省科学技术厅科技创新战略专项资金项目(2020B1212030006):粤港澳中医药与免疫疾病研究联合实验室,负责人:卢传坚;广东省中医院中医药科学技术研究专项(YN2019ML06):基于“肠肾轴”探讨肾保方治疗IgA肾病的临床疗效及机制研究,负责人:卢富华;国家中医药管理局全国名老中医药专家传承工作室建设项目(E52904):杨霓芝全国名老中医药专家传承工作室,负责人:侯海晶。

摘　　要：目的本研究旨在多层次分析名老中医诊治IgA肾病的临床经验,为传承中医肾病名医经验提供方法参考。方法采集并标准化广东省中医院杨霓芝教授门诊在2010—2020年期间诊治IgA肾病患者的医案数据,并将患者分为尿血组、尿浊组及肾衰组。利用FangNet平台进行PageRank算法计算药物THScore得到不同亚组IgA肾病核心药物。通过Python(SciPy包、Clusterheatmap包)可视化证型分布规律及相应用药规律,应用Mplus软件使用加权最小二乘估计法及斜交旋转GEOMIN法进行药物处方探索性及验证性因子分析。结果总共纳入145例IgA肾病患者,共548诊次。其中尿血组54例、尿浊组51例及肾衰组40例。基本证型有9种,含气虚证(91.79%)、血瘀证(77.01%)、湿热证(66.06%)及阴虚证(38.69%)等。总队列核心药物24种,尿血组23种,尿浊组21种,肾衰组16种,主要为益气补阳药、滋阴养血药、活血祛瘀药、清热凉血药等。IgA肾病辨证用药规律(Z-Score>0.5且P<0.05):气虚证常用药物:黄芪、山茱萸、菟丝子。血瘀证常用药物:丹参、泽兰、山茱萸等。湿热证常用药物:蒲公英、石韦、桃仁、土茯苓等。阴虚证常用药物:墨旱莲、太子参、女贞子等。根据探索性及验证性因子分析的结果,可以得出杨霓芝教授治疗IgA肾病核心药物组合因子包括:F1(菟丝子、山茱萸、黄芪);F2(白茅根、小蓟、茜草);F3(女贞子、墨旱莲、太子参);F4(泽兰、桃仁)。结论本研究通过应用PageRank算法及Mplus因子分析,分组分析杨霓芝教授诊治IgA肾病经验,明确以“气虚血瘀、湿热阴虚”为核心证型,“益气活血、清热养阴”为核心治法的IgA肾病岭南中医诊治心得,为传承名医经验提供方法参考,促进中医药的开发利用。Objective The objective of this study was to provide methodological references for the inheritance of the experience of well-known Chinese medicine doctors in the treatment of kidney disease.Methods The study collected medical case data for Ig A nephropathy,diagnosed and treated by Professor Yang Nizhi's outpatient department at Guangdong Provincial Hospital of Traditional Chinese Medicine from 2010 to 2020.The data was standardized and divided into three groups:urine and blood,urine turbidity,and renal failure groups.The study utilized the FangNet platform to apply the PageRank algorithm and calculate the THScore of different subgroups of core herbs for IgA nephropathy.The distribution pattern of syndrome differentiation and corresponding herb use regulations were visualized through Python(Sci Py package,Clusterheatmap package),and the study explored and verified the drug prescription through exploratory and confirmatory factor analysis based on Pearson correlation coefficient.The weighted least squares estimation mean and variance adjusted(WLSMV)and the oblique rotated GEOMIN method were used with the Mplus software.Results The study included a total of 548 treatments for 145 patients with IgA nephropathy,with heamturia group(54 cases),urine turbidity group(51 cases),and renal failure group(40 cases).Results showed 9 basic syndromes such as Qi deficiency syndrome(91.79%),blood stasis syndrome(77.01%),damp-heat syndrome(66.06%),and Yin deficiency syndrome(38.69%).There are 24 core drugs in total,23 in the urine and blood group,21 in the urine turbidity group,and 16 in the renal failure group.These drugs mainly include qi-tonifying and yang-invigorating drugs,nourishing yin and blood drugs,promoting blood circulation and removing blood stasis drugs,and clearing heat and cooling blood drugs.The regulations for the differentiation and medication of Ig A nephropathy(Z-Score>0.5 and P<0.05)were as follows:Huangqi,Shan Zhu Yu,and Tusizi were commonly used in Qi deficiency syndrome;Danshen,Ze Lan,and Shan Zhu Yu were c

关 键 词：因子分析 PAGERANK算法 IGA肾病 名老中医经验 

分 类 号：R249.2.7[医药卫生—中医临床基础]