益气活血法治疗慢性心力衰竭的数据挖掘与临床疗效  

Data Mining and Clinical Efficacy of Qi-tonifying and Blood-activating Therapy in Treatment of Chronic Heart Failure

作　　者：孔京晶 刘攀 戴小华[3] KONG Jingjing;LIU Pan;DAI Xiaohua(The First Clinical School of Medicine,Anhui University of Chinese Medicine,Hefei 230031,China;School of Chinese Medicine,Anhui University of Chinese Medicine,Hefei 230031,China;The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一临床医学院,合肥230031 [2]安徽中医药大学中医学院,合肥230031 [3]安徽中医药大学第一附属医院,合肥230031

出　　处：《世界中医药》2024年第17期2663-2669,共7页World Chinese Medicine

基　　金：国家重点研发计划项目(2017YFC1700306)——面向社会大众的名老中医药专家经验服务示范推广应用;安徽省中医药传承创新科研项目(2022CCZD02)——参芪健心方干预射血分数保留心力衰竭患者的临床评价研究。

摘　　要：目的:通过数据挖掘,探索益气活血法治疗慢性心力衰竭(CHF)的用药规律和“药物-指标”关联关系,并回顾分析益气活血法的临床疗效。方法:选取2021年9月至2023年8月在安徽中医药大学第一附属医院心内科治疗CHF的患者病例资料,根据是否使用中药大于7 d,分为中药组和对照组,录入中药处方、检验和检查数据,使用聚类分析、关联分析、网络可视化等探索用药规律和“药物-指标”关联关系,运用倾向评分法、Kaplan-Meier法回顾中药治疗CHF的疗效。结果:共采集956例CHF患者的资料,其中785例中药组,对照组171例。对785首处方中出现频率前15名的药物进行聚类分析,发现治疗CHF的2组常用中药。第一组中药功在益气温阳,活血利水。第二组中药侧重于益气健脾,淡渗利湿。关联分析得到高频中药组合6对,进一步将“药物-疗效”进行关联分析发现,中药配伍与CHF相关指标的改善有较强的相关性。进行1∶1倾向性匹配,匹配出155对病例样本,统计结果显示,与西药常规治疗比较,使用中药明显降低肌酸激酶、B型脑钠肽、低密度脂蛋白胆固醇、C反应性蛋白、空腹血糖、收缩压和舒张压,显著升高高密度脂蛋白胆固醇水平、左室射血分数、24 h尿量。结论:中药益气活血法可提高CHF患者心功能,改善临床症状,提高生命质量。Objective:To explore the medication rules and the“drug-indicator”associations in the treatment of chronic heart failure(CHF)using the qi-tonifying and blood-activating therapy through data mining and to review the clinical efficacy of this therapy.Methods:Medical data of patients from the Cardiology Department of the First Affiliated Hospital of Anhui University of Chinese Medicine,treated for CHF from September 2021 to August 2023,were enrolled and divided into the Chinese medicine group(using Chinese medicine for more than 7 days)and the control group.Prescription data,laboratory test results,and examination data were recorded.Clustering analysis,association analysis,and network visualization were employed to explore medication rules and“drug-indicator”associations.The efficacy of Chinese medicine in treating CHF was retrospectively analyzed using propensity score matching and the Kaplan-Meier method.Results:Data from 956 CHF patients were collected,including 785 in the Chinese medicine group and 171 in the control group.Clustering analysis of the top 15 frequently used drugs from 785 prescriptions revealed two main categories of drugs against CHF.The first focused on tonifying qi,warming yang,activating blood,and excreting water,while the second emphasized tonifying qi,strengthening the spleen,and eliminating dampness with bland drugs.Association analysis identified six high-frequency drug combinations,and further analysis of“drug-efficacy”associations showed a strong correlation between the drug compatibility and improvements in CHF-related indicators.A 1∶1 propensity score matching produced 155 matched pairs of cases.The statistical results indicated that compared to conventional Western medicine treatment,the use of Chinese medicine significantly reduced creatine kinase,B-type natriuretic peptide,low-density lipoprotein cholesterol,C-reactive protein,fasting blood glucose,systolic blood pressure,and diastolic blood pressure,and significantly increased high-density lipoprotein cholesterol,left

关 键 词：慢性心力衰竭 中药 益气活血法 数据挖掘 临床疗效 聚类分析 关联分析 倾向评分法 

分 类 号：R256.29[医药卫生—中医内科学]