基于数据挖掘理论探究德国偏头痛的中医药证规律及中药疗效

发布时间：2018-03-24 18:55

  本文选题：偏头痛　切入点：数据挖掘　出处：《北京中医药大学》2017年博士论文

【摘要】：对于偏头痛(Migraine)疾病来说,德国人群在全球发病率最高,西药治疗偏头痛的疗效不容乐观。其主要原因在于过度使用镇痛药物,存在严重药物依赖性及不良反应等[1]。而在我国,中医药能够以证候特点及其病情的变化为依据,开展针对性地个体化治疗。近年来在防治偏头痛的临床实践中,中医药治疗显示出巨大优势,成为国内外研究的热点。利用中医理念依据辨证论治思想个体化诊疗,在缓解偏头痛患者痛苦程度,心理负担,精神疲惫等方面做出了巨大贡献,而且中药药物相对西药更为安全,对病人来说能放心地接受治疗。当前使用中药治疗偏头痛已得到了国内外越来越多的医生和患者的认同[2]。目前偏头痛的中药治疗成果只是针对亚洲人群,对于德国人群的偏头痛中医治疗的研究还处于起步阶段。因此,寻找有效的治疗德国偏头痛患者的中药治疗方案是亟待解决的关键问题。本研究旨在通过深入探寻德国人群偏头痛发病特点及用药规律,促进中医药在不同地区人群的疾病治疗中发挥作用,进而推动中医药治疗走向世界。目的:通过对德国魁茨汀中医院(TCM-Klinik Bad Kotzting)住院偏头痛患者的临床病例进行回顾性研究分析,初探德国偏头痛患者发病特点、中医辨证分型及中药组方规律;通过采用循证医学的方法,对以往中药与西药治疗肝阳上亢型偏头痛患者的随机对照试验(RCT,Randomized Controlled Trial)进行Meta分析,为临床常见肝阳上亢型偏头痛患者提供临床中药治疗依据;通过对德国偏头痛患者的头痛发作情况、健康调查简表(SF-36,medical outcomes study36-item short-form health survey)及偏头痛中医疗效评价量表(PRO,Patients-reported outcomes)等指标进行分析,进一步探讨中药对偏头痛证候的改善情况,初探中药在治疗不同地区人群偏头痛患者中所发挥的重要作用。方法:1.本部分研究采用回顾性病历分析和数据挖掘的研究方法,收集德国TCM偏头痛患者住院病例。将病历内容分解为年龄、性别等基本信息与临床症状、舌脉及中医处方用药等诊疗信息,并分别建立相应数据集。运用因子分析和聚类分析等数据挖掘方法对症状信息进行分析,归纳并总结德国偏头痛患者常见证候及其临床用药特点。采用IBM SPSS Modeler 18.0数据挖掘软件,运用关联规则算法及非负稀疏主成分分析法对偏头痛患者的症状、用药规律进行数据挖掘分析,探讨德国偏头痛患者的中医症候特点及用药规律。为研究适合德国人群的偏头痛患者提供有效的中药诊疗方案。2.本部分研究采用循证医学的方法,对以往中药与西药治疗临床常见肝阳上亢型偏头痛患者的RCT进行Meta分析,扩大样本量,增加人群代表性,综合分析中药的临床疗效,为治疗肝阳上亢型偏头痛提供临床中药防治依据。3.本研究采用前瞻性临床病例观察方法,通过对德国偏头痛患者治疗前后头痛发作次数,减半率,头痛程度,PRO量表和SF-36量表等指标的观察,对比总结不同方剂的中药在治疗德国人群常见肝阳上亢型偏头痛患者的临床疗效。为治疗德国偏头痛提供有效的临床诊疗依据。结果:1..一般临床资料结果示:本研究共收集德国偏头痛患者159例。从性别分布来看,其中男性20例,女性139例,男女比例1:7;从年龄分布来看,最小年龄12岁,最大年龄76岁,平均年龄50岁。41-60岁所占人数最多,达69.8%;从职业分布来看,文职人员即脑力劳动者所占比例最多,达45.9%;从病程分布来看,其中74.8%的患者病程达10年及以上,病程持续时间较长,病情容易反复发作且难以治愈;从病史及不良生活习惯来看,偏头痛患者中有消化道病史占37.7%,有颈椎病病史占35.8%。从发病影响因素来看,一定诱因、天气变化、劳累程度及情志变化可影响偏头痛疾病的发生。2.通过频数分布分析得出:本研究共收集的159例德国偏头痛患者从头痛部位分布看,头痛发作部位分布前5位依次为前额部、太阳穴、眼周、颈部和枕部;从头痛性质分布看,分布前5位依次为刺痛、压痛、跳痛、牵拉痛及搏击痛。其中有先兆表现频数为28,构成比为17.6%;从兼证分布来看,分布前5位依次为反复发作、恶心呕吐、口干、心烦易怒、神疲乏力;从舌脉诊方面来看,舌质分布前5位依次为舌暗、舌边有齿印、舌胖、舌尖红、舌有瘀斑;舌苔分布前5位依次为苔薄白,苔白腻,苔薄黄,苔黄腻,苔薄腻;脉象分布前5位依次为滑脉,弦脉,弱脉,细脉,细弦脉;从头痛减轻程度方面来看:中医治疗有效者为66人,无效者为57人。中药对减轻偏头痛患者头痛程度方面的有效率大于50%。3.通过证候因子分析及聚类分析得出:本研究共收集的159例德国偏头痛患者常见病机相关的证候群有两类,一是包括公因子6、9的第一类:面颊部疼痛、面红、五心烦热、腰背酸痛、耳鸣健忘、苔黄腻;二是包括公因子5、7、10的第二类:头重如裹、耳后及耳周痛、全头痛、气短、手足心汗、舌淡红、苔薄、苔白、苔腻、舌有裂、脉滑数。4.通过关联规则分析得出:本研究共收集的159例德国偏头痛患者临床常见中医症状中反复发作、恶心呕吐,舌暗、苔薄白、弦脉、弱脉、滑脉等具有一定关联性。5.本研究共收集的159例德国偏头痛患者共使用126味中药,总使用频次为1958次,而使用频数不低于20次的药物共29味,共使用1449次,占药物使用总频数的73.83%。使用频数最多的前15味药,频数均在40次以上,分布前15位依次为柴胡、黄芩、牛膝、白芷、赤芍、姜黄、蒺藜、三棱、竹茹、白僵蚕、郁金、姜半夏、枸杞子、枳壳、蔓荆子。参照人民卫生出版社、全国高等中医药院校"十二五"规划教材《中药学》,按照功效将这些药物分为解表药、补虚药、活血化瘀药等18类。从中药药类种类分布看,使用频次最高的为活血化瘀类中药,共使用400次,占常用药类频率的20.42%。其后依次为:解表药,共使用321次,占常用药类频率的16.38%;补虚药,共使用268次,占常用药类频率的13.67%;清热药,共使用245次,占常用药类频率的12.5%;平肝熄风药,共使用268次,占常用药类频率的8.43%。从使用频率最多的前15位中药的归经来看,有11味中药都归于肝经,如柴胡、黄芩、牛膝、赤芍、姜黄、蒺藜、白僵蚕、郁金、枸杞子、枳壳、蔓荆子。6.运用非负稀疏主成分法,结合中医临床专业知识提取出159例德国偏头痛患者临床常用中药药对有:柴胡-黄芩;姜半夏-白术;川芎-白芍;蔓荆子-藁本;提取出常用三味中药配伍组合有:柴胡-黄芩-蔓荆子;姜黄-川断-桑枝;姜半夏-茯苓-白术。提取出常用四味中药配伍组合有:柴胡-黄芩-蒺藜-蔓荆子;姜半夏-郁金-白术-白僵蚕;厚朴-陈皮-防风-苍术。7.通过关联规则分析得出:159例德国偏头痛患者的中药处方中,柴胡为出现次数最多的药物。两味药物组合的规则中共得到6条关联规则,其中柴胡-黄芩这一规则关系最为密切,共96实例,支持度为60.4%,置信度为92.7%。8.通过药症关联规则分析得出:白芷、柴胡、黄芩这三味药与偏头痛出现的前额部疼痛、恶心呕吐、反复发作、弦脉、滑脉等主要症状关联度最大,关系最为密切。9.从入选13篇文献的Meta分析研究报告结果显示:中药组治疗肝阳上亢型偏头痛的疗效优于西药对照组(OR:0.41 95%CI:-0.28,0.60)。从3篇纳入门诊患者的研究结果显示:中药组的疗效优于西药组(MD:-1.07 95%CI:-1.53,-0.61)。仅有4篇研究报告中描述了中药有轻微不良反应。10.将26例德国偏头痛患者进行中药辨证治疗,对比治疗前后头痛发作次数及头痛程度的情况。结果示:中药对德国偏头痛患者在头痛发作次数、头痛程度改善方面均有显著疗效(P0.01)。11.将26例德国偏头痛患者进行中药辨证治疗,对比治疗前后SF-36及PRO量表。结果示:经中药辨证治疗后SF-36量表评分均有升高。与治疗前相比,在健康变化(HT,Reported Health Transition)、生理职能(RP,Role-Physical)、精力(VT,Vitality)这三个维度方面有统计学差异。将治疗前后SF-36得分差值对比发现,HT和情感职能(RE,Role-Emotional)两个维度有差异,有统计学意义。经中药辨证治疗后PRO量表评分均有降低,与治疗前相比,躯体状态、功能状态、精神心理及PRO总分均有统计学差异。结论:1.基于数据挖掘技术总结出德国偏头痛发病与气滞、痰饮、瘀血这些病理因素有关,与肝、脾、肾三脏关系密切。在头痛发作时以前额部刺痛、反复发作、伴恶心呕吐,舌暗、苔薄白、弦脉、滑脉为最常见症状。归纳出临床常见证型有肝阳上亢型和气虚痰湿型。在临床治疗中重视从肝论治,用药中强调和解少阳,提倡柴胡、黄芩药对的使用,注重活血化瘀类药物的使用。2.运用Meta分析方法总结文献中关于中药治疗临床常见肝阳上亢型偏头痛的疗效。证实中药有助于提高肝阳上亢型偏头痛的临床疗效,相对西药毒副作用更少,且更适用于门诊患者。3.中药在降低德国偏头痛患者的头痛发作频率和减轻疼痛程度等方面疗效显著;通过对调查量表结果分析发现,中药在改善德国偏头痛患者的头痛状态、生理功能和精神心理层面均有一定的治疗效果。
[Abstract]:For migraine (Migraine) disease, the German population rate is the highest in the global incidence, efficacy of Western medicine in the treatment of migraine is not optimistic. The main reason lies in the excessive use of analgesic drugs, and in our country serious drug dependence and adverse reactions of [1]., TCM syndrome features and changes in the condition as the basis, to carry out targeted individualized treatment of clinical practice in the prevention and treatment of migraine. In recent years, Chinese medicine treatment showed a huge advantage, has become a hot research at home and abroad. On the basis of syndrome differentiation and treatment ideas of individual diagnosis and treatment of Chinese medicine theory in use, alleviate the degree of pain, migraine patients psychological burden, made a great contribution to mental fatigue and etc. traditional Chinese medicine Western medicine is relatively safer, can be treated safely for patients. The use of traditional Chinese medicine in the treatment of migraine has been at home and abroad more and more doctors and [2]. is currently recognized in patients of migraine treatment of traditional Chinese medicine results only for the Asian population, for the study of Chinese medicine treatment of migraine in Germany people are still in the initial stage. Therefore, looking for effective treatment of traditional Chinese medicine in the treatment of migraine patients in Germany scheme is the key problems to be solved. The purpose of this study is to explore the pathogenesis of migraine through the German population characteristics and drug law and promote the role of TCM treatment of disease populations in different regions, thus promoting the treatment of traditional Chinese medicine to the world. Objective: to Germany Kuiciting Hospital of traditional Chinese medicine (TCM-Klinik Bad Kotzting) in clinical cases of migraine patients were retrospectively analyzed, of German migraine patients characteristics of the disease, syndrome differentiation of traditional Chinese medicine and traditional Chinese medicine prescription law; by using the method of evidence-based medicine, the traditional Chinese medicine and Western medicine treating hyperactivity in patients with migraine Randomized controlled trials (RCT Randomized, Controlled Trial) Meta analysis, to provide clinical basis for the clinical treatment of common migraine of liver yang hyperactivity patients; the German patients with migraine headache situation, health survey questionnaire (SF-36, medical outcomes study36-item Short-Form Health Survey) and evaluate the therapeutic effect of traditional Chinese medicine migraine scale (PRO. Patients-reported outcomes) were analyzed, further explore the improvement of traditional Chinese medicine on migraine syndrome, traditional Chinese medicine plays an important role in the treatment of the populations of different regions in migraine. Methods: 1. this study using retrospective study method and case analysis, data mining, collection of German TCM migraine patients hospitalized cases. The contents of medical records the decomposition for age, gender and other basic information and clinical symptoms, tongue and pulse and Chinese medicine prescription medication and medical information, respectively. The establishment of the corresponding data set. Using the factor analysis and clustering analysis method to analyze the symptom information, and summed up the German migraine patients common syndromes and clinical drug characteristics. Using IBM SPSS Modeler 18 data mining software, the application of association rules algorithm and non negative sparse principal component analysis method on patients with migraine symptoms, medication rule for data mining analysis, discusses the German migraine with TCM syndrome characteristics and drug law. Suitable for the study of the German population of migraine patients to provide.2. medicine effective treatment program of this study using the method of evidence-based medicine, traditional Chinese medicine and Western Medicine on the clinical treatment of common migraine of liver Yang hyperactivity in patients with RCT Meta analysis, expand the sample size increased, represent the population, clinical comprehensive analysis of traditional Chinese medicine, for the treatment of migraine of liver yang hyperactivity and provide clinical application On the basis of.3. medicine in prevention and treatment of a prospective clinical observation method, based on the treatment of migraine patients before and after the German headache episodes, half rate, headache degree, observe the PRO scale and SF-36 index, Chinese medicine prescription in the treatment of the contrast of different groups of German common migraine of liver yang hyperactivity in patients with clinical efficacy to provide clinical basis for effective treatment of migraine in Germany. Results: 1.. Clinical data showed: the study collected 159 cases of patients with migraine in Germany. From the gender distribution, among which 20 cases were male, 139 were female, male to female ratio of 1:7; from the age distribution, the minimum age of 12 years, the maximum age of 76 years, the average age of 50.41-60 years old accounted for the largest number reached 69.8%; from the occupation distribution, civilian personnel that mental workers accounted for the highest proportion of 45.9%; in the course of the disease distribution, of which 74.8% of the patients History of 10 years and above, the duration is longer, the disease is easy to recurrent and difficult to cure; from the history and bad habits, migraine in patients with gastrointestinal diseases accounted for 37.7%, with a history of cervical disease accounted for 35.8%. from the risk factors, certain causes, weather changes and emotional changes can affect the degree of fatigue the occurrence of.2. migraine disease by frequency distribution analysis: This study collected 159 cases of patients with migraine headache from German site distribution, headache sites are the top 5 temples, forehead, eye, neck and occipital headache; from the nature of the distribution, the distribution of the first 5 were pain, tenderness jump, pain, pulling pain and pain. There are signs of fighting frequency was 28, accounting for 17.6%; and from the point of view of the distribution of syndrome distribution, the first 5 were recurrent, nausea and vomiting, dry mouth, irritability, lassitude of the tongue; 鑴夎瘖鏂归潰鏉ョ湅,鑸岃川鍒嗗竷鍓，

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