基于数据挖掘的老年性痴呆证治规律研究

发布时间：2018-03-01 07:22

  本文关键词： 数据挖掘 老年性痴呆 证候要素 用药规律　出处：《辽宁中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：目的:从多角度、多方位、多层次对老年性痴呆的证候、证候要素、病机及临床用药规律进行数据挖掘;为完善老年性痴呆的辨证体系,及把握其临床证治规律作出有益探索,本病的防治提供一些借鉴。材料与方法:1.通过对中药治疗老年性痴呆用药规律的文献回顾研究,对相关老年性痴呆的现代临床研究类文献进行收集和整理,然后采用频数统计、聚类分析、关联规则分析等数据统计方法,对老年性痴呆的临床用药规律与配伍特点进行较为详尽的研究。2.通过检索1990-2015年关于老年性痴呆的中医文献,对证候要素、靶位、应证组合规律进行描述性分析,均采用频数与构成比,探讨老年性痴呆的证候分布特点及组合规律。3.对符合要求的112例老年性痴呆患者的中医四诊信息进行整理总结,通过无监督数据分析方法对高频四诊信息进行研究,以SAS9.2软件进行探索性因子分析和聚类分析。具体运用系统聚类对指标(四诊信息)进行聚类分析;运用因子分析提取四诊信息的公因子。结果:1.研究1共纳入符合要求的文献83篇,收集处方93首。从老年性痴呆总体用药情况可以看出,治疗老年性痴呆的常用药物有石菖蒲、黄芪、熟地黄、茯苓、甘草、川芎、远志、当归、丹参、枸杞、何首乌、山茱萸、菟丝子、党参、益智仁、白术、酸枣仁、桃仁等。对药物的功效分析发现,治疗老年性痴呆的处方中涉及补虚药、活血化瘀药、安神药、利水渗湿药、开窍药、清热药、解表药、化痰止咳平喘药、收涩药、平肝熄风药、理气药等。其中以补虚药、活血化瘀药、化痰药、开窍药、安神药使用频率最高。药物归经显示,归经频率最高的前四位为肝、肾、脾、心。通过聚类分析与关联规则分析,发现老年性痴呆临床用药配伍以补虚、活血、开窍、化痰、安神为常见的配伍组合。2.研究2共纳入符合要求的文献58篇,初步得到97种证型,各证型累计出现频数283次。92种证型中,常见证型依次为:气滞血瘀证、痰浊阻窍证、髓海不足证、肝肾阴虚证、脾肾两虚证、心肝火盛证、心脾两虚证、肾精亏虚证、痰阻血瘀证、肾虚髓亏证。通过对老年性痴呆证候要素的提取,归纳出14个证候要素与7个证候靶位。通过对老年性痴呆应证组合规律的描述性分析,总结出老年性痴呆应证组合的不同形式。根据文献研究结果,反映出老年性痴呆病位主要在肾,与肝、脾、脑、心密切相关,其临床病机属本虚标实,以虚为本,血瘀、痰为标。3.对收集的112例老年性痴呆患者的中医四诊信息进行整理分析发现,频数在前15位的症状分别为:善忘、腰膝酸软、发白发枯、倦怠乏力、头晕、失眠、少气懒言、多梦、夜尿频多、齿摇齿脱、小便频数、便干、自汗、情志抑郁、畏寒肢冷。通过聚类分析初步判断本病可能的病位证素为肾、脾、肝、心,病性证素为虚、痰湿、血瘀、火。通过因子分析对研究指标进行降维,以简化问题,结果共提取到18个公因子。通过对老年性痴呆患者的中医四诊信息进行探索性的因子分析,认为AD病机主要可以归纳为痰、瘀、虚三个方面。结论:1.老年性痴呆发病多与肾、脾、肝、心功能失常相关,且与肾脏关系更为密切。补虚是治疗老年性痴呆的基本原则,祛瘀、化痰是治疗老年性痴呆的有效途径。处方用药上,临床从虚论治、补肾益髓,兼以健脾调肝以治本;祛瘀化痰以治标,并注重开窍醒神。2.通过对老年性痴呆辨证分型文献的回顾性研究,总结出老年性痴呆的应证组合规律;虽然中医的证候千变万化,但证候要素与靶位则相对简约,因此研究证候要素与靶位间的应证组合规律,有助于对病机特点与疾病演变规律的把握。3.老年性痴呆高频症状基本以虚性证候表现为主。结合聚类分析与因子分析两种统计分析结果,认为老年性痴呆的主要病位要素主要在肾、脾,其次在肝、心等;病性要素以虚、痰、血瘀主,其次是火、气滞,其中虚是本病最为常见的病性要素,痰与血瘀是本病最重要的病邪证候要素。
[Abstract]:Objective: from the multi angle, multi direction, on senile dementia syndromes levels, syndrome factors, pathogenesis and clinical medication rules for data mining; to perfect the system of syndrome differentiation of senile dementia, and grasp the clinical syndrome rules make the beneficial exploration, provide some reference materials and the prevention and treatment of this disease. Methods: 1. through the research literature review of senile dementia medication rule of traditional Chinese medicine in the treatment of senile dementia, the modern clinical research literatures were collected and compiled, and then uses the frequency statistics, clustering analysis, the statistical methods of data association rules analysis, clinical medication rule and compatibility features of Alzheimer's disease research is.2. a detailed search through the 1990-2015 years of senile dementia TCM syndrome factors, target, law should permit the combination of descriptive analysis, were used to investigate the frequency and proportion of senile dementia The characteristics and rule of combination syndrome distribution of.3. to meet the requirements of the 112 cases of elderly patients with dementia TCM four diagnostic information summary, through the analysis method to study the high-frequency diagnostic information supervision data, using SAS9.2 software for exploratory factor analysis and clustering. The specific use of hierarchical clustering index (four diagnostic information) cluster analysis; factor analysis is used to extract the common factor of diagnostic information. Results: 1. of 1 were included to meet the requirements of the 83 articles, 93. From the first collection of prescription medication of senile dementia overall situation can be seen, commonly used drugs for the treatment of senile dementia with Shichangpu, Radix Astragali, radix rehmanniae, tuckahoe, liquorice, Rhizoma Chuanxiong. Polygala, angelica, Salvia miltiorrhiza, Radix Polygoni Multiflori, Cornus officinalis, medlar, dodder, Codonopsis, Atractylodes, Alpinia, Suanzaoren, peach and so on. The efficacy of drugs analysis found that the treatment of senile dementia in the prescription to the tonic 鑽，

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