基于数据分析对孟如教授辨治系统性红斑狼疮的规律研究

发布时间：2018-05-17 04:33

本文选题：数据分析 + 系统性红斑狼疮　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:通过运用数据分析的相关方法,对国家级名老中医孟如教授治疗系统性红斑狼疮的学术经验进行传承研究,以便探寻其辨治规律。方法:通过影像采集等方法收集导师保存的孟如教授1997年-2000年,2007年-2010年诊治SLE的病历资料。并将其进行规范化整理,获得标准化文本,用ACCESS建立孟如教授所治SLE病历资料的证治方药数据库;用Excel 2013数据透视表统计出症状、体征、证候、证素、方药等的频次,运用SQL Server 2012MAddin数据挖掘软件及Apriori算法对孟如教授所治系统性红斑狼疮的病历资料中的主要症状、药物及证-症-药-方等进行关联规则分析,设定最小支持度和最小置信度;同时运用SPSS 21.0对主要证型和症状进行决策树分析,总结孟如教授治疗SLE的辨治规律。结果:1.频数分析结果:本课题所纳入的病例资料中症状频率出现在10%及以上的依次为:倦怠乏力、鼻唇干燥、唇红、失眠、腰痛、潮热、心悸、关节痛、咽干、面部红斑、脱发、头晕、口渴、大便干结、皮肤红斑、心烦、神疲、面色赤、肢软、口苦、尿短黄、面睑浮肿、咳嗽、唇干;舌象以舌苔薄白,舌质红多见,脉象以脉细、脉滑为主。辨证分型中以气阴两虚证最多,频率30.36%,其次为肝肾阴虚证(26.39%),风湿热痹证(10.91%),热毒炽盛证(9.72%),脾肾两虚证(5.56%),其余证候所占比例较少。证素中病位证素以肾(55.95%)、肝(44.64%)为主要病位;病性证素中阴虚(86.11%)、气虚(53.77%)、湿(27.93%)、热(26.39%)为四种常见病性。对260例,504诊次的方药进行频数分析,其中使用频数最高的前15首处方分别是:二至丸、生脉散、六味地黄丸、增液汤、酸枣仁汤、知柏地黄丸、犀角地黄汤、小柴胡汤、当归芍药散、黄芪生脉二至丸、九味羌活汤、蠲痹汤、青蒿鳖甲汤、杞菊地黄丸、平胃散;使用频率较高的前40味药物分别是:甘草、茯苓、生地黄、麦冬、丹皮、淮山药、泽泻、山萸肉、芍药、女贞子、旱莲草、川芎、五味子、知母、当归、柴胡、半夏、白术、黄柏、玄参、防风、黄芩、连翘、生牡蛎、薏苡仁、生龙骨、苏条参、陈皮、酸枣仁、枳实、白茅根、秦艽、黄芪、桑寄生、苍术、桔梗、青蒿、菊花、太子参、水牛角,是治疗sle的主要药物。药类以补虚药、清热药为主,兼活血化瘀药、解表药、利水渗湿药等。2.关联规则、决策树分析结果:本研究主要对症状、中药及五种常见证型的证-症-药-方进行关联规则分析,从症状关联规则分析可知孟如教授所治sle疾病,各症状之间联系密切,如出现倦怠乏力时会出现神疲、肢软、心悸、潮热、舌边齿痕、失眠、脉细、舌苔薄白、脱发等症状;心烦时会出现急躁易怒;咽干时会出现口苦、唇红、口渴、心烦、面部红斑、鼻唇干燥等症状。从药物关联规则分析可知孟如教授治疗sle常用药对有生地黄-茯苓,山萸肉-淮山药,女贞子-旱莲草等;常用药物组合为“生地黄、山萸肉、淮山药”“茯苓、泽泻、丹皮”“苏条参、麦冬、五味子”“神曲、山楂、莱菔子”“桃仁、红花、川芎、芍药、姜黄、黄芪、当归”等等;从药物依赖关系网络图可归纳总结孟如教授治疗sle的常用处方及核心处方。从“证-症-药-方”的关联规则分析可知五种常见证型各症状、药物之间的相互关系及各证型所对应的常用核心处方。对症状证型进行决策树分析,初步构建孟如教授所治疗sle肝肾阴虚证、气阴两虚证、脾肾两虚证、风湿热痹证、热毒炽盛证等常见证型的诊断模型。结论:1.运用数据分析的相关方法可以提炼出孟如教授治疗sle的辨治规律。如利用频数分析,可以归纳出高频症状、证候、方药,从而得出益气养阴、滋阴清热是辨治系统性红斑狼疮最常用的法则;利用关联规则分析可以得出各症状的关联、药物的配伍规律,以及“证-症-药-方”的相互关系;利用决策树可以清晰明了的反映症状与证型的密切关系,使其证型诊断客观化。同时进一步总结出孟如教授辨治sle的学术经验,即(1)以病为纲,病证结合,辨证论治;(2)注重整体,把握病机,详审病势;(3)善抓主症,整体审察,执简驭繁;(4)谨守病机,活用经方,精于配伍;(5)擅用药对,求新增效,增效减毒。2.运用现代数据分析方法可以从多方面、多角度对名老中医丰富的临床经验进行分析,从而总结其辨治规律,使名老中医经验更直观、易懂,并能够得到客观实用的结论,对临床工作具有指导意义,并对名老中医学术经验的传承研究及传统中医药的发展、创新均具有重要的现实意义。
[Abstract]:Objective: to carry on the study of the academic experience of Professor Meng Ru in the treatment of systemic lupus erythematosus by means of data analysis, in order to explore the rule of differentiation and treatment of lupus erythematosus. Methods: to collect the medical records of Professor Mencius in 1997 -2000 and -2010 in 2007 by image collection and so on. Standardized text was made, standardized text was obtained, and ACCESS was used to establish the database of prescription and administration of SLE medical records by Professor Mencius. The frequency of symptoms, signs, syndromes, syndromes, prescription, and so on were statistically analyzed with Excel 2013 data pivot table, and the systematicness of Professor Meng Ru was used by SQL Server 2012MAddin data mining software and Apriori algorithm. The main symptoms in the medical records of lupus erythematosus, drug, syndrome, medicine and prescription were analyzed, the minimum support and minimum confidence were set. At the same time, SPSS 21 was used to analyze the major syndromes and symptoms, and the rule of differentiation and treatment of SLE was summed up by Professor Meng Ru. Results: the results of the 1. frequency analysis were included in this subject. Symptoms in the case of 10% or more symptoms were: burnout, dry nasolabial, lip red, sleeplessness, low back pain, hot flashes, palpitations, joint pain, sore throat, facial erythema, hair loss, dizziness, thirst, stool dry knot, skin erythema, irritability, fatigue, face color, soft, bitter, short yellow, eyelid swelling, cough, lip, tongue, tongue, tongue, tongue There were two deficiency syndrome in Qi Yin, 30.36% of Qi Yin deficiency syndrome, second syndrome of liver kidney yin deficiency syndrome (26.39%), rheumatic heat syndrome (10.91%), hot and toxic syndrome (9.72%), two deficiency syndrome of spleen and kidney (5.56%), and the proportion of other syndromes in the syndrome differentiation. The main disease position was kidney (55.95%) and liver (44.64%) as the main disease position. Yin deficiency (86.11%), Qi deficiency (53.77%), wet (27.93%), and heat (26.39%) were four common diseases. 260 cases, 504 times of the prescription of the frequency analysis, of which the highest frequency of the first 15 prescriptions were: two to the pill, Shengmai Powder, six flavour Rehmannia pills, Zeng liquid soup, zizzizijen soup, Zhi Bai Dihuang pill, rhino Rehmannia soup, small Bupleurum soup, angelica Peony Scattered, Astragalus raw pulse two pills, nine flavors of Qiang Qi Decoction, Juanbi soup, Artemisia arygwort soup, Qi chrysanthemum pills, flat stomach powder; the use of high frequency of the top 40 drugs are: licorice, Poria cocos, radix rehmanniae, Radix Ophiopogon, Huai yam, Rhizoma Alisma, Fructus Ligustrum, Rhizoma Anemarrhenae, Rhizoma Chuanxiong, Schisandra, Radix Angelicae, Radix Bupleuri, Pinelliae, pachyrhizae, cypress, Radix sabroniae, Wind proof, Scutellaria, forsythia, raw oysters, coix seed, raw dragon bone, soothing bone, citrus peel, sour jujube kernel, Fructus aurantii trifoliate, rhizome root, Radix Gentiana, Radix Astragali, Artemisia rhizome, Artemisia Artemisia, Artemisia Artemisia, chrysanthemum, Radix Astragalus, water ox horn, are the main drugs for the treatment of SLE, and the.2. association rules, such as tonifying deficiency drugs, clearing heat drugs, and activating blood and removing stasis medicine, dissolving the surface medicine and leuewater and humidifying drugs The result of tree analysis: This study mainly analyzes the association rules of symptoms, Chinese medicine and five common syndromes, syndrome, medicine and prescription. From the analysis of symptoms association rules, Professor Meng Ru has a close relationship between the symptoms and symptoms, such as fatigue, soft limbs, palpitations, hot flashes, tongue edges, insomnia, vein fine and tongue thin. White, alopecia and other symptoms; irritability and irritability when irritated; symptoms of pain, lip redness, thirst, irritability, facial erythema, dry nose and lip when dry throat. From the analysis of drug association rules, Professor Meng Ru is used to treat SLE commonly used medications for Rehmannia - Poria, Hillwood meat - Huai yam, Ligustrum lucidum - lotus, and so on; the commonly used drug combination is "rehmannia, mountain, mountain, and so on. "Tuckahoe, HuaiYam" "Poria cocos, Alisma Alisi, Danskin" "sustriae ginseng, Ophiopogon japonicus, Schisandra" "divine comedy, hawthorn, semen Raphani" "peach kernel" "peach kernel", "saffron, Ligusticum chuanxiong, peony, Jiang Huang, Huangqi, angelica" and so on; from the drug dependence network diagram can summarize and summarize the common prescriptions and core prescriptions of Professor Meng Ru treatment SLE. From the association of "syndrome syndrome drug prescription" The rule analysis shows the symptoms of five common syndrome types, the relationship between the drugs and the common core prescriptions corresponding to the syndrome types. The decision tree analysis of the symptoms and syndromes is carried out. The diagnosis model of the common syndrome types, such as SLE liver kidney yin deficiency syndrome, Qi Yin two deficiency syndrome, spleen and kidney two deficiency syndrome, rheumatic fever syndrome, heat and poison inability syndrome, is preliminarily constructed. Conclusion: 1. using the relevant methods of data analysis can be used to extract the rule of Professor Meng Ru's treatment of SLE. For example, the frequency analysis can be used to induce the high frequency symptoms, syndromes and prescriptions, so that it is the most common rule to differentiate and treat the systemic lupus erythematosus. The law of compatibility of drugs and the relationship between "syndrome - syndrome - drug - prescription" and the use of the decision tree can clearly and clearly reflect the close relationship between symptoms and syndrome types to make the syndrome diagnosis objective. At the same time, the academic experience of Professor Meng Ru's identification and treatment of SLE is further summed up. (1) the disease is the outline, the combination of disease and syndrome, syndrome differentiation, and (2) pay attention to the whole and grasp the disease. Machine, detailed examination of the disease; (3) good grasp the main disease, the overall inspection, the implementation of simple control complex; (4) keep the disease machine, use the meridian, the compatibility; (5) to use the medicine pair, the new efficiency, the effect of the modern data analysis method can be analyzed from various aspects of the clinical experience of the famous old Chinese medicine Feng Fu from many aspects, so as to sum up the rule of differentiation and treatment, so that the famous old Chinese medicine classics can be summed up, so that the famous old Chinese medicine classics can be summed up, so that the famous old Chinese medicine classics can be summed up to make the famous old Chinese medicine classics through. It is more intuitionistic, easy to understand, and can get objective and practical conclusions. It is of guiding significance to clinical work, and has important practical significance to the research of the academic experience of old Chinese medicine and the development of traditional Chinese medicine.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R259

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