基于数据挖掘研究史大卓教授治疗介入后冠心病遣方用药规律

发布时间：2018-07-04 18:27

本文选题：介入后冠心病 + 辨证用药　；参考：《中国中医科学院》2017年硕士论文

【摘要】：经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是冠状动脉狭窄或闭塞后改善心肌血流灌注的有效方法,从1977年对冠状动脉粥样硬化狭窄病变进行经皮冠状动脉腔内成形术,至今已有40年的历史。我国从1984年开展PCI到2013年,由每年几十例增至每年45万例左右。冠脉支架植入的血运重建机制主要是血管重塑,但只能解决血管病变部位狭窄,并不能解决心脏所有动脉的狭窄病变,更没有消除引起动脉粥样硬化狭窄的原因,且同时存在再狭窄、血栓形成、心肌组织无复流等问题,影响了临床预后。中药可作用于PCI后相关病理改变的多个病理环节,对改善预后有重要意义。史大卓教授在“病证结合”治疗介入后冠心病方面,形成了自己的诊疗特色。本研究在对导师诊疗介入术后冠心病临床经验学习总结的基础上,应用数理统计学方法和数据挖掘技术,从理、法、方、药方面,对导师治疗介入后冠心病的遣方用药特点进行了系统研究。一.文献综述:益气活血解毒法治疗冠状动脉支架术后进展通过对益气活血解毒方药治疗冠状动脉支架术后相关文献的综述分析,发现血瘀和气虚是PCI后冠心病的主要证候要素,气虚血瘀是冠心病PCI术后的基本病机,益气活血是介入后冠心病主要治法,瘀血阻滞脉络、日久蕴积化毒、因毒致变是发生心血管病事件的关键。二.经验总结:史大卓教授治疗介入后冠心病的临床经验史大卓教授治疗PCI后冠心病,擅于中医个体化宏观辨证和病理生理变化相结合,中药的寒热温凉属性和现代药理研究成果相结合,具体表现为以下几个方面:(1)通阳宣痹注重豁痰化痰、散寒通痹;(2)在活血化瘀的基础上和解毒药有机结合:(3)补气强调不但要补心气、补宗气,还要注意补中气、补元气;(4)补益肝肾强调甘温补肾;(5)圆机活法,注意结合通络、安神、活血利水等法。三.临床研究:基于数据挖掘技术研究史大卓治疗介入后冠心病遣方用药规律目的:挖掘分析史大卓教授辨治介入后冠心病的遣方用药特点和规律。方法:利用中国中医科学院信息研究所开发的名老中医临床诊疗共享系统,进行临床信息的采集、存储,利用ETL工具进行数据管理,利用SPSS13.0软件进行统计分析,利用中医临床科研信息共享系统对中药性味归经进行联机分析(OLAP),关联规则分析药对特点,聚类分析方剂组合,复杂网络分析配伍规律。对史大卓教授治疗介入后冠心病的遣方用药特点进行挖掘分析。结果:1.共计入选317例患者,1165诊次,其中男性208例,占65.62%;女性109例,占34.38%。年龄23-88岁,平均年龄60.545岁。发病年龄主要分布在40至80岁之间。2.临床合并病以高脂血症(122例,占7.58%)最常见,其后依次是高血压(85例,占5.28%)、糖尿病(40例,占2.49%)慢性心力衰竭(27例,占1.68%)、脑血管病(21例,占1.31%)失眠(19例,占1.18%)等。3.中医证候分布情况以血瘀最多占67.04%,其后依次是气虚占10.53%、痰浊占6.45%、阴虚占6.45%、气滞占3.29%、郁热占2.50%、血虚占0.72%、肝阳上亢占0.59%等。4.使用中药250种,使用频次共计14334次,用药频次前十的中药依次是丹参、川芎、赤芍、生黄芪、薤白、莪术、金银花、白蒺藜、醋香附、陈皮。按功效进行分类显示,主要以活血、止痛、和血、清热、安神、祛风、凉血、养血、祛瘀、消痈、解毒、燥湿、行气、健脾为主。中药性味以辛味药最多,1192频次,其次为甘味药(1191次)、苦味药(1178次)、微寒味药(1158次)、温性药(1158次)、平性药(1129次),之后依次是寒酸咸湿性药、涩性药、热性药。患者使用中药的归经以脾经最多,为1858次,其次为肺经、心经、肝经、胃经、心包经、胆经、大肠经、肾经、膀胱经、三焦经、小肠经。5.关联规则定义SUP40%,CON90%,结果显示常用的中药配伍有:莪术配丹参、赤芍配丹参、黄连配丹参、莪术配赤芍、川芎配丹参、生黄芪配丹参、莪术配川芎;常用的药组有:川芎、莪术、赤芍和丹参;莪术、赤芍和丹参;川芎、黄连、赤芍和丹参;莪术、川芎和丹参;莪术、川芎和赤芍;赤芍、生黄芪、川芎和丹参;黄连、丹参和赤芍;赤芍、川芎和丹参;黄连、川芎和丹参等。6.聚类结果显示,聚成14类后,指标数相对合理,能较好体现史教授中医辨证中与药组方用药特点。每一类包含一组中药群,每组中药群均与临床诊治过程中的主病主证相对应。人机结合,在史教授参与指导下,对14类中药群解析如下:第一类药物组成功效可归纳为“清热化浊、益气活血”;第二类药物组成功效可归纳为“化痰祛浊、活血化瘀”;第三类药物组成功效可归纳为“益气活血、散结通络”;第四类药物组成功效可归纳为“活血化瘀、理气行滞”;第五类药物组成功效可归纳为“活血化瘀、调和气机”;第六类药物组成为史教授益气活血利水的经验方;第七类药物组成功效可归纳为“平肝潜阳、活血解毒”;第八类药物组成功效可归纳为“益气养阴、活血化瘀”;第九类药物组成功效可归纳为“活血化瘀、清热解毒、润肠通便”;第十类药物组成功效可归纳为“滋补肝肾、清心安神”;第十一类药物组成功效可归纳为“疏肝健脾、益气活血”;第十二类药物组成为史教授益气养阴、活血解毒的自拟方;第十三类药物组成功效可归纳为“滋补肝肾、活血解毒”;第十四类药物组成功效可归纳为“活血祛瘀、清热解毒散结”。由此可以看出,史教授在治疗介入后冠心病时,常根据合并病的不同选用具有益气活血、滋补肝肾、活血通络、清热解毒等功效的药物。7.复杂网络分析显示:(1)以中药为节点进行分析,在过滤节点≥10时,能较好地展现中药之间的配伍关系,按节点度由大到小依次为丹参、生黄芪、川芎、莪术、赤芍、黄连、三七粉、金银花、白蒺藜、醋香附、薤白、茯苓、天麻、钩藤、川牛膝、党参、葛根、红花、陈皮、当归、法半夏、生白术、黄芩。过滤节点度≥30时,使用中药的前4味关联是丹参、川芎、赤芍、生黄芪;(2)以证候-中药为节点进行分析,按节点度由大到小依次是血瘀对应的中药是赤芍、丹参、莪术、川芎、红花、三七粉,气虚对应的中药是生黄芪、党参、西洋参,痰浊对应的中药是瓜蒌、薤白、半夏、陈皮、茯苓,热毒对应的中药是黄连、金银花、黄芩。过滤节点度≥32时,药物与冠心病主要证候的节点分布较为清晰明确,冠心病核心证候为血瘀证,核心药物组成以生黄芪、川芎、赤芍、丹参为主,核心证候与核心药物功效相符合,体现了史教授临证以补气、活血为主的用药特点;(3)冠心病使用中药-功效分析显示,在过滤节点度≥42时,能较好地展示使用中药功效之间的关联关系,包含的中药功效有活血、清热、止痛、安神、和血。结论:(1)史大卓教授治疗介入后冠心病的核心组方配伍是丹参、赤芍、黄连、川芎、生黄芪。(2)史大卓教授治疗介入后冠心病以益气、活血、破血、化痰、解毒、安神为主要治法。(3)史大卓教授治疗介入后冠心病的用药规律体现了介入后冠心病虚、瘀、痰、毒的病机特点。
[Abstract]:Percutaneous coronary intervention (percutaneous coronary intervention, PCI) is an effective method to improve myocardial perfusion after coronary artery stenosis or occlusion. The percutaneous coronary angioplasty for coronary atherosclerotic stenosis in 1977 has been 40 years old. From 1984 to 2013, China developed from PCI to 2013. The blood transport reconstruction mechanism of coronary stent implantation is mainly vascular remodeling, but it can only solve the stenosis of vascular lesions, and can not solve the stenosis of all arteries of the heart. It does not eliminate the cause of atherosclerotic stenosis, and there is restenosis, thrombosis and myocardial tissue at the same time. No reflux and other problems affect the clinical prognosis. Chinese medicine can play a role in the pathological changes of the pathological links after PCI, and it is of great significance to improve the prognosis. Professor Shi Dazhuo has formed his own diagnosis and treatment characteristics in the treatment of coronary heart disease after the "combination of disease and syndrome" treatment. The clinical experience of coronary heart disease after the interventional therapy of tutor diagnosis and treatment is studied. On the basis of the summing up, using mathematical statistics and data mining techniques, this paper systematically studies the characteristics of the recreational drugs for coronary heart disease after the intervention of the tutor treatment. 1. The literature review: the progress of the treatment of coronary artery stenting after the treatment of coronary artery stenting by the method of invigorating qi and activating blood circulation and detoxifying the coronary artery is to treat the coronary artery by the prescription of Invigorating Qi and activating blood and detoxifying the coronary artery The review and analysis of related literature after stenting, found that blood stasis and Qi deficiency are the main syndromes of coronary heart disease after PCI, Qi deficiency and blood stasis are the basic pathogenesis of coronary heart disease after PCI. The main treatment of coronary heart disease after interventional therapy is the main treatment of coronary heart disease after intervention, blood stasis block choroid, persistent accumulation of poison, and the key to the occurrence of cardiovascular events because of toxic changes. Two. Experience summary Professor Shi Dazhuo's clinical experience in the treatment of coronary heart disease after intervention, Professor Shi Dazhuo treated coronary heart disease after the treatment of coronary heart disease. He was unauthorized to combine the macroscopic syndrome differentiation and pathophysiological changes of traditional Chinese medicine. The cold and warm cold properties of traditional Chinese medicine and modern pharmacological research results were combined, and the following aspects were shown in the following aspects: (1) Tongyang Xuan Bi paid attention to phlegm and phlegm and scattered cold. (2) to reconcile the organic combination of toxic drugs on the basis of activating blood and removing blood stasis: (3) supplementing Qi emphasizes not only to fill the heart, make up the sect gas, but also pay attention to supplementing the middle Qi and nourishing the Qi; (4) tonifying the liver and kidney to emphasize the tonifying of the kidney; (5) circular machine activities, pay attention to the combination of dredging collaterals, Anshen, blood circulation, and other methods. Three. Clinical research: Based on data mining technology to study the intervention intervention of Shi Dazhuo intervention The objective of drug use for post coronary heart disease is to excavate and analyze the characteristics and laws of Professor Shi Dazhuo's medicine for treating coronary heart disease after intervention. Methods: the clinical information sharing system of the famous old Chinese medicine developed by the Information Research Institute of the Chinese Academy of science of traditional Chinese medicine (Chinese Academy of science of traditional Chinese Medicine) was used to collect and store the clinical information and to use the ETL tool to manage the data and use SPSS13.0 The software was analyzed by the statistical analysis, and the traditional Chinese medicine scientific research information sharing system was used to analyze the traditional Chinese medicine flavour meridian (OLAP). The association rules were used to analyze the characteristics of the drugs, the combination of the cluster analysis and the combination of the complex network analysis. The characteristics of the medication for the coronary heart disease after the intervention of Prof Shi Da Zhu were analyzed. Results: 1. There were 317 patients and 1165 times, of which 208 cases were male, 65.62%, and 109 women were 34.38%. age 23-88 years old and the average age was 60.545 years old. The onset age was mainly between 40 and 80 years old with hyperlipidemia (122 cases, 7.58%), followed by hypertension (85, 5.28%), and chronic heart disease. Stress failure (27 cases, 1.68%), cerebrovascular disease (21 cases, 1.31%) insomnia (19 cases, 1.18%), the distribution of.3. TCM syndromes with blood stasis was 67.04%, followed by qi deficiency and 10.53%, phlegm in 6.45%, yin deficiency in 6.45%, qi stagnation up 3.29%, stasis heat occupy 2.50%, blood deficiency occupy 0.72%, liver yang hyperactivity occupied 0.59%.4. and other kinds of traditional Chinese medicine. 14334 times, the first ten of the traditional Chinese medicine were Salvia miltiorrhiza, Ligusticum chuanxiong, Radix Paeoniae, Radix Astragalus, Radix Astragalus, rhizome, rhizome, Rhizoma rhizome, zedoary turmeric, honeysuckle, Tribulus terrestris, vinegar pericarp, and tangerine peel. According to the efficacy, it was mainly used to activate blood, relieve pain, blood, heat, dispel wind, and dispel carbuncle, detoxification, dampness, Qi and spleen. More, 1192 frequency, followed by sweet medicine (1191), bitter medicine (1178 times), micro cold medicine (1158 times), thermo sexual medicine (1158 times), flat drug (1129), followed by cold acid salt wet medicine, astringent medicine, and thermal medicine. The patients used Chinese medicine were the most abundant, 1858 times, followed by lung, meridian, stomach, pericardium, bile meridian, large intestine meridian, kidney. SUP40% and CON90% are defined by the.5. association rules of the bladder meridian, tri focal meridian and small intestine. The results show that zedoary turmeric with Salvia miltiorrhiza, red peony root with Salvia miltiorrhiza, Rhizoma miltiorrhiza with Rhizoma miltiorrhiza, rhizome of Rhizoma Chuanxiong with Salvia miltiorrhiza, Radix Astragali with Salvia miltiorrhiza, zedoary rhizome and Salvia miltiorrhiza; zedoary turmeric root, red peony root and Salvia miltiorrhiza; Ligusticum chuanxiong, Rhizoma Coptidis, Radix Paeoniae and Salvia miltiorrhiza; zedoary rhizome, Rhizoma Chuanxiong and Salvia miltiorrhiza; zedoary turmeric, Rhizoma Chuanxiong and Radix Paeoniae radix; Radix Paeoniae radix, Radix Astragalus, Rhizoma Chuanxiong and Radix Salviae Miltiorrhizae; Rhizoma Coptidis, Salvia miltiorrhiza and Radix Paeoniae radix; Radix Paeoniae Paeoniae, Rhizoma Chuanxiong and Salvia miltiorrhiza; Rhizoma Coptidis, Ligusticum chuanxiong and Salvia miltiorrhiza; after the aggregation of the index number is reasonable, it can better reflect the characteristics of medicine in TCM syndrome differentiation and medicine. One group includes a group of Chinese medicine groups, each group of Chinese medicine should be corresponding to the main main syndrome in the process of clinical diagnosis and treatment. Under the guidance of Professor Shi, the 14 kinds of Chinese medicine groups are analyzed as follows: the first kind of drug composition can be summed up as "clearing heat and activating blood and promoting blood circulation", and the second kinds of drugs can be summed up as "phlegm dispelling turbidity, activating blood circulation" The effect of the composition of the third kinds of drugs can be summed up as "Invigorating Qi and activating blood, removing the collaterals and collaterals"; the composition of the fourth kinds of drugs can be summed up as "activating blood to dissipate blood stasis and regulating qi stagnation"; the efficacy of the fifth types of drugs can be summed up as "activating blood to remove stasis and harmonization of Qi"; the sixth group of drugs became the experience of Professor Shi Yiqi Huoxue Li Shui, and the seventh kind of medicine. The efficacy of the eighth kinds of drugs can be summed up as "Nourishing Qi and nourishing Yin, activating blood and removing blood stasis", and the ninth kinds of drugs can be summed up as "activating blood and removing stasis, clearing heat and detoxifying, moistening intestines and bowel movement", and the efficacy of the tenth kinds of drugs can be summed up as "nourishing liver and kidney, clearing heart and mind"; eleventh types of drugs. The efficacy of drug composition can be summed up as "liver nourishing and invigorating the spleen, invigorating qi and activating blood circulation"; the composition of the twelfth kinds of drugs is the self-made prescription of Professor Shi Yiqi nourishing yin and activating blood to detoxify; the thirteenth kinds of drugs can be summed up as "nourishing the liver and kidney, activating blood and detoxifying", and the efficacy of the fourteenth kinds of drugs can be summed up as "activating blood and removing stasis, clearing heat and detoxification and dispersing the knot". In the treatment of coronary heart disease after intervention, Professor Shi is often used in the complex network analysis of.7. complex network analysis of the effects of combining Qi and activating blood and kidney, nourishing the liver and kidney, activating blood and dredging collaterals, clearing heat and detoxifying and so on. (1) the traditional Chinese Medicine is used as the node to analyze, and when the filter node is more than 10, it can better display the compatibility relationship between the Chinese medicine and press the node. From large to small, the order of Radix Salviae Miltiorrhizae, Radix Astragalus, Rhizoma Chuanxiong, Rhizoma Chuanxiong, Radix Paeoniae, Rhizoma Coptis, Rhizoma Coptidis, 37 powder, honeysuckle, Tribulus terrestris, vinegar incinction, xeba, tuckahoe, Rhizoma rhizome, Radix Achyranthes, Radix Codonopsis, kudzu, kudzu, tangerine, Radix Angelicae, Radix pellucidae, Radix Scutellariae, and scutellaria. The first 4 flavors of traditional Chinese medicine are Salvia miltiorrhiza, Ligusticum chuanxiong, Radix Paeoniae and Astragalus membranaceus; (2) The traditional Chinese medicine is Radix Paeoniae, Salvia miltiorrhiza, Rhizoma Rhizoma Rhizoma, Rhizoma Chuanxiong, red flower, 37 powder, and the corresponding Chinese medicine of qi deficiency, Radix Codonopsis, Panax quinquefolium and phlegm is the gualosanus, and the Chinese herbs of xebai, Pinellia ternata and tuckahoe are the Chinese herbal medicine of Huanglian, honeysuckle and scutellaria. When the degree of filtering node is more than 32, the distribution of main syndromes of drugs and coronary heart disease is clear and clear. The core syndrome of coronary heart disease is blood stasis syndrome. The core drugs are composed of Astragalus membranaceus, Ligusticum chuanxiong, red peony root and Salvia miltiorrhiza. The core syndromes are in accordance with the core drug efficacy, which embodies the characteristics of the history teaching and clinical syndrome to supplement qi and promote blood circulation; (3) coronary heart disease (CHD) The use of traditional Chinese Medicine - efficacy analysis shows that when the degree of filtering nodes is more than 42, it can show the relationship between the efficacy of traditional Chinese medicine and the efficacy of traditional Chinese medicine including activating blood, clearing heat, relieving pain, relieving pain, and blood. Conclusion: (1) the compatibility of Professor Shi Dazhuo in the treatment of coronary heart disease after intervention is Salvia miltiorrhiza, radix paeoniae rubra, Rhizoma Chuanxiong, and Astragalus membranaceus. (2) Shi Dazhuo After the treatment of interventional therapy, coronary heart disease is the main treatment of Qi supplementing, activating blood, breaking blood, eliminating phlegm, detoxification, and Anshen. (3) the rule of medicine for the treatment of coronary heart disease after the intervention of Professor Shi Dazhuo embodies the pathogenesis of coronary heart disease, blood stasis, phlegm and poison after intervention.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R259

【参考文献】