摘要
【目的】采用数据挖掘技术探究冠状动脉粥样硬化性心脏病(简称冠心病)患者的中医证型、证素分布特点及用药规律,以期为冠心病的中医论治提供参考。【方法】以2011年4月至2021年4月就诊于深圳市中医院心血管内科、综合科门诊和住院部,经冠状动脉增强CT或冠脉造影术检查确诊为冠心病,并采用中医或中西医结合治疗的3167例患者为研究对象,借助数据挖掘技术,对冠心病患者的性别、年龄、中医证型、证素和用药频次进行统计分析。【结果】(1)共纳入3167例冠心病有效病例。性别方面,男性患者占63.15%(2000/3167),高于女性患者的36.85%(1167/3167);年龄方面,以50~69岁年龄段的患者最多,占59.96%(1899/3167)。(2)共涉及中医证型34种,使用频数居前3位的证型为脾肾两虚(570例)、心肾不足(505例)、气滞血瘀(494例)。(3)共涉及6个病位证素,其中,肾(1394例)、心(1186例)、脾(911例)是频数最高的3个证素。共涉及9个病性证素,前4位为气虚(604例)、血瘀(538例)、气滞/气阻(497例)和阴虚(495例)。(4)统计得出,共使用中药204味,使用频次居前5位的药物依次为黄芪、延胡索、白术、薤白、党参等;根据冠心病患者的证型分布进一步分析其用药规律,在最常见的脾肾两虚型中,用药频次从高到低依次为黄芪、延胡索、党参、白术、薤白、仙茅、川芎、炙甘草等。【结论】气虚作为冠心病的核心病机贯穿始终,其中以心、脾、肾脏腑亏虚为主,气滞、血瘀为疾病发展中的重要驱动因素。在冠心病的治疗中,应谨守扶正祛邪的基本原则,以补气养心为主,兼以活血祛瘀化痰,常配伍补益药、理气药和活血药。
Objective To explore the characteristics of traditional Chinese medicine(TCM)syndrome types,syndrome elements,and medication rule for the patients with coronary heart disease(CHD,short for coronary atherosclerotic heart disease)through data mining technology,so as to provide reference for the TCM treatment of CHD.Methods The study was carried out in 3167 patients who attended the outpatient and inpatient departments of the cardiovascular medicine and general medicine departments of Shenzhen Traditional Chinese Medicine Hospital from April 2011 to April 2021 and were diagnosed as CHD by coronary artery enhanced CT or coronary angiography.And the patients were treated with Chinese medicine or integrated Chinese and western medicine.The gender,age,TCM syndrome types,syndrome elements,and frequency of medication in CHD patients were statistically analyzed with the data mining technology.Results(1)A total of 3167 effective cases of CHD were included in this study.Male patients(2000 cases,63.15%)were predominated in comparison with the female patients(1167 cases,36.85%)and most of the patients were in the age group of 50-69 years(1899 cases;59.96%).(2)A total of 34 TCM syndrome types were involved,and the top commonly-seen 3 types were deficiency of both spleen and kidney(570 cases),heart and kidney insufficiency(505 cases),and qi stagnation and blood stasis(494 cases).(3)A total of 6 diseases-location syndrome elements were involved,among which,kidney(1394 cases),heart(1186 cases)and spleen(911 cases)were the 3 most frequently-seen elements.A total of 9 disease-nature syndrome elements were involved,and the top 4 were qi deficiency(604 cases),blood stasis(538 cases),qi stagnation/qi obstruction(497 cases),and yin deficiency(495 cases).(4)After statistical counting,a total of 204 Chinese herbal medicines were obtained,and the top 5 herbs used frequently were Radix Astragali(1719 times),Rhizoma Corydalis(1480 times),Rhizoma Atractylodis Macrocephalae(1311 times),Bulbus Allii Macrostemonis(1113 times),and Radix Codonopsis(1063 times).The medication rules for CHD patients based on the distribution of syndrome types showed that the frequently used herbs in the descending order for the most common type of deficiency of both spleen and kidney were Radix Astragali,Rhizoma Corydalis,Radix Codonopsis,Rhizoma Atractylodis Macrocephalae,Bulbus Allii Macrostemonis,Rhizoma Curculigins,Rhizoma Chuanxiong,and Radix Glycyrrhizae Preparata.Conclusion Qi deficiency is the core pathogenesis throughout the course of CHD,insufficiency of the heart,spleen,and kidney is the main cause,and qi stagnation and blood stasis are the important driving factors in the development of the disease.During the treatment of CHD,the basic principle of supporting healthy qi to eliminate pathogens should be adhered to the main focus on replenishing qi and nourishing the heart,accompanying by using the herbs for activating blood,eliminating stasis and removing phlegm,and often combined with herbs of tonics,regulating qi and activating blood.
作者
庄震坤
李颖
陈宏昱
陈奕群
张伟健
程红
ZHUANG Zhen-Kun;LI Ying;CHEN Hong-Yu;CHEN Yi-Qun;ZHANG Wei-Jian;CHENG Hong(The Forth Clinical Medical School of Guangzhou University of Chinese Medicine,Shenzhen 518033 Guangdong,China;Nanhai District People’s Hospital,Foshan 528200 Guangdong,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2022年第10期2219-2225,共7页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
国家自然科学基金项目(编号:82104746)
广东省中医药局科研项目(编号:20221354)
深圳市医疗卫生三名工程项目(编号:SZSM201612033)。
关键词
冠心病
数据挖掘
中医证型
证素
用药规律
补气养心
活血祛瘀化痰
coronary heart disease(CHD)
data mining
traditional Chinese medicine(TCM)syndrome types
syndrome elements
medication rules
replenishing qi and nourishing heart
activating blood
eliminating stasis and removing phlegm
