基于隐结构模型和关联分析探究射血分数保留心力衰竭中医证候特征

Exploring the syndrome regularity of HFpEF in traditional Chinese medicine based on latent structure model and association rules

关键词:  HFpEF  隐结构模型  关联规则  中医证候  数据挖掘

Key words:  HFpEF  latent structure  association rule  TCM syndromes  data mining

摘要:

[目的] 探索射血分数保留的心力衰竭（HFpEF）的中医证候分布特征，为临床个体化辨证施治提供参考。[方法] 采集天津市内6家三甲医院心内科的HFpEF患者的四诊信息，构建回顾性证候数据库。运用Lantern5.0软件和双步隐树分析算法构建隐结构模型，综合聚类后提取HFpEF常见证候。借助SPSS Modeler18.0 的Apriori 关联分析和Cytoscape（3.10.2）的网络分析功能，探索HFpEF证素分布关系。综合SymMap数据库和网络药理学的证候、症状和中药信息，构建系统的HFpEF疾病-证候-症状-中药网络。[结果] 共纳入364 例HFpEF患者，收集到72个症状、7个病位证素和14个病性证素，依据度中心性排列的病位证素分别为心（40）、胃（32）、脾（32）、肺（30）、肾（28）和肝（28），病性证素分别为气虚（36）、血瘀（36）、痰（34）、阴虚（28）、水停（26）、湿（26）、阳虚（24）、热（24）和寒（20）。对隐结构模型和Apriori 关联分析得出的中医证型取交集后发现HFpEF的5种常见中医证型分别为心肺气虚证、心肾阳虚证、心血瘀阻证、气虚血瘀证和痰瘀互结证。[结论] 综合隐结构模型和关联规则的结果，最终归纳出HFpEF的6个病位证素、9个病性证素和5个中医证候，明确了HFpEF本虚标实的证候特征和“虚-瘀-水”的病理演变模式，可为HFpEF的中医临床个性化诊疗方案提供证候学支撑。

Abstract:

[Objective] To explore the distribution characteristics of traditional Chinese medicine（TCM） syndromes in HFpEF and provide references for individualized syndrome differentiation and treatment in clinical practice. [Methods] Diagnostic information was collected from HFpEF patients in the cardiology departments of six tertiary hospitals in Tianjin，forming a retrospective syndrome database. Lantern 5.0 software and a two-step hidden tree analysis algorithm were used to construct a latent structural model，and common syndromes in HFpEF were extracted through comprehensive clustering. The distribution relationships of HFpEF syndrome elements were analyzed using Apriori association analysis in SPSS Modeler 18.0 and network analysis in Cytoscape（3.10.2）. Furthermore，integrating syndrome，symptom，and herbal medicine information from the SymMap database and network pharmacology，a systematic HFpEF disease-syndrome-symptom-herb network was constructed. [Results] A total of 364 HFpEF patients were included，with 72 symptoms，7 disease-location syndrome elements，and 14 disease-nature syndrome elements collected. The disease-location syndrome elements，ranked by degree centrality，were the heart（40），stomach（32），spleen（32），lung（30），kidney（28），and liver（28）. The disease-nature syndrome elements were qi deficiency（36），blood stasis（36），phlegm（34），yin deficiency（28），water retention（26），dampness（26），yang deficiency（24），heat（24），and cold（20）. By intersecting the results of the latent structural model and Apriori association analysis，five common TCM syndromes of HFpEF were identified：heart-lung qi deficiency syndrome，heart-kidney yang deficiency syndrome，heart blood stasis syndrome，qi deficiency-blood stasis syndrome，and phlegm-blood stasis syndrome. [Conclusion] By integrating the latent structural model and association rules，six disease-location syndrome elements，nine disease-nature syndrome elements，and five TCM syndromes of HFpEF were identified. The study clarified the syndrome characteristics of underlying deficiency with superficial excess in HFpEF and revealed its pathological evolution pattern of “deficiency-stasis-water accumulation”. These findings provide a syndrome-based foundation for individualized TCM clinical treatment strategies for HFpEF.