基于关联规则和隐结构模型的中医药治疗脓毒症心肌损伤的用药规律

Application of traditional Chinese medicine in the treatment of myocardial injury in sepsis based on association rule and hidden structure model

关键词:  脓毒症  心肌损伤  关联规则  隐结构  用药规律

Key words:  myocardial injury in sepsis  association rule  hidden structure  drug use rule

摘要:

[目的] 探讨中医药治疗脓毒症心肌损伤的用药规律及中医证型，为临床治疗脓毒症心肌损伤提供中医辨证思路和依据。[方法] 计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库，检索从建库至2023年6月关于脓毒症心肌损伤临床治疗的文献，将文献中的方剂录入Excel，规范中药名，统计药物频次、功效、药性、药味和归经，用SPSS Modeler18.0将频次 ≥ 4的中药用Apriori算法建立模点，得到药物之间的关联规则。利用Lantern5.0软件对频次 ≥ 4的药物进行隐结构及综合聚类分析。[结果] 纳入文献47篇，方剂48首，涉及中药98味，频次 ≥ 4的中药共33味，频次最高的是前五位是丹参、黄芪、当归、川芎、大黄，关联规则分析共4条中强度关联规则，其中，置信度最高的为丹参和黄芪这个组合。隐结构模型分析包含6个隐变量。[结论] 脓毒症心肌损伤的治疗以活血化瘀药为主，根据病情加减清热药和补虚药。通过以方测证，推测脓毒症心肌损伤代表证候为气阴两虚证、毒热瘀阻证、阳气暴脱证、气虚血瘀证，可见病机是本虚标实。

Abstract:

[Objective] To explore the rule of medicine and syndrome type of traditional Chinese medicine (TCM) in the treatment of myocardial injury in sepsis,and to provide ideas and basis for TCM syndrome differentiation in the clinical treatment of myocardial injury in sepsis. [Methods] The literatures on the clinical treatment of myocardial injury in sepsis were searched from CNKI,Wanfang,VIP and SinoMed by computer from the establishment of the database to June 2023. The prescriptions in the literatures were recorded into Excel,the names of TCM were standardized,and the frequency,efficacy,drug properties,drug taste and channel conversion were counted. Apriori algorithm was used to establish model points for Chinese medicine with frequency ≥ 4 by SPSS Model 18.0,and the association rules between drugs were obtained. The hidden structure and comprehensive cluster analysis of drugs with frequency ≥ 4 were carried out by Lantern4.3 software. [Results] 47 literatures were included,including 48 prescriptions,involving 98 TCM flavors,33 TCM flavors with frequency ≥ 4,the top five with the highest frequency were Salviorrhiza,Astragalus,Angelica sinensis,Ligustrum Chuanxiong and Ahubarb,and there were 4 medium intensity association rules in association rule analysis,among which the combination of Salviorrhiza and Astragalus had the highest confidence. The analysis of hidden structure model includes 6 hidden variables. [Conclusion] The main treatment of myocardial injury in sepsis is to promote blood circulation and remove blood stasis,and to add heat-clearing drugs and vacuum-tonifying drugs according to the condition. By means of the prescription test,it is speculated that the representative syndroms of myocardial injury in sepsis are deficiency of qi and yin,stasis of toxic heat,sudden withdrawal of yang and deficiency of qi and blood stasis,it can be seen that the pathogenesis of the disease is deficiency of the primary symptom.