摘要
目的基于医院信息系统(hospital information system,HIS)数据,探讨真实世界亚急性甲状腺炎辨治规律,为临床用药提供参考。方法采用古今云医案平台数据挖掘系统分析湖北省中医院2017年1月至2019年12月临床第一诊断为亚急性甲状腺炎的患者数据,总结归纳其辨治特点及用药规律。结果纳入病案223例,累计处方712张。涉及25种证型,164个症状,高频症状聚类后得到外感风热证、肝经郁热证、痰瘀化热证、痰瘀互结证、痰热内扰证等证型的核心症状组合。证型拆分得到7个实性病机证素(火热、气滞、痰湿、血瘀、外风、外热、外寒),4个虚性病机证素(阴虚、气虚、阳虚、血虚)及6个病位证素(肝、肺、肾、脾、心、胃)。712张处方包含282味中药,以性味苦寒、辛温,归肝经药多见,功效以清热药、补虚药、活血化瘀药、理气药、解表药为主。通过关联规则得到药对16对,对高频药物聚类分析得到6类核心药物组合,分别体现了疏肝清热,透邪解表,化痰散结,解毒利咽,凉血活血等治法。结论本研究中亚急性甲状腺炎以肝经郁热证最为常见,其次为痰瘀化热证、外感风热证、痰瘀互结证、痰热内扰证,遣方用药既要疏肝、清热,又要祛瘀、化痰,对症加减,标本兼治。
Objective To analyze the rules of differentiation and treatment of subacute thyroiditis in the real world based on the hospital information system(HIS).Methods The date of this study was based on Hubei Provincial Hospital of Traditional Chinese Medicine from January 2017 to December 2019.Descriptive analysis and association rules were used to research the characteristics of differentiation and treatment.Results There were 223 medical records and 712 prescriptions,involving 25 types of syndromes and 164 symptoms.The core of the syndrome types such as wind-heat external attack,liver meridian stagnation-heat,phlegm stasis-reducing heat,phlegm stasis mutual accumulation,phlegm-heat internal disturbance.There were 7 solid pathogenesis factors(heat,qi stagnation,phlegm dampness,blood stasis,external wind,external heat,and external cold),and 3 deficiency pathogenesis factors(yin deficiency,qi deficiency,yang deficiency,blood deficiency)and 6 syndrome elements(liver,lung,kidney,spleen,heart,stomach).There were 282 herbs totally.most commonly used for bitter cold,pungent warmth,and liver meridian medicines.The main effects were heat-clearing medicines,tonic medicines,blood stasis-activating medicines,qi regulating medicines,and anti-epidermic medicines.According to association rules,16 pairs of medicines were obtained.Cluster analysis obtains 6 types of core medicine combinations,which respectively reflect the treatment methods of soothing of the liver,clearing away heat,clearing away pathogen,resolving phlegm,detoxification,and cooling down blood circulation and activating blood circulation.Conclusion Syndrome of liver meridian is the most common syndrome in this study,followed by syndrome of phlegm stasis to dissipate heat,external wind heat,phlegm accumulating with stagnation,internal disturbance of phlegm heat.The application of clinical prescription should not only smooth liver and clearing heat,but also remove blood stasis and reduce phlegm,modified according to different syndrome,and treating both symptoms and root
作者
熊梦欣
向楠
周亚娜
曾明星
牧亚峰
邓阿黎
赵玉凤
张慧丰
王凯宁
蔡生兴
Xiong Mengxin;Xiang Nan;Zhou Yana;Zeng Mingxing;Mu Yafeng;Deng Ali;Zhao Yufeng;Zhang Huifeng;Wang Kai'ning;Cai Shengxing(Clinical College of Traditional Chinese Medicine,Hubei University of Chinese Medicine,Wuhan 430065,China;The First Clinical College,Hubei Provincial Hospital ofTCM,Wuhan 430074,China;Medical Affairs Department,The Affiliated Hospital of Hubei University of Chinese Medicine,Wuhan 430074,China;College of Basic Medicine,Hubei University of Chinese Medicine,Wuhan 430074,China;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Chinese Medicine Data Center,China Academy of Chinese Medical Sciences,Beijing 100700,China)
出处
《世界科学技术-中医药现代化》
CSCD
北大核心
2021年第6期1821-1828,共8页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
国家科学技术部中国生物技术发展中心国家重点研发计划项目(2017YFC1703503):病案首页数据采集与中医医疗质量评价系统的创新研究,负责人:赵玉凤
国家中医药管理局全国名老中医传承工作室项目(国中医药办人教函[2018]134号):陈如泉全国名老中医药传承工作室,负责人:陈继东
湖北省卫生和计划生育委员会(鄂卫生计生通报[2018]15号):湖北中医名师向楠工作室,负责人:向楠。
