摘要
目的基于痛风(gout)真实世界研究数据,对不同证型痛风患者的中医证候疗效评价、尿酸达标率和安全性进行统计学分析,总结痛风不同证型下中医治疗的证治规律。方法回顾性统计3287例痛风患者的临床数据,然后进行中医药治疗疗效、安全性、中药关联规则和系统聚类分析。结果最终符合纳入标准的患者有330例,按辨证划分为湿热蕴结证224例、痰瘀互结证67例和脾虚湿阻证39例。3种证型在性别、体质量指数(body mass index,BMI)、血尿素氮(blood urea nitrogen,BUN)、血尿酸(blood uric acid,BUA)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(Creactive protein,CRP)、中医证候疗效评价、尿酸达标率和安全性上差异无统计学意义(P>0.05)。关联规则和聚类分析显示湿热蕴结证痛风常用土茯苓、薏苡仁、苍术等中药治疗,并形成苍术-黄柏、土茯苓-威灵仙等药物组合和苍术、黄柏、川牛膝、土茯苓、薏苡仁这一新核心药方;痰瘀互结证痛风常用土茯苓、薏苡仁、茯苓等中药,形成薏苡仁-秦艽、土茯苓-威灵仙等药物组合和新核心药方为山茱萸、葛根、土茯苓、独活、防风、杜仲、威灵仙、赤芍、地龙、秦艽、川牛膝、薏苡仁、绵萆薢;脾虚湿阻证痛风常用茯苓、苍术、土茯苓等药物和苍术-威灵仙、茵陈-虎杖等药物组合,并形成伸筋草、茵陈、虎杖、陈皮、茯苓这一新核心药方。结论在多中心真实世界研究背景下,系统阐述了中医药治疗痛风的中医证候疗效评价、安全性和证治规律,为中医药辨证论治痛风提供了一定的指导和临床应用价值。
Objective Based on the real-world research data of gout,the evaluation of traditional Chinese medicine(TCM) syndrome efficacy,uric acid standard rate and safety of patients with different syndrome types of gout were statistically analyzed,and the syndrome and treatment rules of TCM treatment under different syndrome types of gout were summarized.Methods The clinical data of 3287 patients with gout were analyzed retrospectively,and then therapeutic effect,safety,association rules of TCM and systematic cluster analysis were carried out.Results A total of 330 patients met the inclusion criteria,and were divided into 224cases of dampness-heat accumulation syndrome,67 cases of phlegm and blood stasis syndrome,and 39 cases of spleen deficiency and dampness retention syndrome.There were no significant differences in gender,body mass index(BMI),blood urea nitrogen(BUN),blood uric acid(BUA),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),evaluation of TCM syndrome curative effect,uric acid standard rate and safety among the three syndrome types(P > 0.05).Association rules and cluster analysis showed that the damp-heat accumulation syndrome of gout were commonly treated with TCM,such as Tufuling(Smilacis Glabrae Rhizoma,SGR),Yiyiren(Coicis Semen,CS),and Cangzhu(Atractylodis Rhizoma,AR),and the combination of herbs such as AR-Huangbai(Phellodendri Chinensis Cortex,PCC),SGR-Weilingxian(Clematidis Radix et Rhizoma,CRR),and the new core prescription were AR,PCC,Chuanniuxi(Cyathulae Radix,CR),SGR and CS;The phlegm and blood stasis syndrome of gout were commonly treated with TCM,such as SGR,CS and Fuling(Poria),forming drug combinations such as CS-Qinjiao(Gentianae Macrophyllae Radix,GMP),SGR-CRR,and the new core prescription were Shanzhuyu(Corni Fructus),Gegen(Puerariae Lobatae Radix),SGR,Duhuo(Angelicae Pubescentis Radix),Fangfeng(Saposhnikoviae Radix),Duzhong(Eucommiae Cortex),CRR,Chishao(Paeoniae Rubra Radix),Dilong(Pheretima),GMP,CR,CS,Mianbixie(Dioscoreae Septemlobae Rhizoma);The spleen deficiency and dampness
作者
姜平
杜星辰
章渊源
姜婷
汪荣盛
朱琦
关凤媛
鲁盈
苏晓
姜洪泽
李鸿斌
方勇飞
赵恒立
彭江云
高明利
苏励
何方
陶庆文
胡春蓉
李鹏
李泽光
朱跃兰
古英
姜泉
张明
张剑勇
薛愉
何东仪
JIANG Ping;DU Xing-chen;ZHANG Yuan-yuan;JIANG Ting;WANG Rong-sheng;ZHU Qi;GUAN Feng-yuan;LU Ying;SU Xiao;JIANG Hong-ze;LI Hong-bin;FANG Yong-fei;ZHAO Heng-li;PENG Jiang-yun;GAO Ming-li;SU Li;HE Fang;TAO Qing-wen;HU Chun-rong;LI Peng;LI Ze-guang;ZHU Yue-lan;GU Ying;JIANG Quan;ZHANG Ming;ZHANG Jian-yong;XUE Yu;HE Dong-yi(Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 200052,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Yingkou Hospital of Traditional Chinese Medicine,Yingkou 115002,China;Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Traditional Chinese Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Affiliated Hospital of Inner Mongolia Medical University,Hohhot 750306,China;Shandong Haiyang Hospital of Traditional Chinese Medicine,Haiyang 265199,China;Chongqing Southwest Hospital,Chongqing 400038,China;Yantai Hospital of Traditional Chinese Medicine,Yantai 264013,China;Yunnan Hospital of Traditional Chinese Medicine,Kunming 650021,China;Liaoning Hospital of Traditional Chinese Medicine,Shenyang 110033,China;Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Community Health Service Center of Xinjing Town Street,Changning District,Shanghai 200336,China;China-Japan Friendship Hospital,Beijing 100029,China;Chongqing Ninth People’s Hospital,Chongqing 400799,China;Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine,Urumqi 830099,China;The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,Harbin 150040,China;Oriental Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100078,China;Sichuan Mianyang Hospital of Traditional Chinese Medicine,Mianyang 621053,China;Guang’anmen Hospital of China Academy of Chinese Medical Sciences,Beijing 100053,China;Yueyang Hospital of Integrate
出处
《中草药》
CAS
CSCD
北大核心
2022年第24期7816-7830,共15页
Chinese Traditional and Herbal Drugs
基金
国家中医药管理局区域中医(专科)诊疗中心建设项目-风湿病科(2018-2022)
国家中医药管理局国家中医药循证医学研究建设项目:基本中医药循证能力建设(2019-2021)
上海市卫健委华东片区中西医结合关节病专科联盟项目(2021.12—2023.12)
上海申康医院发展中心重大疾病多中心临床研究项目:痛风和高尿酸血症治疗新策略(SHDC2020CR1013B)。
关键词
痛风
真实世界
证治规律
数据挖掘
关联规则
系统聚类分析
gout
real world
rule of syndrome and treatment
data mining
association rule
system cluster analysis
