非酒精性脂肪肝与单纯性肥胖中医治疗方剂用药规律对比分析.pdf
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1、804献iverCompSN浙江中医药大学学报2 0 2 3年7 月第47 卷第7 期非酒精性脂肪肝与单纯性肥胖中医治疗方剂用药规律对比分析唐允婷1,2陈宇彬吴小文1林洁程亚伟1,21.广州中医药大学附属海南中医院海口5700002.海南省中医院治未病中心摘要:目的采用数据挖掘分析对比中医药治疗非酒精性脂肪肝及单纯性肥胖的用药特点及组方规律。方法检索中国知网、万方数据知识服务平台、维普中文期刊服务平台、中国生物医学文献服务系统19 8 4年1月至2 0 2 1年11月所有中医药治疗上述两种疾病的临床文献,筛选文献和提取资料后,应用中医传承计算平台V3.0及SPSS23.0软件对方药进行频次统计
2、、关联规则分析及系统聚类分析。结果分别纳入治疗非酒精性脂肪肝和单纯性肥胖的方剂2 51首和2 0 5首,两种疾病在使用补虚药、活血化痧药时差异有统计学意义(P0.01),非酒精性脂肪肝用药多入脾、肝、肺经,特色用药有郁金、虎杖、赤芍、姜黄,关联规则分析得到核心药对是“山楂-泽泻”,聚类分析获得新方的主要功效为健脾祛湿、活血化瘀、疏肝清热。单纯性肥胖用药多入脾、胃、肺经,特色用药有桂枝、生姜,关联规则分析得到核心药对是“茯苓-白术”,聚类分析获得新方的主要功效为健脾祛湿、活血化瘀、行水泄热。结论中医药治疗非酒精性脂肪肝及单纯性肥胖的用药存在共性,两者均重视健脾祛湿,均以泽泻汤为基础进行加减,差异
3、方面,前者以健脾祛湿与活血化瘀并重,佐以疏肝、清热;后者以健脾祛湿为主,佐以活血、清热、疏肝等。关键词:非酒精性脂肪肝;单纯性肥胖;中医传承计算平台;数据挖掘;中医;用药规律;方剂分析中图分类号:R575.5+2文献标志码:A文章编号:10 0 5-550 9(2 0 2 3)0 7-0 8 0 4-0 9D0I:10.16466/j.issn1005-5509.2023.07.017arative Analysis on Composition Principles of Traditional Chinese Medicine Prescriptions for Non-alcoholic
4、 Fatty LDisease and Simple Obesity TANG Yunting2,CHEN Yubin,WU Xiaowen,et al 1.Hainan Hospital of Traditional ChineseMedicine Affiliated to Guangzhou University of Chinese Medicine,Haikou(570000),China 2.Center for Preventive Treatment ofDisease,Hainan Traditional Chinese Medicine HospitalAbstract:O
5、bjective To analyze and compare the characteristics and prescription rules of traditional Chinese medicine in the treatment ofnon-alcoholic fatty liver disease and simple obesity by data mining.Methods Search China National Knowledge Infrastructure(CNKI),WanFang Data Knowledge Service Platform(Wanfa
6、ng Database),VIP Chinese Scientific Journal Database(VIP),China Biology Medicinedisc(CBMdisc)for all the clinical literatures of traditional Chinese medicine in the treatment of the above two diseases from January 1984 toNovember 2021.After screening the literatures and extracting data,the frequency
7、 statistics,association rule analysis and systematiccluster analysis were carried out by using the Traditional Chinese Medicine Inheritance Computer System V3.0 and SPSS 23.0 software.Results Totally 251 and 205 prescriptions for the treatment of non-alcoholic fatty liver disease and simple obesity
8、were includedrespectively,and there was a statistically significant difference in the use of tonic and blood-activating and stasis-removing drugs for thetwo diseases(P0.01).Most of the drugs for non-alcoholic fatty liver disease belonged to the spleen,liver and lung meridians,and thecharacteristic d
9、rugs were Curcumae Radix,Polygoni Cuspidati Rhizoma et Radix,Paeoniae Radix Rubra and Curcumae Longae Rhizoma.According to the analysis of association rules,the core drug pair was Crataegi Fructus-Alismatis Rhizoma.Cluster analysis showed that themain effects of the new prescription were tonifying t
10、he spleen and removing dampness,invigorating blood circulation and removing bloodstasis,soothing the liver and clearing heat.Most of the drugs for simple obesity belonged to the spleen,stomach and lung meridians,andthe characteristic drugs are Cinnamomi Ramulus and Zingiberis Rhizoma Recens.Accordin
11、g to the analysis of association rules,the coredrug pair was PoriaCocos-Atractylodis Macrocephalae Rhizoma.Cluster analysis showed that the main effects of the new prescription weretonifying the spleen and removing dampness,invigorating blood circulation and removing blood stasis,promoting water cir
12、culation andreleasing heat.Conclusion There are similarities in the use of traditional Chinese medicine in the treatment of non-alcoholic fatty liverdisease and simple obesity.Both attach importance to tonifying the spleen and removing dampness,and both add and subtract on the basisof Zexie Decoctio
13、n.In terms of differences,the former focuses on tonifying the spleen and removing dampness,invigorating bloodcirculation and removing blood stasis,supplemented by soothing the liver and clearing heat;while the latter is mainly treated with drugs fortonifying the spleen and removing dampness,suppleme
14、nted by invigorating blood circulation,clearing heat,soothing the liver and so on.基金项目:海南省基础与应用基础研究计划(自然科学领域)高层次人才项目(2 0 19 RC383);海南省省级中医重点专科建设项目(琼卫中医函【2 0 19 J6号);海南省重大科技计划项目(ZDKJ2021034)Fund projects:Hainan Provincial Basic and Applied Basic Research Project(Natural Science Field)High-Level Talen
15、t Project(2019RC383);Construction Project of Key Specialties of Traditional Chinese Medicine Preventive Treatment of Disease in HainanProvince(Q.W.TCM.H.20196);Hainan Province Science and Technology Special Fund Project(ZDKJ2021034)通信作者:程亚伟,E-mail:805性肥胖traditining;Key浙江中医药大学学报2 0 2 3年7 月第47 卷第7 期wo
16、rds:non-alcoholic fatty liver disease;simple obesity;Traditional Chinese Medicine Inheritance Computer System;data mional Chinese medicine;medication rules;prescription analysis非酒精性脂肪肝,现称为代谢相关脂肪性肝病,是一种除外酒精因素引起的肝内脂肪过量堆积的疾病,其发病率不断攀升,已经超过病毒性肝炎,成为世界范围内的头号慢性肝病 2。本病在中医上曾被归人“胁痛”“痰浊”“积聚”的范畴,后为规范命名,被国家中医药管理局
17、定名为“肝癖”3。单纯性肥胖是指除外代谢性、外伤或其他原因引起的体脂沉淀或分布失常,在全球范围内其患病率亦逐年攀升4。中医方面,单纯性肥胖被归人“水肿”“痰症”“肥人”“脂人”“膏人”“肥满”等范畴 5。单纯性肥胖为非酒精脂肪肝的重要危险因素,这两种疾病既可单独出现,也可合并发生6,在中医理论方面均与痰浊密切相关 7-8,中医药治疗这两种疾病有着独特的效果,因此对这两种疾病的用药规律进行比较分析,对于指导临床精准用药有着重要的参考价值。本文借助中医传承计算平台V3.0收集现代文献中治疗非酒精性脂肪肝和单纯性肥胖的方剂,并结合SPSS23.0软件进行对比分析,以期明确区分两种疾病的病因病机和治则
18、治法,为指导临床精准用药提供参考。1资资料和方法1.1资料来源选择中国知网、万方数据知识服务平台、维普中文期刊服务平台、中国生物医学文献服务系统,对19 8 4年1月至2 0 2 1年11月发表的,与非酒精性脂肪肝、单纯性肥胖相关的文献进行检索,采用“非酒精性脂肪肝”“代谢相关脂肪性肝病”“单纯性肥胖”“肥胖”等主题词与“中医”“中药”等主题词搭配进行精确检索,经筛选后共得到非酒精性脂肪肝相关方剂2 51首、单纯性肥胖相关方剂2 0 5首。1.2方法1.2.1纳人标准(1)含有中医内服方剂的中医或中西医结合辨证论治非酒精性脂肪肝、单纯性肥胖的文献;(2)含有中医内服方剂的专家治疗非酒精性脂肪肝
19、、单纯性肥胖的经验介绍和医案文献。1.2.2排除标准(1)方药组成或剂量不详者;(2)少数民族医药文献;(3)中医外治方药;(4)疑似重复发表文献,保留其中之一;(5)综述;(6)合并其他疾病者;(7)动物实验文献;(8)基本方后涉及加减用药者,舍弃加减药物,保留基本方。1.2.3中药名称的规范参考2 0 15年版中国药典与中药学9,对中药名称进行整理规范,如当归头、当归身、当归尾录为当归,焦三仙拆分为麦芽、神曲、山楂,川军、酒军、生军等录为大黄等。1.2.4方剂录人与核对由专人整理上述筛选出的方剂,并逐条录人到Excel2019软件中,随后双人对数据进行核对,核对无误后将数据导入中医传承计算
20、平台V3.0中。1.2.5数据分析在中医传承计算平台V3.0数据分析栏目中,分别点击统计分析与方剂分析,对两组数据进行频次统计、关联规则分析、聚类分析(k-means算法和回归模型相统一)等。运用SPSS23.0软件进行统计学分析,两种疾病的用药分类差异比较采用检验,以P0.05),而在寒、温、平和热性药的使用方面,差异有统计学意义(P0.05),而在苦、甘、酸和咸味药的使用方面,差异有统计学意义(P0.05),而归脾、肝和肾经等的用药频率差异有统计学意义(P0.05)。见表3。8064唐允婷浙江中医药大学学报2 0 2 3年7 月第47 卷第7 期表1两种疾病用药四气分析非酒精性脂肪肝(n=
21、2562)单纯性肥胖(n=2013)统计量四气累计频次频率(%)累计频次频率(%)x值P值寒109742.8261230.4074.260.001温84232.8682340.8831.320.001平52720.5747823.756.630.01863.36723.580.160.686热100.39281.3913.700.001表2两种疾病用药五味分析非酒精性脂肪肝(n=2562)单纯性肥胖(n=2013)统计量五味累计频次频率(%)累计频次频率(%)x值P值苦144835.4394430.8616.410.001132832.49116938.2225.20.001辛酸成82720.
22、2366821.842.720.13338.151976.447.430.0061513.69812.656.10.01表3两种疾病用药归经分析非酒精性脂肪肝(n=7012)单纯性肥胖(n=5633)统计量归经累计频次频率(%)累计频次频率(%)X值P值脾145120.691.31823.4013.360.001肝1 40320.0178813.9979.010.001肺99714.2286615.373.320.069胃98514.0588015.626.160.013心72410.335259.323.550.06肾5287.535219.2512.140.001胆3334.751352.
23、448.50.05),而补虚药、活血化痧药的用药频率差异有统计学意义(P0.01)见表6。表4非酒精性脂肪肝常用药物序号药物频次频率(%)序号药物频次频率(%)1山楂16164.1419积壳4015.942泽泻15260.5620薏苡仁4015.943茯苓14959.3621川芎3614.344丹参14356.9722赤芍3614.345柴胡12851.0023党参3313.156白术12349.0024灸甘草3112.357郁金9236.6525苍术3011.958决明子9136.2526当归2811.169陈皮7831.0827姜黄259.9610白芍7329.0828香附259.9611
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