来源：风湿病与关节炎,2017,6（11）:11-16,23.

基于关联规则挖掘健脾化湿、清热通络中药对骨关节炎

患者血小板参数的影响（临床研究）

齐亚军¹，刘　健²，文建庭^１，万　磊²，忻　凌²，方妍妍¹，董文哲¹

　　【摘　要】目的：采用关联规则技术挖掘分析刘健教授运用健脾化湿、清热通络中药治疗骨关节炎的用药规律，为临床辨证论治骨关节炎提供依据。方法：整理安徽中医药大学第一附属医院风湿免疫科2012年6月至2016年12月电子病历录入的诊断为骨关节炎患者的资料，采用SPSS 21.0、SPSS Clementine 11.1软件Aprior模块和统计学方法分析中药、中成药及外用药对患者实验室指标的影响。结果：①共纳入骨关节炎患者1970例，经健脾化湿、清热通络中药治疗后，患者血小板参数、炎症指标及免疫指标等均有所改善。②本院风湿免疫科治疗骨关节炎常用药物有5大类：健脾化湿药、祛风除湿药、活血化瘀药、清热解毒药和补益肝肾药。根据每类药物使用频次前5位提取，健脾化湿药为茯苓、陈皮、泽泻、薏苡仁、山药，祛风除湿药为威灵仙、烫狗脊、豨莶草、伸筋草、独活，活血化瘀药为丹参、桃仁、红花、鸡血藤、牛膝，清热解毒药为蒲公英、白花蛇舌草、黄芩、黄柏、知母，补益肝肾药为杜仲、桑寄生、熟地黄、枸杞子、千年健。③设关联规则支持度为20%，置信度为70%，口服中药及中成药分别与实验室指标关联，关联度最高的前5位，蒲公英、丹参、薏苡仁关联于血小板计数（PLT）指标下降，薏苡仁、泽泻、独活关联于免疫球蛋白IgG指标下降，丹参、鸡血藤、黄芩关联于超敏C-反应蛋白指标下降，蒲公英、威灵仙关联于α1-酸性蛋白指标下降，黄芩、丹参、鸡血藤关联于三酰甘油指标下降，新风胶囊关联于PLT指标下降，新风胶囊、芙蓉膏关联于红细胞沉降率、IgG、补体C3、补体C4指标下降。④由聚类分析得出，聚1类丹参、狗脊、桃仁、红花，聚2类茯苓、陈皮、山药、薏苡仁，聚3类蒲公英、白花蛇舌草、豨莶草、威灵仙、泽泻，聚4类知母、黄柏、熟地黄、枸杞子，聚5类桑寄生、牛膝、伸筋草、黄芩，聚6类杜仲、独活，聚7类鸡血藤。结论：骨关节炎活动期患者实验室指标及血小板参数处于异常活跃状态，中药治疗可以改善患者实验室指标，减轻免疫炎症反应，其中尤以健脾化湿、清热通络中药为主。

　　【关键词】　骨关节炎；血小板参数；健脾化湿；清热通络；关联规则；聚类分析

Mining the Effect of Chinese Medicine of Invigorating Spleen and Removing Dampness and Clearing Away Heat and Dredging Collateral on Platelet Parameters in Patients with Osteoarthritis based on Association Rules 

QI Ya-jun,LIU Jian,WEN Jian-ting,WAN Lei,XIN Ling,FANG Yan-yan,DONG Wen-zhe

　　【ABSTRACT】Objective:To mine the medication rules of professor LIU Jian's using Chinese medicinal of invigorating spleen and removing dampness and clearing away heat and dredging collateral to treat osteoarthritis,in order to provide the basis for clinical syndrome differentiation and treatment of osteoarthritis.Methods:Data（from June 2012 to December 2016）of patients with osteoarthritis in the electronic medical records of Rheumatology Department of the First Affiliated Hospital of Anhui University of Chinese Medicine were collected.Aprior modules in soft wares of SPSS 21.0 and SPSS Clementine 11.1 and statistical methods were used to analyze the effects of Chinese medicine,Chinese patent medicine and external medicine on laboratory indicators of patients.Results:① There were a total of 1970 patients in the study.After treatment of invigorating spleen and removing dampness and clearing away heat and dredging collateral with Chinese medicine,platelet parameters,inflammatory index and immune index of them were improved.②There are five categories of  commonly used Chinese medicine in this hospital for treatment of osteoarthritis:invigorating-spleen and removing-dampness medicine,wind-damp-dispelling medicine,blood-activating and stasis-resolving medicine,heat-toxin-clearing medicine and liver-kidney tonifying medicine.According to frequency,the five top medicines of each category are as follows:invigorating-spleen and removing-dampness medicine including Fuling（Poria）,Chenpi（Pericarpium Citri Reticulatae）,Zexie（Rhizoma Alismatis）,Yiyiren（Semen Coicis）,and Shanyao （Rhizoma Dioscoreae）;wind-damp-dispelling medicine including Weilingxian（Radix et Rhizoma Clematidis）,Tanggouji（cibot rhizome）,Xixiancao（Herba Siegesbeckiae）,Shenjincao（Herba Lycopodii）,and Duhuo（Radix Angelicae Pubescentis）;blood-activating and stasis-resolving medicine including Danshen（Radix et Rhizoma Salviae Miltiorrhizae）,Taoren（Semen Persicae）,Honghua（Flos Carthami）,Jixueteng（Caulis Spatholobi）,and Niuxi（Radix Achyranthis Bidentatae）;heat-toxin-clearing medicine including Pugongying（Herba Taraxaci）,Baihuasheshecao（Herba Hedyotis Diffusae）,Huangqin（Radix Scutellariae）,Huangbai（Cortex Phellodendri Chinensis）,and Zhimu（Rhizoma Anemarrhenae）;liver-kidney tonifying medicine including Duzhong（Cortex Eucommiae）,Sangjisheng（Herba Taxilli）,Shudihuang（Radix Rehmanniae Praeparata）,Gouqizi（Fructus Lycii）,and Qiannianjian（Rhizoma Homalomenae）.③Given that the support of association rules was 20%,and the confidence level was 70%,oral administration of Chinese medicine and Chinese patent medicine were respectively correlated with the laboratory index.Platelet count correlated with Pugongying,Danshen and Yiyiren decreased.Immunoglobulin IgG index correlated with Yiyiren,Zexie and Duhuo decreased.High sensitive C-reactive protein correlated with Danshen,Jixueteng and Huangqin decreased.Α1-AGP index correlated with Pugongying and Weilingxian decreased.TG index correlated with Huangqin,Danshen and Jixueteng decreased.PLT index correlated with Xinfeng Jiaonang（新风胶囊）decreased.Erythrocyte sedimentation rate,IgG,complement C3,and complement C4 index correlated with Xinfeng Jiaonang and Furong Gao（芙蓉膏）decreased.④ Acorrding to cluster analysis,Cluster 1 included Danshen,Gouji,Taoren and Honghua;Clust 2 included Fuling,Chenpi,Shanyao and Yiyiren;Cluster 3 included Pugongying,Baihuasheshecao,Xixiancao,Weilingxian,and Zexie;Clust 4 included Zhimu,Huangbai,Shudihuang and Gouqizi;Cluster 5 included Sangjisheng,Niuxi,Shenjincao and Huangqin;Cluster 6 included Duzhong and Duhuo;and Cluster 7 included Jixueteng.Conclusion:When laboratory indexes and platelet parameters in patients with osteoarthritis are in active hyperactive state,treatment with Chinese medicine can improve the laboratory index and reduce the immune inflammatory reaction,especially invigorating-spleen and removing-dampness medicine and clearing away heat and dredging collateral.

　　【Keywords】 osteoarthritis;platelet parameters;invigorating spleen and removing dampness;clearing heat and dredging collateral;association rules;cluster analysis