来源：风湿病与关节炎,2019,8（4）:5-10,19.

基于HIS数据挖掘4238份病历探讨中医药治疗活动期类风湿关节炎的处方模式（临床研究）

侯阿美¹，刘　健²，郭锦晨¹，忻　凌²

　　【摘　要】目的：探讨中医药治疗类风湿关节炎的配伍模式或规律。方法：基于数据挖掘技术，对安徽中医药大学第一附属医院风湿病科2012年5月至2017年12月住院治疗的2351例活动期RA患者4238份病历资料进行回顾性研究。使用BM SPSS Clementine 14.2软件Apriori模块、SPSS 22.0软件进行中药频数统计、关联规则分析、聚类分析与实验室指标分析。结果：共3881张中药处方被纳入研究，主要分析结果如下：①寒性与温性、味苦与味甘，以及归脾（胃）经的中药使用最为频繁；②健脾化湿药（利水渗湿药茯苓、薏苡仁、泽泻；补虚药甘草、山药、黄芪、白术；理气药陈皮；消食药麦芽；化痰药半夏）使用最为频繁，活血化瘀药、清热药、祛风湿药也较为常用；③关联规则发现，最常用的3个药对为桃仁与红花、白花蛇舌草与蒲公英、泽泻与茯苓；④聚类分析得出，桃仁、红花，茯苓、陈皮，蒲公英、白花蛇舌草，白术、黄芪等9组药物组合体；⑤试验组治疗后类风湿因子（RF）、超敏C-反应蛋白（hs-CRP）、红细胞沉降率（ESR）、补体C3、补体C4、抗环瓜氨酸肽（抗CCP）抗体、免疫球蛋白G（IgG）、免疫球蛋白A（IgA）比治疗前降低，超氧化物歧化酶升高，差异有统计学意义（P < 0.01或P < 0.05）。治疗后，试验组差值ESR、C3、IgG、IgA较对照组明显降低，差异有统计学意义（P < 0.01）；⑥关联规则分析得出，黄芩、茯苓与RF降低关联度较高；半夏分别和豨莶草、泽泻与ESR、hs-CRP降低关联度较高；蒲公英、山药与C3降低关联度较高；杜仲分别和威灵仙、山药与IgA、IgG降低关联度较高。结论：类风湿关节炎的辨治与脾之间有密切关系。这些处方重点为具有健脾化湿（利水渗湿药、补虚药、理气药、消食药、化痰药）作用的中药，其可能是治疗过程中的关键因素。同时，与活血化瘀药、清热药、祛风湿药的配伍是处方的基础。

　　【关键词】　关节炎，类风湿；从脾论治；关联规则；聚类分析；处方模式

Exploring the Prescription Patterns of Traditional Chinese Medicine for Active Rheumatoid Arthritis Based on HIS Data Mining of 4238 Medical Records

HOU A-mei,LIU Jian,GUO Jin-chen,XIN Ling

　　【ABSTRACT】Objective:To explore the compatibility patterns or rules of traditional Chinese medicine（TCM）in the treatment of rheumatoid arthritis（RA）.Methods:Based on data mining technology,4238 medical records of 2351 RA patients in the active period of hospitalization from May 2012 to December 2017 in the Rheumatology Department of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine were retrospectively studied.Using Apriori module of IBM SPSS Clementine 14.2 software and SPSS 22.0 software to carry out frequency statistics,association rule analysis,cluster analysis and laboratory index analysis of traditional Chinese medicine.Results:A total of 3881 Chinese herbal prescriptions were included in the study.The main results were as follows:①Medicinals with cold and warm nature,bitter and sweet taste,and attribution to the spleen（stomach）meridian were most frequently used;②Spleen-strengthening and dampness-removing medicinals were most frequently used,among which Fuling（Poria）,Yiyiren（Semen Coicis）,and Zexie（Rhizoma Alismatis）were used to promote urination and percolate dampness;Gancao（Radix et Rhizoma Glycyrrhizae）,Shanyao（Rhizoma Dioscoreae）,Huangqi（Radix Astragali）and Baizhu（Rhizoma Atractylodis Macrocephalae）were used to supplement deficiency;Chenpi（Pericarpium Citri Reticulatae）was used to rectify qi;Maiya（Fructus Hordei Germinatus）was used for digestion;and Banxia（Rhizoma Pinelliae）was used to dissolve phlegm.Blood-invigorating and stasis-dissolving medicinals,heat-cleaning medicinals,wind-dispelling medicinals were also frequently used.③It was found by association rules that the three most commonly used couplet medicinals were Taoren（Semen Persicae）and Honghua（Flos Carthami）,Baihuasheshecao（Herba Hedyotis Diffusae）and Pugongying（Herba Taraxaci）,and Zexie（Rhizoma Alismatis）and Fuling.④Cluster analysis found nine drug combinations by Taoren,Honghua,Fuling,Chenpi,Pugongying,Baihuasheshecao,Baizhu and Huangqi.⑤RF,hs-CRP,ESR,C3,C4,anti-CCP antibody,IgG and IgA in the experimental group were lower than those before treatment,and the levels of SOD were higher after treatment,with a statistical significance（P < 0.01 or P < 0.05）.After treatment,ESR,C3,IgG,IgA in the experimental group were significantly lower than the control group,with a statistical significance（P < 0.01）.⑥Association rule analysis showed that Huangqi,Fuling and RF had a higher correlation;Banxia,Xixiancao（Herba Siegesbeckiae）and Zexie had a higher correlation with ESR and hs-CRP;Pugongying and Shanyao had a higher correlation with C3;Duzhong（Cortex Eucommiae）had a higher correlation with Weilingxian（Radix et Rhizoma Clematidis）,Shanyao,and the decrease of IgG and IgA.Conclusion:There is a close relationship between the differentiation and treatment of RA and spleen.These prescriptions focus on medicinals with the functions of invigorating the spleen and removing dampness,which may be the key factor in the treatment.Meanwhile,compatibility with blood-activating and stasis-removing drugs,heat-clearing drugs and rheumatism-removing drugs is the basis of prescriptions.

　　【Keywords】 arthritis,rheumatoid;treatment from spleen;association rules;cluster analysis;prescription pattern