来源：风湿病与关节炎,2020,9（4）:11-15.

强直性脊柱炎患者脂蛋白代谢变化及中医药干预数据挖掘研究（临床研究）

韩馨悦¹，刘　健²，孙艳秋¹，忻　凌²，张国磊¹，贺明玉¹

　　【摘　要】目的：分析强直性脊柱炎患者脂蛋白代谢的变化及其与炎症、免疫指标的相关性以及与所用中药的关联。方法：整理安徽中医药大学第一附属医院风湿免疫科2012年9月至2019年5月593例强直性脊柱炎住院患者的病例资料，采用SPSS 23.0软件对实验室指标总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白-A1（ApoA1）、载脂蛋白-B（ApoB）与炎症指标C-反应蛋白（CRP）、α1-酸性糖蛋白（α1-AGP）、红细胞沉降率（ESR）、免疫球蛋白（IgA、IgG、IgM）、补体（C3、C4）进行相关性分析。对其所使用的中药进行频数统计；通过SPSS Clementine 12.0软件Aprior模块分析中药与脂代谢相关指标的相关性。结果：593例强直性脊柱炎患者HDL-C下降292例（49.24%），ApoA1下降408例（68.80%）。相关性分析示：HDL-C与IgM呈显著正相关，与IgA、C3、C4、CRP、α1-AGP、ESR呈显著负相关（P < 0.05或P < 0.01）。ApoA1与IgM呈显著正相关，与IgA、C3、CRP、α1-AGP、ESR呈显著负相关（P < 0.05或P < 0.01）。中药使用频次分析示：使用频次最高的前4类药物为活血化瘀药、健脾利湿药、补虚药、祛风湿药。在最小支持度设为10％，最小置信度设为80％的前提下，提取与指标变化关联较高的中药组合：猪苓关联于ApoA1上升，猪苓和杜仲组合关联于ApoA1上升。结论：强直性脊柱炎患者存在脂蛋白代谢紊乱，主要表现为HDL-C和ApoA1下降，且与免疫、炎症等指标相关。中医药干预与指标的改善有相关性，使用频次最高的前4类药物为活血化瘀药、健脾利湿药、补虚药、祛风湿药。中药猪苓，中药组合猪苓、杜仲关联于脂代谢指标ApoA1上升。

　　【关键词】　脊柱炎，强直性；脂蛋白代谢；中医药；数据挖掘

Study on the Changes of Lipoprotein Metabolism in Patients with Ankylosing Spondylitis and Data Mining of Intervention with Chinese Medicine

HAN Xin-yue,LIU Jian,SUN Yan-qiu,XIN Ling,ZHANG Guo-lei,HE Ming-yu

　　【ABSTRACT】Objective:To analyze the changes of lipoprotein metabolism in patients with ankylosing spondylitis and its correlation with inflammatory and immune indexes,as well as the relationship with applied Chinese medicine.Methods:The data（from September 2012 to May 2019）of 593 cases of ankylosing spondylitis in the Department of Rheumatology and Immunology,the First Affiliated Hospital of Anhui University of Chinese Medicine were collected and statistical software SPSS 23.0 was used to analyze TC,TG,LDL-C,HDL-C,ApoA1,ApoB,CRP,αl-AGP,ESR,IgA,IgG,IgM,C3,and C4.The frequency of Chinese medicine was counted and the correlation between Chinese medicine and related index of lipid metabolism was analyzed by the Aprior module of software SPSS Clementine 12.0.Results:Among the 593 cases,HDL-C decreased in 292 cases（49.24%）and ApoA1 decreased in 408 cases（68.80%）.The correlation analysis showed that HDL-C was positively correlated with IgM and negatively correlated with IgA,C3,C4,CRP,α1-AGP and ESR（P < 0.05 or P < 0.01）.ApoA1 was positively correlated with IgM and negatively correlated with IgA,C3,CRP,α1-AGP and ESR（P < 0.05 or P < 0.01）.The analysis of the frequency of applied Chinese medicine showed that the top four kinds of medicine with the highest frequency are blood-activating and stasis-removing medicine,spleen-invigorating and dampness-removing medicine,deficiency-correcting medicine and wind-dampness-removing medicine.Under the premise of the minimum support of 10% and the minimum confidence of 80%,the medicine groups with higher correlation are Zhuling（Polyporus umbellatus）associated with the rise of ApoA1,and Zhuling and Duzhong（Eucommia ulmoides）associated with the rise of ApoA1.Conclusion:Patients with ankylosing spondylitis have the disorder of lipoprotein metabolism,which is mainly manifested by the decrease of HDL-C and ApoA1,and is related to the indexes of immunity and inflammation.There is a correlation between the intervention of Chinese medicine and the improvement of indicators.The top four medicines with the highest frequency of use are blood-activating and stasis-removing medicine,spleen-invigorating and dampness-removing medicine,deficiency-correcting medicine and wind-dampness-removing medicine.Zhuling and Duzhong are associated with the rise of ApoA1.

　　【Keywords】spondylitis,ankylosing;lipoprotein metabolism;Chinese medicine;data mining