主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2021, Vol. 44 ›› Issue (6): 527-537.doi: 10.3969/j.issn.1006-2157.2021.06.007

• 中医信息 • 上一篇    下一篇

对2 826名2型糖尿病患者证候-治法-中药对应关系及时序演变规律的研究*

邢颖1, 皮敏2, 张润顺3, 何雄4, 杨杰5, 文天才1,5#   

  1. 1 中国中医科学院中医临床基础医学研究所 北京 100700;
    2 深圳市中医院;
    3 中国中医科学院广安门医院;
    4 北京交通大学计算机与信息技术学院;
    5 中国中医科学院中医药数据中心
  • 收稿日期:2020-12-08 出版日期:2021-06-30 发布日期:2021-06-25
  • 通讯作者: #文天才,男,博士,正高级工程师,硕士生导师,主要研究方向:中医真实世界临床研究与数据挖掘,E-mail:wtcsnake@163.com
  • 作者简介:邢颖,女,在读硕士生
  • 基金资助:
    *国家自然科学基金面上项目(No.81774158),中央级公益性科研院所基本科研业务费专项资金资助项目(No.ZZ10-005)

Study on the pattern-treatment-medicinal correspondence and its evolution in 2,826 patients with type 2 diabetes*

Xing Ying1, Pi Min2, Zhang Runshun3, He Xiong4, Yang Jie5, Wen Tiancai1,5#   

  1. 1 Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China;
    2 Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518033, China;
    3 Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China;
    4 School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China;
    5 Traditional Chinese Medicine Data Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
  • Received:2020-12-08 Online:2021-06-30 Published:2021-06-25
  • Contact: Wen Tiancai, Senior Engineer, Master’s Supervisor. Data Center of Traditional Chinese Medicine, Chinese Academy of Traditional Chinese Medicine. No.16 Dongzhimenneinan Street, Dongcheng District, Beijing 100700. E-mail: wtcsnake@163.com
  • Supported by:
    National Natural Science Foundation of China (No. 81774158)

摘要: 目的 分析2型糖尿病患者证候-治法-中药对应关系及时序演变规律,为辅助2型糖尿病临床辨治提供参考。方法 基于2 826名2型糖尿病患者的门诊电子病例数据,利用复杂网络社团发现算法、有向加权复杂网络法、桑基图、核心网络分析法对不同证候在不同治疗下的时序演变规律和不同治疗下的核心中药配伍进行数据挖掘。结果 49.5%的患者为男性,50.5%为女性;51.59%患者41~60岁;92.75%患者就诊2~10次。通过对2型糖尿病证候和治法复杂网络进行社团划分,最终得到7个核心证候社团和5个治法社团,占比最高的分别为气虚血瘀阴阳两虚证(26.84%)及滋阴清热祛湿化痰法(33.33%)。2型糖尿病治疗前后两阶段的“证候-治法”对应关系与演变规律结果显示,每一类证候中使用滋阴清热祛湿化痰法和行气活血化瘀通络法的诊次数量之和均超过50%;每一类证候无论采用哪种治法,短期内平均有50%诊次的证候不发生变化,其次则转化为气虚血瘀阴阳两虚证。“证候-治法”长期时序演变规律结果显示,经治疗后多数证候保持不变,但也有相当部分向气虚血瘀阴阳两虚证、脾虚胃热肝气瘀滞证或阴虚火旺痰热互结证转化。而糖尿病各治法社团的用药与治法相匹配,常用中药配伍包括黄芩-黄连、黄连-黄柏、黄芪-白芍、黄连-干姜等。结论 滋阴清热祛湿化痰法、行气活血化瘀通络法及具有相应功效的中药在2型糖尿病的临床治疗中较为常用,虽然大多证候经过治疗短期内难以产生明显变化,但从长期结果来看,部分证候经过治疗后往往具有向脾虚胃热并肝气瘀滞、阴虚火旺并痰热互结、气虚血瘀并阴阳两虚证转变的趋势。

关键词: 2型糖尿病, 真实世界研究, 数据挖掘, 复杂网络, 复杂网络社团发现算法, 桑基图, 证候, 治法, 演变规律

Abstract: Objective To analyze the pattern-treatment-medicinal correspondence and its evolution over time in patients with type 2 diabetes (T2DM) to provide reference for the clinical treatment of type 2 diabetes. Methods Complex network community discovery algorithm, directed weighted complex network, Sankey graph and core network analysis were used to conduct data mining on the electronic case data of 2,826 patients with T2DM to identify the temporal evolution of patterns and the core combination of Chinese herbal medicinals corresponding to different treatment plans. Results 49.5% of the patients were male and 50.5% female. 51.59% were aged from 41 to 60. 92.75% visited the clinic twice to 10 times. The complex network of pattern and treatment of T2DM were divided into 7 core pattern communities and 5 treatment communities. The top two communities that occupy the largest proportion were the qi-deficiency blood-stasis yin-yang-deficiency pattern community (26.84%) and the yin-enriching heat-clearing dampness-dispelling phlegm-dissolving treatment community (33.33%). The results showed that the sum of the number of visits by T2DM patients receiving yin-enriching heat-clearing dampness-dispelling phlegm-dissolving treatment and qi-moving blood-invigorating stasis-dissolving collateral-unblocking treatment in any pattern community before and after treatment accounted for more than 50% of the total. No matter what treatment method was adopted for any type of pattern, the pattern did not change in short term in about 50% patient visits, followed by those with patterns turning into the qi-deficiency blood-stasis yin-yang-deficiency pattern. The long-term evolution of the pattern-treatment relationship in patients with T2DM showed that most patterns remained the same after long-term treatment while a considerable amount turned into qi-deficiency blood-stasis yin-yang-deficiency pattern, spleen-deficiency stomach-heat liver-qi-stagnation pattern, and yin-deficiency effulgent-fire phlegm-heat-binding pattern. The medicinals used corresponded perfectly to the treatment communities. The commonly used combination of Chinese medicinal herbs included Huangqin (Scutellaria Root, Radix Scutellariae)-Huanglian (Golden Thread, Rhizoma Coptidis), Huanglian-Huangbai (Amur Cork-tree Bark, Cortex Phellodendri Chinensis), Huangqi (Milk-vetch Root, Radix Astragali)-Baishao (White Peony Root, Radix Paeoniae Alba), and Huanglian-Ganjiang (Dried Ginger Rhizome, Rhizoma Zingiberis). Conclusion The yin-enriching heat-clearing dampness-dispelling phlegm-dissolving treatment and qi-moving blood-invigorating stasis-dissolving collateral-unblocking treatment and Chinese herbal medicinals with the above mentioned functions are commonly used in the clinical treatment of T2DM. Although most patterns would fail to change significantly in the short term, over the long term, the patterns of a considerable proportion patients may turn into spleen-deficiency stomach-heat liver-qi-stagnation pattern, yin-deficiency effulgent-fire phlegm-heat-binding pattern, and qi-deficiency blood-stasis yin-yang-deficiency pattern.

Key words: type 2 diabetes, real world studies, data mining, complex networks, complex network community discovery algorithm, Sankey diagram, pattern, treatment, evolution

中图分类号: 

  • R259