基于复杂网络分析系统性红斑狼疮阴虚证中医临床核心症状及方药规律
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摘要
目的:挖掘系统性红斑狼疮(SLE)阴虚证临床核心症状及方药,为中医临床辨证及治疗SLE阴虚证提供参考。方法:用复杂网络分析方法,通过临床回顾在广州中医药大学第一附属医院2011年1月至2017年5月病案室322例SLE患者病历以及计算机检索筛选出的134篇中医药治疗SLE的文献,对SLE阴虚证中医临床的症状、用药进行复杂网络构建,计算网络的拓扑性质参数,分析SLE阴虚证中医临床核心症状、方药、配伍规律和组方特点。结果:运用复杂网络分析方法得出,本研究中治疗SLE阴虚证的核心中药主要有生地黄、牡丹皮、赤芍、知母、黄芩、青蒿清热,山萸肉收涩,秦艽祛风湿热,鳖甲、女贞子补阴,白芍补血,茯苓、泽泻、薏苡仁利水消肿,山药、甘草片补气,制半夏化痰;核心处方为青蒿鳖甲汤、六味地黄丸;核心症状有疲乏、眠差、纳差、低热、五心烦热、盗汗、头晕、皮疹、皮肤红斑、面部鲜红蝶形红斑、斑疹暗红、脱发、腰膝酸软、关节痛、肌肉痛、耳鸣、口干、咽痛、舌红、苔少、脉细数。核心症状与证候诊断标准进行比较,有新的临床常见症状出现,即眠差、纳差、面部鲜红蝶形红斑、斑疹暗红。结论:SLE以阴虚血热为主要病机,治疗应养阴生津、清热凉血、清虚热,本文运用复杂网络分析法对计算机文献检索及临床病历回顾性研究探讨SLE阴虚证中医临床的症方药规律得出结论与临床基本一致,可为SLE阴虚证中医临床辨证治疗作参考。
Objective: To explore the laws of core symptom and traditional Chinese medicine( TCM prescription in treatment of the Yin deficiency syndrome of systemic lupus erythematosus( SLE),in order to provide the objective basis for the treatment of SLE with TCM based on complex network. Method: Complex network analysis method was used to retrospectively study 322 TCM prescriptions collected from the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2011 and May 2017 and 134 literatures about treatment of SLE with TCM through computer retrieval. The topological property parameters of the complex network were calculated,and used to analyze the structure of the core network and the compatibility rule of symptom and TCM. Then the core syndrome,herbs,compatibility rules and characteristics of commonly used prescriptions for SLE were analyzed. Result: The results of analysis of complex network showed that the core TCM herbs for Yin deficiency syndrome of SLE mainly included Rehmanniae Radix,Moutan Cortex,Paeoniae Radix Rubra,Anemarrhenae Rhizoma, Scutellariae Radix, Artemisiae Annuae Herba, Cornt Fructus, Gentianae Macrophyllae Radix,Trionycis Carapax,Ligustri Lucidi Fructus,Paeoniae Radix Alba,Poria,Alismatis Rhizoma,Coicis Semen, Dioscoreae Rhizoma, Glycyrrhizae Radix et Rhizoma, Pinelliae Rhizoma. Core prescriptions included Qinghao Biejia Tang and Liuwei Dihuang Wan. Core syndromes included fatigue,poor sleep,anorexia,low fever,five upset heat,night sweats,dizziness,rash,skin erythema,facial red butterfly erythema,dark red rash,alopecia,weak waist and knees,joint pain,muscle pain,tinnitus,thirst,sore throat,red tongue,tongue with less fur,and thready and rapid pulse. Compared with the diagnostic criteria of the syndrome,the core symptoms included some new common clinical symptoms,such as poor sleep,anorexia,facial red butterfly erythema,dark red rash. Conclusion: The main pathogenesis of SLE is Yin deficiency and blood heat,so the treatment should be nourishing Yin and generating body fluid,removing pathogenic heat from blood and clearing deficient heat. In this study,the results of clinical retrospective review and computer retrieval by the complex network analysis method were basically consistent with the clinical application. It can be used as a reference for the clinical syndrome differentiation and treatment of Yin deficiency syndrome of SLE.
Objective: To explore the laws of core symptom and traditional Chinese medicine( TCM prescription in treatment of the Yin deficiency syndrome of systemic lupus erythematosus( SLE),in order to provide the objective basis for the treatment of SLE with TCM based on complex network. Method: Complex network analysis method was used to retrospectively study 322 TCM prescriptions collected from the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2011 and May 2017 and 134 literatures about treatment of SLE with TCM through computer retrieval. The topological property parameters of the complex network were calculated,and used to analyze the structure of the core network and the compatibility rule of symptom and TCM. Then the core syndrome,herbs,compatibility rules and characteristics of commonly used prescriptions for SLE were analyzed. Result: The results of analysis of complex network showed that the core TCM herbs for Yin deficiency syndrome of SLE mainly included Rehmanniae Radix,Moutan Cortex,Paeoniae Radix Rubra,Anemarrhenae Rhizoma, Scutellariae Radix, Artemisiae Annuae Herba, Cornt Fructus, Gentianae Macrophyllae Radix,Trionycis Carapax,Ligustri Lucidi Fructus,Paeoniae Radix Alba,Poria,Alismatis Rhizoma,Coicis Semen, Dioscoreae Rhizoma, Glycyrrhizae Radix et Rhizoma, Pinelliae Rhizoma. Core prescriptions included Qinghao Biejia Tang and Liuwei Dihuang Wan. Core syndromes included fatigue,poor sleep,anorexia,low fever,five upset heat,night sweats,dizziness,rash,skin erythema,facial red butterfly erythema,dark red rash,alopecia,weak waist and knees,joint pain,muscle pain,tinnitus,thirst,sore throat,red tongue,tongue with less fur,and thready and rapid pulse. Compared with the diagnostic criteria of the syndrome,the core symptoms included some new common clinical symptoms,such as poor sleep,anorexia,facial red butterfly erythema,dark red rash. Conclusion: The main pathogenesis of SLE is Yin deficiency and blood heat,so the treatment should be nourishing Yin and generating body fluid,removing pathogenic heat from blood and clearing deficient heat. In this study,the results of clinical retrospective review and computer retrieval by the complex network analysis method were basically consistent with the clinical application. It can be used as a reference for the clinical syndrome differentiation and treatment of Yin deficiency syndrome of SLE.
引文
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[21]邓君,马晓君,毕强.社会网络分析工具Ucinet和Gephi的比较研究[J].情报理论与实践,2014,37(8):133-138.
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[23] YUAN W G,LIU Y,CHENG J J,et al. Empirical analysis of microblog centrality and spread influence based on Bi-directional connection[J]. Acta Physica Sinica,2013,62(3):193-216.
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[26]黄源,杨铭,陈佳蕾,等.基于复杂网络的中医药治疗慢性阻塞性肺疾病的用药配伍特点[J].中国实验方剂学杂志,2012,18(15):7-11.
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[29]李宁,廖映烨.从“元气学说”论系统性红斑狼疮[J].河南中医,2014,34(10):1875-1876.
[30]吴晓霞,禤国维,陈达灿.系统性红斑狼疮的中医药研究进展[J].中国中医药信息杂志,2004,11(1):84-86.
[31]方乃青.邓志恭主任治疗系统性红斑狼疮心得[J].南京中医药大学学报:自然科学版,2002,18(5):308-309.
[32]邓小敏,唐丽丽,陆斌,等.生脉散合六味地黄丸治疗2型糖尿病气阴两虚证[J].中国实验方剂学杂志,2014,20(11):192-194.
[33] Perry B,ZHANG J,Saleh T,et al. Liuwei Dihuang a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats[J]. J Integr Med,2014,12(5):447-454.
[34]谢宝刚,方修忠,陈颖,等.基于HPLC-UV的代谢组学方法对六味地黄丸的抗炎药效评价[J].中国中药杂志,2012,37(17):2635-2638.
[35] ZHANG W,HAO J,LIU R,et al. Soluble Aβlevels correlate with cognitive deficits in the 12-month-old APPswe/PS1dE9 mouse model of Alzheimer's disease[J]. Behav Brain Res,2011,222(2):342-350.
[36] LI F,GONG Q H,WU Q,et al. Icariin isolated from Epimedium brevicornum Maxim attenuates learning and memory deficits induced by dgalactose in rats[J].Pharmacol Biochem Behav,2010,96(3):301-305.
[2] Crispin J C, Liossis S N, Kis-Toth K, et al.Pathogenesis of human systemic lupus erythe matosus:recent advances[J]. Trends Molecular Med,2010,16(2):47-57.
[3]沈丕安.红斑狼疮中医临床研究[M].北京:人民卫生出版社,1997:18.
[4]卢晓峰.增液祛斑汤治疗红斑狼疮临床体会[J].黑龙江中医药,2002,31(4):27-28.
[5]张婉瑜,刘宏潇.冯兴华辨治系统性红斑狼疮经验[J].中医杂志,2011,52(22):1903-1905.
[6]王春毅,孙冬阳,陈发喜,等.陈发喜治疗系统性红斑狼疮经验[J].辽宁中医杂志,2008,35(3):334-335.
[7]陈会茹,李振洁.艾儒棣治疗系统性红斑狼疮的经验[J].浙江中医杂志,2003,38(2):3-4.
[8]江雪纯,钱程亮,张谨枫,等.狼疮静联合泼尼松治疗系统性红斑狼疮临床疗效[J].中国实验方剂学杂志,2016,22(17):126-129.
[9]王福祖,马辉中,周春言,等.狼疮Ⅰ号方治疗系统性红斑狼疮37例[J].中国实验方剂学杂志,2013,19(23):278-281.
[10]吴军伟.加味知柏地黄汤治疗系统性红斑狼疮52例[J].中国实验方剂学杂志,2013,19(7):324-326.
[11]刘建香.复杂网络及其在国内研究进展的综述[J].系统科学学报,2009,17(4):31-37.
[12]吕庆莉.数据挖掘与复杂网络的融合及其在中医药领域应用[J].中草药,2016,47(8):1430-1436.
[13]朱亚梅,李桓,周学平.基于复杂网络分析国医大师周仲瑛治疗类风湿关节炎的用药经验[J].中国实验方剂学杂志,2016,22(9):198-202.
[14]严蓓华,杨铭,陈佳蕾,等.复杂网络在中医药方面的研究和应用[J].中国实验方剂学杂志,2012,18(7):276-280.
[15]王丹妮,蒋自强,许前磊,等.基于复杂网络分析回顾性研究艾滋病中医方药规律[J].中国实验方剂学杂志,2017,23(3):187-191.
[16] Aletaha D,Neogi T,Silman A J,et al. 2010 rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Annals Rheum Dis,2010,69(9):1580-1588.
[17]国家食品药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:111-115.
[18]国家药典委员会.中国药典[M].北京:中国医药科技出版社,2015:3-384.
[19]南京中医药大学.中药大辞典[M].上海:上海科学技术出版社,2006:59.
[20]钟赣生.中药学[M]. 4版.北京:中国中医药出版社,2017:54-459.
[21]邓君,马晓君,毕强.社会网络分析工具Ucinet和Gephi的比较研究[J].情报理论与实践,2014,37(8):133-138.
[22] YU H,LIU Z,LI Y J. Key nodes in complex networks identified by multi-attribute decision-making method[J]. Acta Physica Sinica,2013,62(2):020204.
[23] YUAN W G,LIU Y,CHENG J J,et al. Empirical analysis of microblog centrality and spread influence based on Bi-directional connection[J]. Acta Physica Sinica,2013,62(3):193-216.
[24] Ulrik B. A faster algorithm for betweenness centrality[J]. J Mathematical Sociol,2001,25(2):163-177.
[25]刘勇,杜一.网络数据可视化与分析利器(Gephi中文教程)[M].北京:电子工业出版社,2017:18.
[26]黄源,杨铭,陈佳蕾,等.基于复杂网络的中医药治疗慢性阻塞性肺疾病的用药配伍特点[J].中国实验方剂学杂志,2012,18(15):7-11.
[27]沈丕安.风湿病中医诊治手册[M].北京:人民军医出版社,2009:96.
[28]李荣良,沈贤发,薛鸾.补虚泻实论治系统性红斑狼疮探讨[J].陕西中医,2017,38(8):1118-1119.
[29]李宁,廖映烨.从“元气学说”论系统性红斑狼疮[J].河南中医,2014,34(10):1875-1876.
[30]吴晓霞,禤国维,陈达灿.系统性红斑狼疮的中医药研究进展[J].中国中医药信息杂志,2004,11(1):84-86.
[31]方乃青.邓志恭主任治疗系统性红斑狼疮心得[J].南京中医药大学学报:自然科学版,2002,18(5):308-309.
[32]邓小敏,唐丽丽,陆斌,等.生脉散合六味地黄丸治疗2型糖尿病气阴两虚证[J].中国实验方剂学杂志,2014,20(11):192-194.
[33] Perry B,ZHANG J,Saleh T,et al. Liuwei Dihuang a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats[J]. J Integr Med,2014,12(5):447-454.
[34]谢宝刚,方修忠,陈颖,等.基于HPLC-UV的代谢组学方法对六味地黄丸的抗炎药效评价[J].中国中药杂志,2012,37(17):2635-2638.
[35] ZHANG W,HAO J,LIU R,et al. Soluble Aβlevels correlate with cognitive deficits in the 12-month-old APPswe/PS1dE9 mouse model of Alzheimer's disease[J]. Behav Brain Res,2011,222(2):342-350.
[36] LI F,GONG Q H,WU Q,et al. Icariin isolated from Epimedium brevicornum Maxim attenuates learning and memory deficits induced by dgalactose in rats[J].Pharmacol Biochem Behav,2010,96(3):301-305.
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