2020 年第 8 期 第 15 卷

冠状动脉粥样硬化性心脏病心力衰竭不同兼症及合并病中医治疗方案优化研究

Traditional Chinese medicine treating heart failure due to coronary heart disease with different symptoms and complications

作者：冯妍1王以新1马涵英1高杰1康晨瑜1徐浩2周雪忠3

英文作者：Feng Yan1 Wang Yixin1 Ma Hanying1 Gao Jie1 Kang Chenyu1 Xu Hao2 Zhou Xuezhong3

单位：1首都医科大学附属北京安贞医院全科医疗科100029；2中国中医科学院西苑医院心血管科，北京100091；3北京交通大学计算机与信息技术学院100044

英文单位：1Department of General Practice Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Cardiology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing 100091 China; 3School of Computer and Information Technology Beijing Jiaotong University Beijing 100044 China

关键词：冠状动脉粥样硬化性心脏病；心力衰竭；中医治疗；主题模型

英文关键词：Coronaryheartdisease；Heartfailure；TraditionalChinesemedicinetreatment；Thememodel

• 摘要：

• 目的 探讨基于主题模型的冠状动脉粥样硬化性心脏病（冠心病）心力衰竭的不同兼症及合并病中医治疗方案优化方法 。方法 选择“临床科研一体化平台”数据库中冠心病心力衰竭患者235例。采集患者的临床信息包括基本信息、临床主要症状、中医证候、兼症、合并病及治疗用药等，数据在预处理后进行分析挖掘。以中医兼症、证候要素及中药作为研究主题，应用主题模型法分析主题1、2、3中特定证候要素、兼症的中药用药规律；以合并病、证候要素及中药作为研究主题，分析主题4、5、6中特定证候要素、合并病的中药用药规律。结果 中医兼症、中药及证候要素主题1中，咯痰、咳嗽、浮肿、脘痞是冠心病心力衰竭气虚血瘀患者常见中医兼症的症状表现，对应使用的中药及分布概率为葶苈子（0.244）、丹参（0.148）、黄芪（0.109）、党参（0.087）；主题2中，气喘、头晕、浮肿、腰酸是冠心病心力衰竭血瘀气虚患者常见中医兼症的症状表现，对应使用的中药及分布概率为丹参（0.283）、黄芪（0.246）、泽泻（0.087）、桂枝（0.076）；主题3中，气喘、浮肿、腹胀、脘痞是冠心病心力衰竭血瘀气虚水饮患者常见中医兼症的症状表现，对应使用的中药及分布概率为黄芪（0.263）、丹参（0.234）、桂枝（0.141）、泽泻（0.117）；证候要素、合并病、中药主题4 中，冠心病心力衰竭气虚血瘀痰浊证患者常见合并高血压、陈旧性心肌梗死、心律失常、糖尿病等合并病，对应使用的中药及分布概率为黄芪（0.158）、葶苈子（0.128）、红花（0.102）、白术（0.086）；主题5中，冠心病心力衰竭血瘀气虚阴虚证患者常见陈旧性心肌梗死、高血压、糖尿病、心律失常等合并病，对应使用的中药及分布概率为当归（0.133）、茯苓（0.125）、甘草（0.101）、赤芍（0.091）；主题6中，冠心病心力衰竭气虚阴虚血瘀证患者常见陈旧性心肌梗死、高血压、糖尿病、高脂血症等合并病，对应使用的中药及分布概率为当归（0.154）、甘草（0.132）、茯苓（0.132）、泽泻（0.088）。结论 应用冠心病心力衰竭证候要素及中药主题模型能够提取出特定证候要素、兼症、合并病的中药用药规律，为冠心病心力衰竭患者辨证论治理论的方剂随症加减分析提供了一种新颖的智能分析方法。

• Objective To explore the optimization method of traditional Chinese medicine （TCM） treatment plan for different symptoms and complications of heart failure due to coronary heart disease based on the theme model. Methods Totally 235 patients with heart failure due to coronary heart disease were selected from the database of "integrated platform of clinical research". The collected clinical information of patients including basic information, main clinical symptoms, TCM syndromes, concurrent diseases, complications and treatment drugs, etcwere analyzed and mined after preprocessing. The research theme was symptomatic, syndrome elements and traditional Chinese medicine. The theme model method was used to analyze the specific syndrome elements and the drug law of symptomatic in theme 1, 2 and 3. The research theme was symptomatic factors and TCM of comorbidity, heart failure due to coronary heart disease. The drug law of specific syndrome elements and comorbidity in theme 4, 5 and 6 was analyzed. Results Theme 1 suggested that phlegm, cough, edema and abdomen bellied were common symptoms of TCM in patients with coronary heart disease, the corresponding TCM and distribution probability were Tinglizi (0.244), Salvia miltiorrhiza (0.148), astragalus (0.109), dangshen (0.087). In Theme 2, asthma, dizziness, edema and back pain were common symptoms of TCM syndrome in patients with coronary heart disease and heart failure, Qi deficiency and blood stasis, the corresponding TCM and distribution probability were salvia miltiorrhiza (0.283), astragalus membranaceus (0.246), zexie (0.087) and guizhi (0.076). In theme 3, asthma, edema, abdominal distention and abdomen bellied were the crown, the symptoms of common TCM syndromes in patients with heart disease and heart insufficiency, Qi deficiency, blood stasis and water drink were as follows: astragalus membranaceus (0.263), salvia miltiorrhiza (0.234), ramulus Cinnamomi (0.141), alisma orientalis (0.117). In the theme of syndrome elements, complications and relationship between TCM, heart insufficiency and Qi deficiency in coronary heart disease patients with blood stasis and phlegm turbid syndrome were often complicated with hypertension, old myocardial infarction, arrhythmia, diabetes and other complications. The elements of such syndrome, the corresponding Chinese medicine used by the combined disease group and the distribution probability were astragalus (0.158), tinglizi (0.128), safflower (0.102), atractylodes macrocephala (0.086). In theme 5, patients with coronary heart disease with heart insufficiency, Qi deficiency, blood stasis and yin deficiency syndrome were often accompanied with old myocardial infarction, hypertension, diabetes, arrhythmia and other complications. The elements of these syndromes, the corresponding Chinese medicine used by the complications and their distribution probability were angelicae (0.133), poria (0.125), glycyrrhiza (0.101), paeonia lactiflora (0.091). In theme 6, old myocardial infarction， hypertension, diabetes, hyperlipidemia, were found in patients with coronary heart disease with heart failure, Qi deficiency, yin deficiency and blood stasis, The syndrome elements, Chinese medicine used in the disease group and the distribution probability were angelicae (0.154), glycyrrhiza (0.132), poria (0.132), alisma orientalis (0.088). Conclusion The application of syndrome elements and TCM theme model of coronary heart disease can extract the TCM medication rules of specific syndrome elements, concurrent symptoms and complications, and provide a new intelligent analysis method for the syndrome differentiation and treatment theory of formula with syndrome addition and subtraction analysis of heart failure due to coronary heart disease.