刘伟胜教授治疗肺癌用药规律的挖掘分析
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摘要
目的:基于中医传承辅助系统(V2.5)探讨刘伟胜教授治疗肺癌的中医用药经验及组方规律。方法:收集刘伟胜教授在广东省中医院2016年2月至2017年2月门诊接诊的肺癌病例为研究对象,提取处方,建立数据库,采用该软件集成的规则分析、改进互信息法、复杂系统熵聚类及无监督的熵层次聚类等数据挖掘方法,挖掘分析用药经验。结果:纳入患者290例,并录入处方290个,使用中药共148味。确定处方中药物的使用频次和药物之间的关联规则,其中使用频次高于65的中药共24味,使用频次最高的前5味药依次为半枝莲(267),白花蛇舌草(265),全蝎(238),桃仁(228),淫羊藿(221),5味药所对应的常用剂量分别为20,20,10,10,15 g;支持度为185,置信度为0.95时,共有药物组合32组,使用频次最高的前5位药物组合依次为白花蛇舌草-半枝莲(259),全蝎-半枝莲(226),白花蛇舌草-全蝎(223),白花蛇舌草-全蝎-半枝莲(220),桃仁-半枝莲(218);设置相关度为9,惩罚度为2,演化出22个药物核心组合及11首新方。结论:刘伟胜教授临证以"攻毒扶正"为根本,强调癌毒是肺癌发生的直接因素,而正气不足是肺癌发病的关键,临证主张清热毒、破瘀毒、化痰毒并注重顾护脾肾之气,尤以温补肾阳为主。
Objective: To analyze the experience and herbal prescription rules of professor LIU Weisheng in treating lung cancer by using the traditional Chinese medicine( TCM) inheritance system( V2. 5)software. Method: We collected the prescriptions used for lung cancer cases at Professor LIU's clinic in the Guangdong Provincial Hospital of Chinese Medicine from February 2016 to February 2017,and screened the prescriptions to establish a formula database. Based on association rules,revised mutual information,complex system entropy cluster, unsupervised hierarchical clustering and other data mining methods, the principle experience and rules were analyzed and summarized. Result: Totally 290 cases were included, with 290 prescriptions and 148 herbs. The frequency of each herb and association rules of the herbs included in the database were identified. A total of 24 herbs had a frequency of more than 65,and top 5 herbs with high using frequency were Scutellariae Barbatae Herba( 267),Hedyotidis Herba( 265),Scorpio( 238),Persicae Semen( 228),and Epimedii Folium( 221),whose common clinical dosage was 20,20,10,10,and 15 g respectively. There were 32 combinations of related herbs with degree of support level of 185 and the confidence level of 0. 95. Top 5 herb combinations of high using frequency were Hedyotidis Herba-Scutellariae Barbatae Herba( 259), ScorpioScutellariae Barbatae Herba( 226),Hedyotidis Herba-Scorpio( 223),Hedyotidis Herba-Scorpio-Scutellariae Barbatae Herba( 220),and Persicae Semen-Scutellariae Barbatae Herba( 218). With association degree of 9 and punishment degree of 2,22 groups of core herbs combinations and 11 new prescriptions were developed.Conclusion: Professor LIU Wei-sheng mainly used herbs of eliminating cancer toxin and strengthening the benefitQi in treating lung cancer. He advocated expelling toxic heat,removing blood stasis,resolving phlegm and underlined the protection of spleen Qi and kidney with a particular emphasis at nourishing and warming kidneyYang. He thought cancer toxin is the direct factor of lung cancer,and deficiency of vital Qi is the key to the development of lung cancer.
Objective: To analyze the experience and herbal prescription rules of professor LIU Weisheng in treating lung cancer by using the traditional Chinese medicine( TCM) inheritance system( V2. 5)software. Method: We collected the prescriptions used for lung cancer cases at Professor LIU's clinic in the Guangdong Provincial Hospital of Chinese Medicine from February 2016 to February 2017,and screened the prescriptions to establish a formula database. Based on association rules,revised mutual information,complex system entropy cluster, unsupervised hierarchical clustering and other data mining methods, the principle experience and rules were analyzed and summarized. Result: Totally 290 cases were included, with 290 prescriptions and 148 herbs. The frequency of each herb and association rules of the herbs included in the database were identified. A total of 24 herbs had a frequency of more than 65,and top 5 herbs with high using frequency were Scutellariae Barbatae Herba( 267),Hedyotidis Herba( 265),Scorpio( 238),Persicae Semen( 228),and Epimedii Folium( 221),whose common clinical dosage was 20,20,10,10,and 15 g respectively. There were 32 combinations of related herbs with degree of support level of 185 and the confidence level of 0. 95. Top 5 herb combinations of high using frequency were Hedyotidis Herba-Scutellariae Barbatae Herba( 259), ScorpioScutellariae Barbatae Herba( 226),Hedyotidis Herba-Scorpio( 223),Hedyotidis Herba-Scorpio-Scutellariae Barbatae Herba( 220),and Persicae Semen-Scutellariae Barbatae Herba( 218). With association degree of 9 and punishment degree of 2,22 groups of core herbs combinations and 11 new prescriptions were developed.Conclusion: Professor LIU Wei-sheng mainly used herbs of eliminating cancer toxin and strengthening the benefitQi in treating lung cancer. He advocated expelling toxic heat,removing blood stasis,resolving phlegm and underlined the protection of spleen Qi and kidney with a particular emphasis at nourishing and warming kidneyYang. He thought cancer toxin is the direct factor of lung cancer,and deficiency of vital Qi is the key to the development of lung cancer.
引文
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[11]孙琳.李铁临床应用活血中药的经验[J].中国中医基础医学杂志,2011,17(6):646-647.
[12]王洪琦,成晓燕,胡玲.清热解毒中药诱导肝癌H22细胞HSP70表达的研究[J].中国中医基础医学杂志,2006,12(5):396-398.
[13]陈玉,冯大刚,胡荣,等.半枝莲和白花蛇舌草总多糖对S180荷瘤小鼠的抗肿瘤作用研究[J].新中医,2013,45(5):171-174.
[14]彭平亚.全蝎、蜈蚣、壁虎治疗肺癌的临床调研及各药对小鼠Lewis肺癌的抑瘤实验[D].广州:广州中医药大学,2011.
[15]国家药典委员会.中华人民共和国药典.一部[M].北京:中国医药科技出版社,2015:300.
[16]王爱武,田景奎,袁久荣,等.中药猫爪草的研究概况与展望[J].中国药业,2005,14(1):25-27.
[17]童晔玲,杨锋,戴关海,等.猫爪草总皂苷体外抗人非小细胞肺癌A549细胞活性研究[J].中华中医药学刊,2013,31(10):2181-2183.
[18]张晶,舒琦瑾,高继良,等.南方红豆杉水提物对肿瘤细胞增殖抑制作用的研究[J].中国中西医结合杂志,2013,33(6):805-809.
[19]卢君仁,刘伟胜,徐凯,等.消积饮治疗中晚期肺癌的临床观察[J].广州中医药大学学报,2001,18(3):195-201.
[20]李柳宁,陈海.刘伟胜从医50年临证集萃[M].北京:人民卫生出版社,2013:48-49.
[21]凌仕良.肺癌的中医诊治[J].浙江中西医结合杂志,2009,19(2):73-74.
[22]刘嘉湘,施志明,徐振晔,等.滋阴生津益气温阳法治疗晚期原发性肺腺癌的临床研究[J].中医杂志,1995,35(3):155-158.
[23]王容容,蒋益兰,王其美.蒋益兰治疗肺癌经验[J].湖南中医杂志,2014,30(3):20-22.
[2]Torre L A,Bray F,Siegel R L,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[3]CHEN W,ZHENG R,Baade P D,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[4]Henschke C,Mccauley D D,Naidich D,et al.Early Lung Cancer Action Project:overall design and findings from baseline screening[J].Cancer,2000,89(11Suppl):2474-2482.
[5]中华人民共和国卫生部.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:220-221.
[6]杨洪军,赵亚丽,唐仕欢,等.基于熵方法分析中风病方剂中药物之间的关联度[J].中国中医基础医学杂志,2005,11(9):706-709.
[7]唐仕欢,陈建新,杨洪军,等.基于复杂系统熵聚类方法的中药新药处方发现研究思路[J].世界科学技术—中医药现代化,2009,11(2):225-228.
[8]YANG H J,CHEN J X,TANG S H,et al.New drug R&D of traditional Chinese medicine-role of data mining approaches[J].J Biol System,2011,17(03):329-347.
[9]邓宏,河文峰,李柳宁,等.刘伟胜教授治疗肺癌的临床经验[J].时珍国医国药,2011,22(9):2312-2314.
[10]卢笑晖,单崎玮.基于中医传承辅助系统分析卢尚岭教授治疗头风病用药经验[J].中国实验方剂学杂志,2012,18(9):5-9.
[11]孙琳.李铁临床应用活血中药的经验[J].中国中医基础医学杂志,2011,17(6):646-647.
[12]王洪琦,成晓燕,胡玲.清热解毒中药诱导肝癌H22细胞HSP70表达的研究[J].中国中医基础医学杂志,2006,12(5):396-398.
[13]陈玉,冯大刚,胡荣,等.半枝莲和白花蛇舌草总多糖对S180荷瘤小鼠的抗肿瘤作用研究[J].新中医,2013,45(5):171-174.
[14]彭平亚.全蝎、蜈蚣、壁虎治疗肺癌的临床调研及各药对小鼠Lewis肺癌的抑瘤实验[D].广州:广州中医药大学,2011.
[15]国家药典委员会.中华人民共和国药典.一部[M].北京:中国医药科技出版社,2015:300.
[16]王爱武,田景奎,袁久荣,等.中药猫爪草的研究概况与展望[J].中国药业,2005,14(1):25-27.
[17]童晔玲,杨锋,戴关海,等.猫爪草总皂苷体外抗人非小细胞肺癌A549细胞活性研究[J].中华中医药学刊,2013,31(10):2181-2183.
[18]张晶,舒琦瑾,高继良,等.南方红豆杉水提物对肿瘤细胞增殖抑制作用的研究[J].中国中西医结合杂志,2013,33(6):805-809.
[19]卢君仁,刘伟胜,徐凯,等.消积饮治疗中晚期肺癌的临床观察[J].广州中医药大学学报,2001,18(3):195-201.
[20]李柳宁,陈海.刘伟胜从医50年临证集萃[M].北京:人民卫生出版社,2013:48-49.
[21]凌仕良.肺癌的中医诊治[J].浙江中西医结合杂志,2009,19(2):73-74.
[22]刘嘉湘,施志明,徐振晔,等.滋阴生津益气温阳法治疗晚期原发性肺腺癌的临床研究[J].中医杂志,1995,35(3):155-158.
[23]王容容,蒋益兰,王其美.蒋益兰治疗肺癌经验[J].湖南中医杂志,2014,30(3):20-22.