基于数据挖掘的徐金星主任医师治疗小儿过敏性紫癜辨治规律研究.docx

基于数据挖掘的徐金星主任医师治疗小儿过敏性紫癜辨治规律研究 摘要 目的：基于数据挖掘方法分析徐金星主任医师治疗小儿过敏性紫癜的辨证、用药及组方规律方法：对徐金星主任医师诊治的小儿过敏性紫癜案例进行收集整理，将符合标准的临床资料建立病案采集存贮数据库，运用频数统计分析及关联规则分析，对病案中的病机证素、证候、治法、方药之间的关联性或相关性，并结合病例资料对挖掘结果进行分析、归纳，总结徐金星主任医师辨治小儿过敏性紫癜的临床经验结果：1、“小儿过敏性紫癜气虚致病论”是徐金星主任医师的主要学术观点，“正虚邪侵，风热伤络，血瘀为斑”是徐金星主任医师对过敏性紫癜病机的总结2、益气、解毒、凉血、活血为徐金星主任治疗小儿紫癜的主要方法3、临床中重视参类及黄芪等补气药的使用关键词：小儿紫癜；数据挖掘；名老中医经验；病案回顾分析Research on differentiation and treatment of pediatric allergic purpura treated by chief physician Xu Jinxing based on Data MiningMa Si-feng 1Xu Jin-xing 1 Zhang Zhi-gang 1∆ Yang Pu-zhong1（Chinese Medicine Hospital of Daqing City, Daqing, Heilongjiang 163311）Abstract Objective: To investigate the effect of Yiqi Liangxue Huoxue Prescription of Qihuang Xiaoban Decoction Treatment of children refractory allergic purpura. Methods: 63 patients were randomly pided into the treatment group (36 cases), control group (22 cases) clinical observation system, were analyzed statistically and compared before and after treatment. Results: Chinese medicine treatment group can be quickly reduced in children with urinary protein levels; western medicine group in reducing proteinuria levels advantage; 2, Chinese medicine treatment group decreased urinary red blood cells have a better effect; 3, TCM treated less recurrence rate, efficacy is more stable; 4, Medicines fewer side effects than western medicine group, were more likely to be tolerated.Keywords: Yiqi Liangxue Huoxue; refractory Henoch-Schonlein purpura; curative effectAbstract Objective: to analyze the syndrome differentiation, medication and prescription rules of chief physician Xu Jinxing in treating children with Henoch Schonlein purpura based on data mining method. Methods: to collect and sort out the cases of allergic purpura in children diagnosed and treated by chief physician Xu Jinxing, and establish a medical record collection and storage database based on the clinical data in line with the standard. The correlation or correlation among pathogenesis, syndrome, treatment and prescription in the medical record was analyzed and summarized by using frequency statistics and association rule analysis Objective to summarize the clinical experience of chief physician Xu Jinxing in treating Henoch Schonlein purpura in children.Results: 1. "Pathogenic theory of qi deficiency in children with Henoch Schonlein purpura" is the main academic point of chief physician Xu Jinxing. "Positive deficiency evil invasion, wind heat injury collaterals, blood stasis as spots" is the chief physician Xu Jinxings summary of the pathogenesis of allergic purpura. 2. Yiqi, detoxification, cooling blood and promoting blood circulation are the main methods of treating childrens purpura by director Xu Jinxing. 3. We should pay attention to the use of Qi tonic drugs such as ginseng and Astragalus in clinic.Key words: Childrens purpura; data mining; experience of famous traditional Chinese medicine; retrospective analysis of medical records徐金星主任医师为第二批全国优秀中医临床人才，第五批及第六批全国老中医药专家学术继承工作指导老师，临证经验丰富，对儿童过敏性紫癜诊疗积累了丰富经验。

运用益气、解毒、凉血、活血四法治疗儿童过敏性紫癜，疗效显著为探索挖掘徐金星主任医师治疗过敏性紫癜的用药规律，我们利用数据挖掘技术，对徐金星主任医师诊治的过敏性紫癜病案进行了数据挖掘的研究，总结徐金星主任医师治疗过敏性紫癜的经验及用药特点现报告如下：1.资料与方法1.1病例来源：临床病案来源于2013年12月-2017年12月大庆市中医医院儿科门诊、住院处经徐金星主任医师诊治的小儿紫癜病例285例病案1139诊次，全部病案内容均由徐金星主任医师本人亲诊或口述或查房后随时记录存档的病历内容包括患者一般情况、病史、诊断、证型、治法、方药、相关理化检查等内容1.2诊断标准1.2.1西医诊断标准参照第 8 版《诸福棠实用儿科学》[1]中载入的过敏性紫癜诊断标准1.皮肤紫癜：可触性紫癜，分批出现，或双下肢有明显的瘀点，而血小板无减少2.腹痛：有的可有急性弥漫性的腹痛，也有的可出现肠套叠或者胃肠道出血情况3.组织学检查：白细胞碎裂性血管炎主要以 IgA 免疫复合物沉积为主，或增殖性肾小球肾炎以 IgA 沉积为主4.关节炎或关节痛：（1）关节炎：可出现急性的关节肿痛，或者有疼痛伴随有活动受限；（2）关节痛：多以急性的关节疼痛为主，可无关节肿胀或活动受限。

5.肾脏受累（1）蛋白尿：24小时尿蛋白定量>0.3g，或者晨尿中白蛋白肌酐比值>30mmol/mg；（2）血尿或红细胞管型尿：高倍视野红细胞大于 5 个，或尿潜血≥2+，或者是尿沉渣见红细胞管型注：诊断过敏性紫癜时，第1条为必要条件，加上2-5中的至少一条即可诊断；如果病例不典型，尤其是在皮疹出现之前已出现其他系统的症状时需要注意鉴别诊断，容易误诊、漏诊1.2.2中医诊断标准按徐金星主任医师病历记载统计整理1.3纳入标准：符合西医过敏性紫癜诊断标准；依从性好，临床资料完整，至少持续就诊3诊以上者1.4排除标准不符合病过敏性紫癜中西医诊断标准的界定标准；年龄在4岁以下或15岁以上者；患儿合并腹型、肾型紫癜者；合并原发血液系统、心脑血管、泌尿系统、风湿免疫系统或患有精神障碍的患儿；临床资料不完整,或不按规定服药,或中途退出或正在参加其它药物的临休试验者2研究与统计方法采用OFFICE2003软件excel电子表格分别记录各观察时间点之辨证、治法、方药采用频数统计分析法和关联规则分析法，整理徐金星主任医师治疗小儿过敏性紫癜主要的证型、治法、方药，归纳其关于病因、病机和治疗的演变2.结果2.1观察病例数表1三期病例例数/诊次急性期（0-1月）迁延期（1-6月）慢性期（6月以上合计162/36290/51033/267本次观察的过敏性紫癜285例，其中急性期162例（56.84%）、迁延期90例（31.58%）、慢性期33例（12.36%）。

2.2证素分析根据徐金星主任医师诊疗过敏性紫癜的病证特点，总结出气虚、风邪、阴虚、阳虚、气滞、血瘀、疫气、毒热、湿热、血热十大证素，统计出现频次及频率表2证素出现频次及频率（285人次1139诊次）证素气虚血热血瘀湿热阴虚频次705642389353225频率61.90%56.37%34.15%30.99%19.75%证素风邪毒热阳虚气滞疫气频次18978763526频率16.59%6.85%6.67%3.07%2.28%结果显示了气虚、血热、血瘀、湿热、阴虚、风邪为六种最主要证素，出现频率均＞15%其中气虚出现频率61.90%，血热出现频率56.37%，血瘀出现频率34.15%，说明气虚、血热、血瘀为小儿紫癜主要病理因素，贯穿疾病始终2.3三期证型分布情况表3急性期各诊次证型分布（362诊次666证）证型风邪伤络血热型气虚型湿热型血瘀型其他型频次1521421061028678频率41.9839.2329.2828.1823.7621.55结果显示急性期各诊次证型分布风邪伤络型>血热型>气虚型>湿热型>血瘀型>其他，说明急性期外邪侵袭为主要矛盾表4迁延期各诊次证型分布（。