2019 年第 12 期 第 14 卷

急性心肌梗死不同兼症及合并病中医治疗方案优化研究

Traditional Chinese medicine treating acute myocardial infarction with different accompanied symptoms and comorbidities

作者：冯妍王以新马涵英康晨瑜徐浩周雪忠

英文作者：

单位：100029首都医科大学附属北京安贞医院全科医疗科(冯妍、王以新、马涵英、康晨瑜)；100091北京，中国中医科学院西苑医院心血管科(徐浩)；100044北京交通大学计算机与信息技术学院(周雪忠)

英文单位：

关键词：急性心肌梗死；中医治疗；主题模型

英文关键词：

• 摘要：

• 【摘要】目的    探讨基于主题模型的急性心肌梗死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”数据库中急性心肌梗死患者624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、急性心肌梗死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，咳嗽、头晕、头痛、自汗是急性心肌梗死血瘀痰浊患者常见中医兼症的症状表现，该类证候要素、兼症群所对应使用的中药及分布概率为川芎(0.140)、茯苓(0.061)、枳壳(0.061)、瓜蒌(0.053)；主题2中，恶心呕吐、气喘、口干欲饮、肢体麻木是急性心肌梗死气虚血瘀痰浊证患者常见中医兼症的症状表现，该类证候要素、兼症群所对应使用的中药及分布概率为丹参(0.224)、五味子(0.122)、黄芪(0.102)、陈皮(0.071)；主题3中，自汗、恶心呕吐、咯痰、肢凉是急性心肌梗死气虚血瘀兼见痰浊证患者常见中医兼症的症状表现，该类证候要素、兼症群所对应使用的中药及分布概率为桃仁(0.122)、延胡索(0.089)、佩兰(0.081)、麦冬(0.065)。急性心肌梗死证候要素、合并病、中药关系主题4中，急性心肌梗死气虚血瘀痰浊证患者常见高血压、糖尿病、肺部感染、中风等合并病，该类证候要素、合并病群所对应使用的中药及分布概率为黄芪(0.147)、陈皮(0.130)、甘草(0.122)、川芎(0.107)；主题5中，急性心肌梗死气虚血瘀痰浊证患者常见高血压、高脂血症、糖尿病、中风等合并病，该类证候要素、合并病群所对应使用的中药及分布概率为当归(0.144)、赤芍(0.115)、桃仁(0.105)、瓜蒌(0.091)；主题6中，急性心肌梗死气虚血瘀痰浊证患者常见高血压、糖尿病、中风、肺部感染等合并病，该类证候要素、合并病群所对应使用的中药及分布概率为丹参(0.095)、当归(0.090)、半夏(0.087)、黄芪(0.087)。结论    应用中医兼症、证候要素及中药和合并病、急性心肌梗死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，为急性心肌梗死患者中医临床方案优化方法研究提供依据，可在多种疾病中尝试推广，并为医疗机构智能化疾病管理模式研究提供方法学基础。

• 【Abstract】Objective    To explore the optimization methods of traditional Chinese medicine（TCM） treatment for acute myocardial infarction（AMI） with different accompanied symptoms and comorbidities based on the topic model. Methods    Clinical data of 624 patients with AMI were retrieved from the "Integrated Platform for Clinical Scientific Research" database. Basic information, main symptoms, TCM syndromes, accompanied symptoms, comorbidities and medication were collected. Topic model analysis was performed using accompanied symptoms, syndrome elements and medication information in topics 1, 2, 3 and using comorbidities, syndrome elements and medication information in topics 4, 5, 6. Results    Topic 1 suggested that cough, dizziness, headache and spontaneous sweating were common symptoms of AMI with blood stasis and phlegm turbidity; the recommended Chinese herbal medicines and the distribution probabilities were Ligusticum wallichii(0.140), Poria cocos(0.061), Fructus aurantii(0.061) and Fructus trichosanthes(0.053). Topic 2 suggested that nausea and vomiting, asthma, dry mouth, limb numbness were common symptoms of AMI with qi deficiency, blood stasis and phlegm turbidity; the recommended Chinese herbal medicines and the distribution probabilities were Salvia miltiorrhiza(0.224), Schisandra chinensis(0.122), Astragalus membranaceus(0.102) and Dried tangerine peel(0.071). Topic 3 suggested that spontaneous sweating, nausea and vomiting, phlegm and limb coolness were common symptoms of TCM with Qi deficiency, blood stasis and phlegm turbidity; the recommended Chinese herbal medicines and the distribution probabilities were Peach kernel(0.122), Corydalis tuber(0.089), Eupatorium(0.081) and Radix ophiopogonis(0.065). Topic 4 suggested that hypertension, diabetes, pulmonary infection and stroke were common comorbdities of AMI with qi deficiency, blood stasis and phlegm turbidity; the recommended Chinese herbal medicines and the distribution probabilities were Astragalus membranaceus(0.147), Dried tangerine peel(0.130), Licorice(0.122) and Ligusticum wallichii(0.107). Topic 5 suggested that hypertension, hyperlipidemia, diabetes and stroke were common comorbidities of AMI with qi deficiency, blood stasis and phlegm turbidity; the recommended Chinese herbal medicines and the distribution probabilities were Angelica sinensis(0.144), Radix paeoniae rubra(0.115), Peach kernel(0.105) and Fructus trichosanthis(0.091). Theme 6 suggested that hypertension, diabetes, stroke and pulmonary infection were common comorbidities of AMI with qi deficiency, blood stasis and phlegm turbidity; the recommended Chinese herbal medicines and the distribution probabilities were Salvia miltiorrhiza(0.095), Angelica sinensis(0.090), Pinellia ternata(0.087) and Astragalus membranaceus(0.087). Conclusion    The topic model analysis provides a optimization method of TCM treatment for AMI according to specific syndromes, accompanied symptoms, comorbidities and rules of compound prescription, which can be applied in many diseases and provide methodological basis for the research on intelligent management mode.