本文選題：偏頭痛　切入點(diǎn)：數(shù)據(jù)挖掘　出處：《北京中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：對(duì)于偏頭痛(Migraine)疾病來(lái)說(shuō),德國(guó)人群在全球發(fā)病率最高,西藥治療偏頭痛的療效不容樂(lè)觀。其主要原因在于過(guò)度使用鎮(zhèn)痛藥物,存在嚴(yán)重藥物依賴性及不良反應(yīng)等[1]。而在我國(guó),中醫(yī)藥能夠以證候特點(diǎn)及其病情的變化為依據(jù),開(kāi)展針對(duì)性地個(gè)體化治療。近年來(lái)在防治偏頭痛的臨床實(shí)踐中,中醫(yī)藥治療顯示出巨大優(yōu)勢(shì),成為國(guó)內(nèi)外研究的熱點(diǎn)。利用中醫(yī)理念依據(jù)辨證論治思想個(gè)體化診療,在緩解偏頭痛患者痛苦程度,心理負(fù)擔(dān),精神疲憊等方面做出了巨大貢獻(xiàn),而且中藥藥物相對(duì)西藥更為安全,對(duì)病人來(lái)說(shuō)能放心地接受治療。當(dāng)前使用中藥治療偏頭痛已得到了國(guó)內(nèi)外越來(lái)越多的醫(yī)生和患者的認(rèn)同[2]。目前偏頭痛的中藥治療成果只是針對(duì)亞洲人群,對(duì)于德國(guó)人群的偏頭痛中醫(yī)治療的研究還處于起步階段。因此,尋找有效的治療德國(guó)偏頭痛患者的中藥治療方案是亟待解決的關(guān)鍵問(wèn)題。本研究旨在通過(guò)深入探尋德國(guó)人群偏頭痛發(fā)病特點(diǎn)及用藥規(guī)律,促進(jìn)中醫(yī)藥在不同地區(qū)人群的疾病治療中發(fā)揮作用,進(jìn)而推動(dòng)中醫(yī)藥治療走向世界。目的:通過(guò)對(duì)德國(guó)魁茨汀中醫(yī)院(TCM-Klinik Bad Kotzting)住院偏頭痛患者的臨床病例進(jìn)行回顧性研究分析,初探德國(guó)偏頭痛患者發(fā)病特點(diǎn)、中醫(yī)辨證分型及中藥組方規(guī)律;通過(guò)采用循證醫(yī)學(xué)的方法,對(duì)以往中藥與西藥治療肝陽(yáng)上亢型偏頭痛患者的隨機(jī)對(duì)照試驗(yàn)(RCT,Randomized Controlled Trial)進(jìn)行Meta分析,為臨床常見(jiàn)肝陽(yáng)上亢型偏頭痛患者提供臨床中藥治療依據(jù);通過(guò)對(duì)德國(guó)偏頭痛患者的頭痛發(fā)作情況、健康調(diào)查簡(jiǎn)表(SF-36,medical outcomes study36-item short-form health survey)及偏頭痛中醫(yī)療效評(píng)價(jià)量表(PRO,Patients-reported outcomes)等指標(biāo)進(jìn)行分析,進(jìn)一步探討中藥對(duì)偏頭痛證候的改善情況,初探中藥在治療不同地區(qū)人群偏頭痛患者中所發(fā)揮的重要作用。方法:1.本部分研究采用回顧性病歷分析和數(shù)據(jù)挖掘的研究方法,收集德國(guó)TCM偏頭痛患者住院病例。將病歷內(nèi)容分解為年齡、性別等基本信息與臨床癥狀、舌脈及中醫(yī)處方用藥等診療信息,并分別建立相應(yīng)數(shù)據(jù)集。運(yùn)用因子分析和聚類分析等數(shù)據(jù)挖掘方法對(duì)癥狀信息進(jìn)行分析,歸納并總結(jié)德國(guó)偏頭痛患者常見(jiàn)證候及其臨床用藥特點(diǎn)。采用IBM SPSS Modeler 18.0數(shù)據(jù)挖掘軟件,運(yùn)用關(guān)聯(lián)規(guī)則算法及非負(fù)稀疏主成分分析法對(duì)偏頭痛患者的癥狀、用藥規(guī)律進(jìn)行數(shù)據(jù)挖掘分析,探討德國(guó)偏頭痛患者的中醫(yī)癥候特點(diǎn)及用藥規(guī)律。為研究適合德國(guó)人群的偏頭痛患者提供有效的中藥診療方案。2.本部分研究采用循證醫(yī)學(xué)的方法,對(duì)以往中藥與西藥治療臨床常見(jiàn)肝陽(yáng)上亢型偏頭痛患者的RCT進(jìn)行Meta分析,擴(kuò)大樣本量,增加人群代表性,綜合分析中藥的臨床療效,為治療肝陽(yáng)上亢型偏頭痛提供臨床中藥防治依據(jù)。3.本研究采用前瞻性臨床病例觀察方法,通過(guò)對(duì)德國(guó)偏頭痛患者治療前后頭痛發(fā)作次數(shù),減半率,頭痛程度,PRO量表和SF-36量表等指標(biāo)的觀察,對(duì)比總結(jié)不同方劑的中藥在治療德國(guó)人群常見(jiàn)肝陽(yáng)上亢型偏頭痛患者的臨床療效。為治療德國(guó)偏頭痛提供有效的臨床診療依據(jù)。結(jié)果:1..一般臨床資料結(jié)果示:本研究共收集德國(guó)偏頭痛患者159例。從性別分布來(lái)看,其中男性20例,女性139例,男女比例1:7;從年齡分布來(lái)看,最小年齡12歲,最大年齡76歲,平均年齡50歲。41-60歲所占人數(shù)最多,達(dá)69.8%;從職業(yè)分布來(lái)看,文職人員即腦力勞動(dòng)者所占比例最多,達(dá)45.9%;從病程分布來(lái)看,其中74.8%的患者病程達(dá)10年及以上,病程持續(xù)時(shí)間較長(zhǎng),病情容易反復(fù)發(fā)作且難以治愈;從病史及不良生活習(xí)慣來(lái)看,偏頭痛患者中有消化道病史占37.7%,有頸椎病病史占35.8%。從發(fā)病影響因素來(lái)看,一定誘因、天氣變化、勞累程度及情志變化可影響偏頭痛疾病的發(fā)生。2.通過(guò)頻數(shù)分布分析得出:本研究共收集的159例德國(guó)偏頭痛患者從頭痛部位分布看,頭痛發(fā)作部位分布前5位依次為前額部、太陽(yáng)穴、眼周、頸部和枕部;從頭痛性質(zhì)分布看,分布前5位依次為刺痛、壓痛、跳痛、牽拉痛及搏擊痛。其中有先兆表現(xiàn)頻數(shù)為28,構(gòu)成比為17.6%;從兼證分布來(lái)看,分布前5位依次為反復(fù)發(fā)作、惡心嘔吐、口干、心煩易怒、神疲乏力;從舌脈診方面來(lái)看,舌質(zhì)分布前5位依次為舌暗、舌邊有齒印、舌胖、舌尖紅、舌有瘀斑;舌苔分布前5位依次為苔薄白,苔白膩,苔薄黃,苔黃膩,苔薄膩;脈象分布前5位依次為滑脈,弦脈,弱脈,細(xì)脈,細(xì)弦脈;從頭痛減輕程度方面來(lái)看:中醫(yī)治療有效者為66人,無(wú)效者為57人。中藥對(duì)減輕偏頭痛患者頭痛程度方面的有效率大于50%。3.通過(guò)證候因子分析及聚類分析得出:本研究共收集的159例德國(guó)偏頭痛患者常見(jiàn)病機(jī)相關(guān)的證候群有兩類,一是包括公因子6、9的第一類:面頰部疼痛、面紅、五心煩熱、腰背酸痛、耳鳴健忘、苔黃膩;二是包括公因子5、7、10的第二類:頭重如裹、耳后及耳周痛、全頭痛、氣短、手足心汗、舌淡紅、苔薄、苔白、苔膩、舌有裂、脈滑數(shù)。4.通過(guò)關(guān)聯(lián)規(guī)則分析得出:本研究共收集的159例德國(guó)偏頭痛患者臨床常見(jiàn)中醫(yī)癥狀中反復(fù)發(fā)作、惡心嘔吐,舌暗、苔薄白、弦脈、弱脈、滑脈等具有一定關(guān)聯(lián)性。5.本研究共收集的159例德國(guó)偏頭痛患者共使用126味中藥,總使用頻次為1958次,而使用頻數(shù)不低于20次的藥物共29味,共使用1449次,占藥物使用總頻數(shù)的73.83%。使用頻數(shù)最多的前15味藥,頻數(shù)均在40次以上,分布前15位依次為柴胡、黃芩、牛膝、白芷、赤芍、姜黃、蒺藜、三棱、竹茹、白僵蠶、郁金、姜半夏、枸杞子、枳殼、蔓荊子。參照人民衛(wèi)生出版社、全國(guó)高等中醫(yī)藥院校"十二五"規(guī)劃教材《中藥學(xué)》,按照功效將這些藥物分為解表藥、補(bǔ)虛藥、活血化瘀藥等18類。從中藥藥類種類分布看,使用頻次最高的為活血化瘀類中藥,共使用400次,占常用藥類頻率的20.42%。其后依次為:解表藥,共使用321次,占常用藥類頻率的16.38%;補(bǔ)虛藥,共使用268次,占常用藥類頻率的13.67%;清熱藥,共使用245次,占常用藥類頻率的12.5%;平肝熄風(fēng)藥,共使用268次,占常用藥類頻率的8.43%。從使用頻率最多的前15位中藥的歸經(jīng)來(lái)看,有11味中藥都?xì)w于肝經(jīng),如柴胡、黃芩、牛膝、赤芍、姜黃、蒺藜、白僵蠶、郁金、枸杞子、枳殼、蔓荊子。6.運(yùn)用非負(fù)稀疏主成分法,結(jié)合中醫(yī)臨床專業(yè)知識(shí)提取出159例德國(guó)偏頭痛患者臨床常用中藥藥對(duì)有:柴胡-黃芩;姜半夏-白術(shù);川芎-白芍;蔓荊子-藁本;提取出常用三味中藥配伍組合有:柴胡-黃芩-蔓荊子;姜黃-川斷-桑枝;姜半夏-茯苓-白術(shù)。提取出常用四味中藥配伍組合有:柴胡-黃芩-蒺藜-蔓荊子;姜半夏-郁金-白術(shù)-白僵蠶;厚樸-陳皮-防風(fēng)-蒼術(shù)。7.通過(guò)關(guān)聯(lián)規(guī)則分析得出:159例德國(guó)偏頭痛患者的中藥處方中,柴胡為出現(xiàn)次數(shù)最多的藥物。兩味藥物組合的規(guī)則中共得到6條關(guān)聯(lián)規(guī)則,其中柴胡-黃芩這一規(guī)則關(guān)系最為密切,共96實(shí)例,支持度為60.4%,置信度為92.7%。8.通過(guò)藥癥關(guān)聯(lián)規(guī)則分析得出:白芷、柴胡、黃芩這三味藥與偏頭痛出現(xiàn)的前額部疼痛、惡心嘔吐、反復(fù)發(fā)作、弦脈、滑脈等主要癥狀關(guān)聯(lián)度最大,關(guān)系最為密切。9.從入選13篇文獻(xiàn)的Meta分析研究報(bào)告結(jié)果顯示:中藥組治療肝陽(yáng)上亢型偏頭痛的療效優(yōu)于西藥對(duì)照組(OR:0.41 95%CI:-0.28,0.60)。從3篇納入門(mén)診患者的研究結(jié)果顯示:中藥組的療效優(yōu)于西藥組(MD:-1.07 95%CI:-1.53,-0.61)。僅有4篇研究報(bào)告中描述了中藥有輕微不良反應(yīng)。10.將26例德國(guó)偏頭痛患者進(jìn)行中藥辨證治療,對(duì)比治療前后頭痛發(fā)作次數(shù)及頭痛程度的情況。結(jié)果示:中藥對(duì)德國(guó)偏頭痛患者在頭痛發(fā)作次數(shù)、頭痛程度改善方面均有顯著療效(P0.01)。11.將26例德國(guó)偏頭痛患者進(jìn)行中藥辨證治療,對(duì)比治療前后SF-36及PRO量表。結(jié)果示:經(jīng)中藥辨證治療后SF-36量表評(píng)分均有升高。與治療前相比,在健康變化(HT,Reported Health Transition)、生理職能(RP,Role-Physical)、精力(VT,Vitality)這三個(gè)維度方面有統(tǒng)計(jì)學(xué)差異。將治療前后SF-36得分差值對(duì)比發(fā)現(xiàn),HT和情感職能(RE,Role-Emotional)兩個(gè)維度有差異,有統(tǒng)計(jì)學(xué)意義。經(jīng)中藥辨證治療后PRO量表評(píng)分均有降低,與治療前相比,軀體狀態(tài)、功能狀態(tài)、精神心理及PRO總分均有統(tǒng)計(jì)學(xué)差異。結(jié)論:1.基于數(shù)據(jù)挖掘技術(shù)總結(jié)出德國(guó)偏頭痛發(fā)病與氣滯、痰飲、瘀血這些病理因素有關(guān),與肝、脾、腎三臟關(guān)系密切。在頭痛發(fā)作時(shí)以前額部刺痛、反復(fù)發(fā)作、伴惡心嘔吐,舌暗、苔薄白、弦脈、滑脈為最常見(jiàn)癥狀。歸納出臨床常見(jiàn)證型有肝陽(yáng)上亢型和氣虛痰濕型。在臨床治療中重視從肝論治,用藥中強(qiáng)調(diào)和解少陽(yáng),提倡柴胡、黃芩藥對(duì)的使用,注重活血化瘀類藥物的使用。2.運(yùn)用Meta分析方法總結(jié)文獻(xiàn)中關(guān)于中藥治療臨床常見(jiàn)肝陽(yáng)上亢型偏頭痛的療效。證實(shí)中藥有助于提高肝陽(yáng)上亢型偏頭痛的臨床療效,相對(duì)西藥毒副作用更少,且更適用于門(mén)診患者。3.中藥在降低德國(guó)偏頭痛患者的頭痛發(fā)作頻率和減輕疼痛程度等方面療效顯著;通過(guò)對(duì)調(diào)查量表結(jié)果分析發(fā)現(xiàn),中藥在改善德國(guó)偏頭痛患者的頭痛狀態(tài)、生理功能和精神心理層面均有一定的治療效果。
[Abstract]:For migraine (Migraine) disease, the German population rate is the highest in the global incidence, efficacy of Western medicine in the treatment of migraine is not optimistic. The main reason lies in the excessive use of analgesic drugs, and in our country serious drug dependence and adverse reactions of [1]., TCM syndrome features and changes in the condition as the basis, to carry out targeted individualized treatment of clinical practice in the prevention and treatment of migraine. In recent years, Chinese medicine treatment showed a huge advantage, has become a hot research at home and abroad. On the basis of syndrome differentiation and treatment ideas of individual diagnosis and treatment of Chinese medicine theory in use, alleviate the degree of pain, migraine patients psychological burden, made a great contribution to mental fatigue and etc. traditional Chinese medicine Western medicine is relatively safer, can be treated safely for patients. The use of traditional Chinese medicine in the treatment of migraine has been at home and abroad more and more doctors and [2]. is currently recognized in patients of migraine treatment of traditional Chinese medicine results only for the Asian population, for the study of Chinese medicine treatment of migraine in Germany people are still in the initial stage. Therefore, looking for effective treatment of traditional Chinese medicine in the treatment of migraine patients in Germany scheme is the key problems to be solved. The purpose of this study is to explore the pathogenesis of migraine through the German population characteristics and drug law and promote the role of TCM treatment of disease populations in different regions, thus promoting the treatment of traditional Chinese medicine to the world. Objective: to Germany Kuiciting Hospital of traditional Chinese medicine (TCM-Klinik Bad Kotzting) in clinical cases of migraine patients were retrospectively analyzed, of German migraine patients characteristics of the disease, syndrome differentiation of traditional Chinese medicine and traditional Chinese medicine prescription law; by using the method of evidence-based medicine, the traditional Chinese medicine and Western medicine treating hyperactivity in patients with migraine Randomized controlled trials (RCT Randomized, Controlled Trial) Meta analysis, to provide clinical basis for the clinical treatment of common migraine of liver yang hyperactivity patients; the German patients with migraine headache situation, health survey questionnaire (SF-36, medical outcomes study36-item Short-Form Health Survey) and evaluate the therapeutic effect of traditional Chinese medicine migraine scale (PRO. Patients-reported outcomes) were analyzed, further explore the improvement of traditional Chinese medicine on migraine syndrome, traditional Chinese medicine plays an important role in the treatment of the populations of different regions in migraine. Methods: 1. this study using retrospective study method and case analysis, data mining, collection of German TCM migraine patients hospitalized cases. The contents of medical records the decomposition for age, gender and other basic information and clinical symptoms, tongue and pulse and Chinese medicine prescription medication and medical information, respectively. The establishment of the corresponding data set. Using the factor analysis and clustering analysis method to analyze the symptom information, and summed up the German migraine patients common syndromes and clinical drug characteristics. Using IBM SPSS Modeler 18 data mining software, the application of association rules algorithm and non negative sparse principal component analysis method on patients with migraine symptoms, medication rule for data mining analysis, discusses the German migraine with TCM syndrome characteristics and drug law. Suitable for the study of the German population of migraine patients to provide.2. medicine effective treatment program of this study using the method of evidence-based medicine, traditional Chinese medicine and Western Medicine on the clinical treatment of common migraine of liver Yang hyperactivity in patients with RCT Meta analysis, expand the sample size increased, represent the population, clinical comprehensive analysis of traditional Chinese medicine, for the treatment of migraine of liver yang hyperactivity and provide clinical application On the basis of.3. medicine in prevention and treatment of a prospective clinical observation method, based on the treatment of migraine patients before and after the German headache episodes, half rate, headache degree, observe the PRO scale and SF-36 index, Chinese medicine prescription in the treatment of the contrast of different groups of German common migraine of liver yang hyperactivity in patients with clinical efficacy to provide clinical basis for effective treatment of migraine in Germany. Results: 1.. Clinical data showed: the study collected 159 cases of patients with migraine in Germany. From the gender distribution, among which 20 cases were male, 139 were female, male to female ratio of 1:7; from the age distribution, the minimum age of 12 years, the maximum age of 76 years, the average age of 50.41-60 years old accounted for the largest number reached 69.8%; from the occupation distribution, civilian personnel that mental workers accounted for the highest proportion of 45.9%; in the course of the disease distribution, of which 74.8% of the patients History of 10 years and above, the duration is longer, the disease is easy to recurrent and difficult to cure; from the history and bad habits, migraine in patients with gastrointestinal diseases accounted for 37.7%, with a history of cervical disease accounted for 35.8%. from the risk factors, certain causes, weather changes and emotional changes can affect the degree of fatigue the occurrence of.2. migraine disease by frequency distribution analysis: This study collected 159 cases of patients with migraine headache from German site distribution, headache sites are the top 5 temples, forehead, eye, neck and occipital headache; from the nature of the distribution, the distribution of the first 5 were pain, tenderness jump, pain, pulling pain and pain. There are signs of fighting frequency was 28, accounting for 17.6%; and from the point of view of the distribution of syndrome distribution, the first 5 were recurrent, nausea and vomiting, dry mouth, irritability, lassitude of the tongue; 鑴夎瘖鏂歸潰鏉ョ湅,鑸岃川鍒嗗竷鍓，

本文編號(hào)：1659593