本文關(guān)鍵詞： 數(shù)據(jù)挖掘 老年性癡呆 證候要素 用藥規(guī)律　出處：《遼寧中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：目的:從多角度、多方位、多層次對老年性癡呆的證候、證候要素、病機(jī)及臨床用藥規(guī)律進(jìn)行數(shù)據(jù)挖掘;為完善老年性癡呆的辨證體系,及把握其臨床證治規(guī)律作出有益探索,本病的防治提供一些借鑒。材料與方法:1.通過對中藥治療老年性癡呆用藥規(guī)律的文獻(xiàn)回顧研究,對相關(guān)老年性癡呆的現(xiàn)代臨床研究類文獻(xiàn)進(jìn)行收集和整理,然后采用頻數(shù)統(tǒng)計(jì)、聚類分析、關(guān)聯(lián)規(guī)則分析等數(shù)據(jù)統(tǒng)計(jì)方法,對老年性癡呆的臨床用藥規(guī)律與配伍特點(diǎn)進(jìn)行較為詳盡的研究。2.通過檢索1990-2015年關(guān)于老年性癡呆的中醫(yī)文獻(xiàn),對證候要素、靶位、應(yīng)證組合規(guī)律進(jìn)行描述性分析,均采用頻數(shù)與構(gòu)成比,探討老年性癡呆的證候分布特點(diǎn)及組合規(guī)律。3.對符合要求的112例老年性癡呆患者的中醫(yī)四診信息進(jìn)行整理總結(jié),通過無監(jiān)督數(shù)據(jù)分析方法對高頻四診信息進(jìn)行研究,以SAS9.2軟件進(jìn)行探索性因子分析和聚類分析。具體運(yùn)用系統(tǒng)聚類對指標(biāo)(四診信息)進(jìn)行聚類分析;運(yùn)用因子分析提取四診信息的公因子。結(jié)果:1.研究1共納入符合要求的文獻(xiàn)83篇,收集處方93首。從老年性癡呆總體用藥情況可以看出,治療老年性癡呆的常用藥物有石菖蒲、黃芪、熟地黃、茯苓、甘草、川芎、遠(yuǎn)志、當(dāng)歸、丹參、枸杞、何首烏、山茱萸、菟絲子、黨參、益智仁、白術(shù)、酸棗仁、桃仁等。對藥物的功效分析發(fā)現(xiàn),治療老年性癡呆的處方中涉及補(bǔ)虛藥、活血化瘀藥、安神藥、利水滲濕藥、開竅藥、清熱藥、解表藥、化痰止咳平喘藥、收澀藥、平肝熄風(fēng)藥、理氣藥等。其中以補(bǔ)虛藥、活血化瘀藥、化痰藥、開竅藥、安神藥使用頻率最高。藥物歸經(jīng)顯示,歸經(jīng)頻率最高的前四位為肝、腎、脾、心。通過聚類分析與關(guān)聯(lián)規(guī)則分析,發(fā)現(xiàn)老年性癡呆臨床用藥配伍以補(bǔ)虛、活血、開竅、化痰、安神為常見的配伍組合。2.研究2共納入符合要求的文獻(xiàn)58篇,初步得到97種證型,各證型累計(jì)出現(xiàn)頻數(shù)283次。92種證型中,常見證型依次為:氣滯血瘀證、痰濁阻竅證、髓海不足證、肝腎陰虛證、脾腎兩虛證、心肝火盛證、心脾兩虛證、腎精虧虛證、痰阻血瘀證、腎虛髓虧證。通過對老年性癡呆證候要素的提取,歸納出14個(gè)證候要素與7個(gè)證候靶位。通過對老年性癡呆應(yīng)證組合規(guī)律的描述性分析,總結(jié)出老年性癡呆應(yīng)證組合的不同形式。根據(jù)文獻(xiàn)研究結(jié)果,反映出老年性癡呆病位主要在腎,與肝、脾、腦、心密切相關(guān),其臨床病機(jī)屬本虛標(biāo)實(shí),以虛為本,血瘀、痰為標(biāo)。3.對收集的112例老年性癡呆患者的中醫(yī)四診信息進(jìn)行整理分析發(fā)現(xiàn),頻數(shù)在前15位的癥狀分別為:善忘、腰膝酸軟、發(fā)白發(fā)枯、倦怠乏力、頭暈、失眠、少氣懶言、多夢、夜尿頻多、齒搖齒脫、小便頻數(shù)、便干、自汗、情志抑郁、畏寒肢冷。通過聚類分析初步判斷本病可能的病位證素為腎、脾、肝、心,病性證素為虛、痰濕、血瘀、火。通過因子分析對研究指標(biāo)進(jìn)行降維,以簡化問題,結(jié)果共提取到18個(gè)公因子。通過對老年性癡呆患者的中醫(yī)四診信息進(jìn)行探索性的因子分析,認(rèn)為AD病機(jī)主要可以歸納為痰、瘀、虛三個(gè)方面。結(jié)論:1.老年性癡呆發(fā)病多與腎、脾、肝、心功能失常相關(guān),且與腎臟關(guān)系更為密切。補(bǔ)虛是治療老年性癡呆的基本原則,祛瘀、化痰是治療老年性癡呆的有效途徑。處方用藥上,臨床從虛論治、補(bǔ)腎益髓,兼以健脾調(diào)肝以治本;祛瘀化痰以治標(biāo),并注重開竅醒神。2.通過對老年性癡呆辨證分型文獻(xiàn)的回顧性研究,總結(jié)出老年性癡呆的應(yīng)證組合規(guī)律;雖然中醫(yī)的證候千變?nèi)f化,但證候要素與靶位則相對簡約,因此研究證候要素與靶位間的應(yīng)證組合規(guī)律,有助于對病機(jī)特點(diǎn)與疾病演變規(guī)律的把握。3.老年性癡呆高頻癥狀基本以虛性證候表現(xiàn)為主。結(jié)合聚類分析與因子分析兩種統(tǒng)計(jì)分析結(jié)果,認(rèn)為老年性癡呆的主要病位要素主要在腎、脾,其次在肝、心等;病性要素以虛、痰、血瘀主,其次是火、氣滯,其中虛是本病最為常見的病性要素,痰與血瘀是本病最重要的病邪證候要素。
[Abstract]:Objective: from the multi angle, multi direction, on senile dementia syndromes levels, syndrome factors, pathogenesis and clinical medication rules for data mining; to perfect the system of syndrome differentiation of senile dementia, and grasp the clinical syndrome rules make the beneficial exploration, provide some reference materials and the prevention and treatment of this disease. Methods: 1. through the research literature review of senile dementia medication rule of traditional Chinese medicine in the treatment of senile dementia, the modern clinical research literatures were collected and compiled, and then uses the frequency statistics, clustering analysis, the statistical methods of data association rules analysis, clinical medication rule and compatibility features of Alzheimer's disease research is.2. a detailed search through the 1990-2015 years of senile dementia TCM syndrome factors, target, law should permit the combination of descriptive analysis, were used to investigate the frequency and proportion of senile dementia The characteristics and rule of combination syndrome distribution of.3. to meet the requirements of the 112 cases of elderly patients with dementia TCM four diagnostic information summary, through the analysis method to study the high-frequency diagnostic information supervision data, using SAS9.2 software for exploratory factor analysis and clustering. The specific use of hierarchical clustering index (four diagnostic information) cluster analysis; factor analysis is used to extract the common factor of diagnostic information. Results: 1. of 1 were included to meet the requirements of the 83 articles, 93. From the first collection of prescription medication of senile dementia overall situation can be seen, commonly used drugs for the treatment of senile dementia with Shichangpu, Radix Astragali, radix rehmanniae, tuckahoe, liquorice, Rhizoma Chuanxiong. Polygala, angelica, Salvia miltiorrhiza, Radix Polygoni Multiflori, Cornus officinalis, medlar, dodder, Codonopsis, Atractylodes, Alpinia, Suanzaoren, peach and so on. The efficacy of drugs analysis found that the treatment of senile dementia in the prescription to the tonic 鑽，

本文編號：1550940