基于临床数据分析原发性肝癌的证治规律(1)
〔摘要〕 目的 分析原發性肝癌证治规律。方法 选取来自湖南省中医药研究院附属医院近5年住院的原发性肝癌病历资料。使用SPSS 21.0软件，采用频次统计和聚类分析对肝癌四诊信息及用药进行数据挖掘。结果 依据纳入标准和排除标准，最终获取628份合格病历。对628例患者病历的四诊信息进行逐一提取，共获得73个四诊信息表现字段，总频次达4 978次，出现频次在30次以上的核心四诊有50个。628例患者生存期>6个月以上原发性肝癌患者病历中，共使用中药348味，药物总频次28 547次，使用频次在100次以上的核心药物共57味。从原发性肝癌四诊信息聚类分析及用药规律发现原发性肝癌以肝区疼痛、倦怠乏力、纳呆恶食、夜寐差、形体消瘦为主要临床特点;黄芪、甘草、白术、白花蛇舌草、半枝莲、茯苓、重楼为主要药物;其四个基本证型分别是肝瘀脾虚证、湿热蕴脾证、湿热毒结证、肝肾阴虚证。结论 “瘀、毒、虚”为原发性肝癌基本病机，益气健脾、化瘀软坚、清热解毒法为中医治疗肝癌的主要治法，其中益气健脾为治疗根本。
〔关键词〕 原发性肝癌;证候;肝区疼痛;倦怠乏力;益气健脾;清热解毒;黄芪;白术
〔中图分类号〕R273;R735.7 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.01.010
An Analysis of Diagnostic and Therapeutic Rules for Primary Liver Cancer Based on Clinical Data
SHAO Feng1， ZENG Puhua2， ZENG Guang1， GAO Wenhui1， HE Zuomei1， XIA Shuaishuai1， LI Jing1， HUANG Huiyong3*
(1. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China; 2. The Affiliated Hospital of Hunan Academy of Chinese Medicine， Changsha， Hunan 410006， China; 3. TCM Diagnostics Research Institute， Hunan University of Chinese Medicine， Changsha， Hunan 410208， China)
〔Abstract〕 Objective To analyze the diagnostic and therapeutic rules for primary liver cancer. Methods The medical records of primary liver cancer in The Affiliated Hospital of Hunan Academy of Chinese Medicine in recent 5 years were collected. SPSS 21.0 was used to process the information obtained by four diagnostic methods and medication used with frequency analysis and cluster analysis in order to obtain rules. Results According to the inclusion criteria and exclusion criteria， 628 valid medical records were obtained. The information obtained by four diagnostic methods from 628 patients was collected， and 73 information fields were obtained， with a total frequency of 4978 times; there were 50 core information fields that appeared more than 30 times. A total of 348 traditional Chinese medicines were used in the medical records of the primary liver cancer patients with a survival time of >6 months among the 628 cases， with a total frequency of 28 547 times， and 57 core medicines were used more than 100 times. According to medication rules and the cluster analysis of the information obtained by four diagnostic methods， it was found that the main clinical features of primary liver cancer were pain in the liver area， fatigue， poor appetite and nausea， poor sleep quality， and emaciation; Astragalus membranaceus， Radix Glycyrrhizae， Atractylodes macrocephala， Hedyotis diffusa， Scutellaria barbata， Poria cocos， and Rhizoma Paridis were the main drugs used; the four basic syndrome types were liver stasis and spleen deficiency， damp-heat retention in spleen， damp-heat-toxin accumulation， and liver-kidney Yin deficiency. Conclusion Stasis， toxin， and deficiency are the basic pathogenesis of primary liver cancer. Tonifying Qi and strengthening the spleen， resolving stasis and softening hard mass， and clearing heat and detoxicating are the main therapies for liver cancer in traditional Chinese medicine， and tonifying Qi and strengthening the spleen is the basic treatment., 百拇医药(邵峰 曾普华 曾光 郜文辉 贺佐梅 夏帅帅 李静 黄惠勇)
〔关键词〕 原发性肝癌;证候;肝区疼痛;倦怠乏力;益气健脾;清热解毒;黄芪;白术
〔中图分类号〕R273;R735.7 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.01.010
An Analysis of Diagnostic and Therapeutic Rules for Primary Liver Cancer Based on Clinical Data
SHAO Feng1， ZENG Puhua2， ZENG Guang1， GAO Wenhui1， HE Zuomei1， XIA Shuaishuai1， LI Jing1， HUANG Huiyong3*
(1. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China; 2. The Affiliated Hospital of Hunan Academy of Chinese Medicine， Changsha， Hunan 410006， China; 3. TCM Diagnostics Research Institute， Hunan University of Chinese Medicine， Changsha， Hunan 410208， China)
〔Abstract〕 Objective To analyze the diagnostic and therapeutic rules for primary liver cancer. Methods The medical records of primary liver cancer in The Affiliated Hospital of Hunan Academy of Chinese Medicine in recent 5 years were collected. SPSS 21.0 was used to process the information obtained by four diagnostic methods and medication used with frequency analysis and cluster analysis in order to obtain rules. Results According to the inclusion criteria and exclusion criteria， 628 valid medical records were obtained. The information obtained by four diagnostic methods from 628 patients was collected， and 73 information fields were obtained， with a total frequency of 4978 times; there were 50 core information fields that appeared more than 30 times. A total of 348 traditional Chinese medicines were used in the medical records of the primary liver cancer patients with a survival time of >6 months among the 628 cases， with a total frequency of 28 547 times， and 57 core medicines were used more than 100 times. According to medication rules and the cluster analysis of the information obtained by four diagnostic methods， it was found that the main clinical features of primary liver cancer were pain in the liver area， fatigue， poor appetite and nausea， poor sleep quality， and emaciation; Astragalus membranaceus， Radix Glycyrrhizae， Atractylodes macrocephala， Hedyotis diffusa， Scutellaria barbata， Poria cocos， and Rhizoma Paridis were the main drugs used; the four basic syndrome types were liver stasis and spleen deficiency， damp-heat retention in spleen， damp-heat-toxin accumulation， and liver-kidney Yin deficiency. Conclusion Stasis， toxin， and deficiency are the basic pathogenesis of primary liver cancer. Tonifying Qi and strengthening the spleen， resolving stasis and softening hard mass， and clearing heat and detoxicating are the main therapies for liver cancer in traditional Chinese medicine， and tonifying Qi and strengthening the spleen is the basic treatment., 百拇医药(邵峰 曾普华 曾光 郜文辉 贺佐梅 夏帅帅 李静 黄惠勇)
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