[关键词]
[摘要]
目的 验证钩藤玄参方治疗高血压病的降压疗效,探讨其对患者不适症状的改善情况,为高血压病的临床个体化用药提供参考。方法 本研究采用回顾性队列研究设计,数据来源于2013年1月1日至2023年1月1日山东中医药大学附属医院6770名高血压患者的电子病历数据,以接受钩藤玄参方(包括钩藤、玄参、莱菔子)治疗为暴露因素,倾向性评分处理混杂因素后,观察患者治疗后的血压变化。同时,为了分析患者的症状改善情况,本研究使用Apriori算法挖掘患者的核心症状,并构建患者症状网络,使用BGLL算法症状进行社团划分,形成症状图谱。最后,利用生存分析和Cox回归寻找钩藤玄参方的敏感症状社团,并分析相关因素。结果 暴露组和对照组各纳入468人。治疗后,暴露组中更多患者达到目标血压(P < 0.01),在降低收缩压方面疗效更佳(P < 0.05),且未出现明显的安全性指标异常。在症状改善方面,病历记录的134个症状被划分为6个社团,随着服药时间增加,患者的头部不适更易缓解,在治疗8周时效果最佳,且对于心血管风险极高危或3级高血压的患者更为敏感。结论 本研究通过电子病历数据验证了钩藤玄参方治疗高血压的临床疗效,初步揭示了钩藤玄参方治疗高血压的潜在作用及其规律。
[Key word]
[Abstract]
Objective To provide a reference for the clinical individualized medication of hypertension, the antihypertensive efficacy of Gouteng Xuanshen prescription in the treatment of hypertension was verified, and its improvement on the discomfort symptoms of patients was explored. Methods This study adopted a retrospective cohort study design. The data were derived from the electronic medical records of 6770 hypertensive patients in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from J anuary 1, 2013 to January 1, 2023. The exposure factor was the treatment of Uncaria rhynchophylla, Scrophularia ningpoensis, and Radish Seed. After the propensity score was used to deal with the confounding factors, the changes in blood pressure of the patients after treatment were observed. At the same time, in order to analyze the improvement of patients' symptoms, the Apriori algorithm to mine the core symptoms of patients was explored, and the patient symptom network was constructed. The BGLL algorithm was used to divide the symptoms into communities to form a symptom map. Finally, survival analysis and Cox regression were used to find the sensitive symptom community of Gouteng Xuanshen prescription, and the related factors were analyzed. Results 468 people were included in the exposure group and the control group. After treatment, more patients in the exposure group reached the target blood pressure (P < 0.01), and the effect was better in lowering systolic blood pressure (P < 0.05), and no obvious abnormalities in safety indicators were found. In terms of symptom improvement, the 134 symptoms recorded in the medical records were divided into 6 groups. As the medication time increased, the patient's head discomfort was easier to relieve. The effect was best at 8 weeks of treatment, and it was more sensitive to patients with extremely high cardiovascular risk or grade 3 hypertension. Conclusion This study verified the clinical efficacy of the Gouteng Xuanshen prescription in the treatment of hypertension through electronic medical record data, which preliminarily revealed the potential role and law of the Gouteng Xuanshen prescription in the treatment of hypertension.
[中图分类号]
[基金项目]
山东省科学技术厅山东省重大科技示范工程项目(编号2021SFGC0503):重大心血管疾病智能化精准诊疗新技术开发与示范应用,负责人:张运、李运伦。国家中医药管理局高水平中医药重点学科建设项目(编号zyyzdxk-2023120):中医心病学,负责人:李运伦。山东省科学技术厅中央引导地方科技发展专项资金(编号YDZX2022140):基于藏医“五源三因”学说的高原高血压病临床诊治及藏药开发研究,负责人:李运伦。