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1、基于聚类分析探讨王玉林教授临床治疗急性尿路感染的用药组方规律 徐献梅 1, 王玉林1, 杨亮1,* （1. 贵阳中医学院第二附属医院, 贵阳市 550001） 摘要：目的：探讨和总结王玉林教授临床治疗热淋的学术思想和临床用药规律。方法：随 机抽取 63 例王玉林临床治疗“急性尿路感染（热淋） ”的医案，将其首诊信息及处方录入 到专家数据库，运用 SPSS Statistics 19.0 对数据库进行频数分析和聚类分析。结果：药物 频数统计共涉及中草药 108 味，使用频数在 10 次以上的药物共 19 味，聚类为三类。结论： 聚类分析得到的急性尿路感染的用药规律印证了王玉林教授临床辩证思路，为
2、进一步研究 和开发相关医院制剂奠定坚实的临床理论基础。 关键词：急性尿路感染；聚类分析；中草药；用药规律 Based on clustering analysis to explore the medication rule of Pro. Wang clinical treatment of acute urinary tract infection XU Xianmei1, WANG Yulin1, YANG Liang1,* (1. No. 2 Hospital Affiliated to T.C.M. College of Guiyang, Guiyang 550001) ABSTRA
3、CT OBJECTIVE: To explore the combination relationship of Pro. Wang clinical treat- ment of acute urinary tract infection (Heat strangury). METHODS: Random drawing the 63 cases of Heat strangury consilia, input the data and processing by SPSS Statistics 19.0. RESULTS: Drug frequency statistics refer
4、to 108 chinese herb, use frequency in more than 10 times drug sum up to 19 species, cluster into three categories. CONCLUSION: Clustering analysis confirm the Pro. Wangs thread cure for acute urinary tract infection, and create the foundation for further research and development of hospital preparat
5、ions. KEY WORDS Acute urinary tract infection; Clustering analysis; Chinese herb; Medication rule 急性尿路感染，属于中医学淋症热淋的范畴，是下焦感受湿热病邪，膀胱 气化不利所致。多以小便频数短涩，滴沥刺痛，欲出未尽，小腹拘急或痛引腰 腹为主要症状1。热淋以女性患者居多，多发于中老年人。贵阳中医学院第二 附属医院知名老中医王玉林教授，凭借其四十余年的临床医、教、研工作经验， 通过临床辨证治疗热淋疗效确切。然而在临床中，中医辨证思维、随证加减药 味具有相当的模糊性，鉴于此，课题组以生物信息学思维模式应
6、用数理统计学 模糊聚类的分析方法，深入、客观的研究分析王玉林教授临床治疗热淋的用药 规律，探索继承发扬名老中医临床思维模式的新途径。 1 临床病例一般资料临床病例一般资料 本研究筛选 2010 年 9 月至 2011 年 3 月我院门诊就诊患者，诊断符合第二 届全国肾病学术会议通过的尿路感染诊断标准。王玉林教授采用中医临床辨证 加减治疗，每日 1 剂，煎汤 2 次共约 500 mL，分 2 次分服，5 日为一个疗程。 疗效判定，参照中药新药临床研究指导原则 、 中医病证诊断疗效标准 。符 合诊断标准纳入病例共计 60 例；其中男性 9 例，年龄 3089 岁，平均 59.4 岁； 女性 51
7、例，年龄 1888 岁，平均 52.5 岁；疗效判定结果，治愈 13 例，有效 40 例，无效 7 例。有效率 88.3 %。 1 资料与方法资料与方法 1.1 数据收集数据收集 以患者“姓名、性别、年龄、病名、证型、处方用药、备注”为字段，以 Visual FoxPro 9.0 为数据库开发软件建立专家医案数据库。查阅王玉林教授原始 病案记录，随机抽取 2010 年 9 月至 2011 年 3 月在我院门诊初诊为“急性尿路 感染（热淋） ”医案 63 例，录入该库。 1.2 数据的量化数据的量化 参考中国药典2010 年版一部2规范数据库中的中药药名和性味归经。 本研究约定若某种中药具有某味
8、、某性，归某经记为“1” ，否则记为“0” ，并 取“淡”味附于“甘”味， “涩”味附于“酸”味。 1.3 数据整理和分析数据整理和分析 病案资料经逻辑校对后录入专家数据库，将量化后的中药处方以数据矩阵 的形式导入 IBM SPSS Statistics 19.034，对中药使用频次进行分析，对于频次 高于平均频次的中药进行探索性聚类分析。采用系统聚类的样品聚类，选用组 间距离法，变量的距离测度采用欧式距离平方。 2 结果结果 2.1 药物频数统计药物频数统计 63 例“急性尿路感染（热淋） ”医案共涉及使用中草药 108 味，药物使用 总频次为 1047 次，每味药物的使用平均次数约为 9.
9、69 次。 2.2 高频用药的聚类分析高频用药的聚类分析 根据上述频数统计结果，选取使用频数在 10 次以上的药物共 19 味（对应 编号为：1-荷叶；2-桑叶；3-瓜蒌皮；4-法半夏；5-没药；6-通草；7-甘草；8- 枳壳；9-蝉蜕；10-半枝莲；11-白花蛇舌草；12-蒲公英；13-蒲黄炭；14-荜澄茄 15-金荞麦；16-杠板归；17-黄柏；18-六月雪；19-桂枝）进行系统聚类分析。 如图 1 所示高频用药主要聚类为三类。 3 讨论讨论 急性尿路感染属于“热淋”范畴是中医参与治疗比较有优势的病种之一， 有鲜明的特色。传统中医理论认为肺为华盖，主皮毛，为水之上源，肾主水， 与膀胱互为表
10、里，司二便，气化出则水道利， 内经云：“清阳出上窍，浊阴 出下窍” ， “清阳不升，浊阴不降” ，升清降浊，气机疏利，升清则肺气肃降，通 调水道，下输膀胱，气化出，水道利，小便自畅。药物频数统计共涉及中草药 108 味，使用频数在 10 次以上的药物共 19 味，聚类为三类，以调整气机，清 利湿热为主要构成，印证了王玉林教授治疗急性尿路感染（热淋）升清降浊之 法。该法以疏风理气调滞并清热解毒清除泌尿系之湿热郁结顽疾，清除肾、膀 胱及下焦虚热伏火，共凑升清降浊，清热解毒，疏调气机郁滞，水道畅通，湿 毒有化气出路，而不留着肾与膀胱，小便自利，尿频急痛等证霍然而愈，故临 床应用颇多疗效。 参考文献
11、1张晶晶,舒惠荃.尿路感染的中医治疗进展J.甘肃中医,2007,20(10):58-59. 2国家药典委员会编著.中国药典2010 年版一部S.北京:中国医药科技出版社,2010. 3刘明芝,周仁郁主编.中医药统计学与软件应用M.北京:中国中医药出版社,2006. 4周鲁,唐向阳,付超,等.解表类中药的模糊聚类分析J.华西药学杂志,2004,19(5):339-341. Editors note: Judson Jones is a meteorologist, journalist and photographer. He has freelanced with CNN for four y
12、ears, covering severe weather from tornadoes to typhoons. Follow him on Twitter: jnjonesjr (CNN) - I will always wonder what it was like to huddle around a shortwave radio and through the crackling static from space hear the faint beeps of the worlds first satellite - Sputnik. I also missed watching
13、 Neil Armstrong step foot on the moon and the first space shuttle take off for the stars. Those events were way before my time. As a kid, I was fascinated with what goes on in the sky, and when NASA pulled the plug on the shuttle program I was heartbroken. Yet the privatized space race has renewed m
14、y childhood dreams to reach for the stars. As a meteorologist, Ive still seen many important weather and space events, but right now, if you were sitting next to me, youd hear my foot tapping rapidly under my desk. Im anxious for the next one: a space capsule hanging from a crane in the New Mexico d
15、esert. Its like the set for a George Lucas movie floating to the edge of space. You and I will have the chance to watch a man take a leap into an unimaginable free fall from the edge of space - live. The (lack of) air up there Watch man jump from 96,000 feet Tuesday, I sat at work glued to the live
16、stream of the Red Bull Stratos Mission. I watched the balloons positioned at different altitudes in the sky to test the winds, knowing that if they would just line up in a vertical straight line we would be go for launch. I feel this mission was created for me because I am also a journalist and a ph
17、otographer, but above all I live for taking a leap of faith - the feeling of pushing the envelope into uncharted territory. The guy who is going to do this, Felix Baumgartner, must have that same feeling, at a level I will never reach. However, it did not stop me from feeling his pain when a gust of
18、 swirling wind kicked up and twisted the partially filled balloon that would take him to the upper end of our atmosphere. As soon as the 40-acre balloon, with skin no thicker than a dry cleaning bag, scraped the ground I knew it was over. How claustrophobia almost grounded supersonic skydiver With e
19、ach twist, you could see the wrinkles of disappointment on the face of the current record holder and capcom (capsule communications), Col. Joe Kittinger. He hung his head low in mission control as he told Baumgartner the disappointing news: Mission aborted. The supersonic descent could happen as ear
20、ly as Sunday. The weather plays an important role in this mission. Starting at the ground, conditions have to be very calm - winds less than 2 mph, with no precipitation or humidity and limited cloud cover. The balloon, with capsule attached, will move through the lower level of the atmosphere (the
21、troposphere) where our day-to-day weather lives. It will climb higher than the tip of Mount Everest (5.5 miles/8.85 kilometers), drifting even higher than the cruising altitude of commercial airliners (5.6 miles/9.17 kilometers) and into the stratosphere. As he crosses the boundary layer (called the
22、 tropopause), he can expect a lot of turbulence. The balloon will slowly drift to the edge of space at 120,000 feet (22.7 miles/36.53 kilometers). Here, Fearless Felix will unclip. He will roll back the door. Then, I would assume, he will slowly step out onto something resembling an Olympic diving p
23、latform. Below, the Earth becomes the concrete bottom of a swimming pool that he wants to land on, but not too hard. Still, hell be traveling fast, so despite the distance, it will not be like diving into the deep end of a pool. It will be like he is diving into the shallow end. Skydiver preps for t
24、he big jump When he jumps, he is expected to reach the speed of sound - 690 mph (1,110 kph) - in less than 40 seconds. Like hitting the top of the water, he will begin to slow as he approaches the more dense air closer to Earth. But this will not be enough to stop him completely. If he goes too fast
25、 or spins out of control, he has a stabilization parachute that can be deployed to slow him down. His team hopes its not needed. Instead, he plans to deploy his 270-square-foot (25-square-meter) main chute at an altitude of around 5,000 feet (1,524 meters). In order to deploy this chute successfully
26、, he will have to slow to 172 mph (277 kph). He will have a reserve parachute that will open automatically if he loses consciousness at mach speeds. Even if everything goes as planned, it wont. Baumgartner still will free fall at a speed that would cause you and me to pass out, and no parachute is g
27、uaranteed to work higher than 25,000 feet (7,620 meters). It might not be the moon, but Kittinger free fell from 102,800 feet in 1960 - at the dawn of an infamous space race that captured the hearts of many. Baumgartner will attempt to break that record, a feat that boggles the mind. This is one of those monumental moments I will always remember, because there is no way Id miss this.