| 1 ObjectiveBy the theoretical guidance of " the Combination of Disease and Syndrome, correspondence between syndrome and prescription, and dynamic space-time ", to explore the approach of identification the Chinese medicine and Western medicine group modules of acute ischemic stroke patients in medical electronic data applicative the complex network, and to find the distribution of core Chinese medicine and Western medicine in acute ischemic stroke hospitalized patients, and to get the multidimensional dynamic Chinese medicine and Western medicine group modules with "patient-syndrome-drug-time-effective". The ultimate goals to provide methodological reference for the study of traditional Chinese medicines and Western medicines by a large sample of medical electronic data, and to understanding features of ischemic stroke drug used in real-world, and to provide basic evidence for study the efficacy, safety and mechanism of combined with Chinese medicine and Western medicine, Furthermore, to improve the clinical effect of ischemic stroke Chinese and Western medicine treatment.3 MethodsThe research subjects are 27,678 cases of acute ischemic stroke patients come from 14 large 3A grade hospitals as. It is mainly adopt to complex network analysis approach to get the features of combined use the core Chinese medicine and Western medicine in acute phase four period after in hospital within 1 day,2-3 days,4-7 days and 8-14 days, and identify the relationship between dynamic Chinese medicine and Western medicine group modules and the evolution of the syndrome.3.1 Decision Tree AlgorithmAdopting Decision Tree Algorithm based on information gain. The large information gain value to describe a factor greater impact on the outcome and divide people by this factor as a decision tree node.3.2 Complex Networks Analysis(1) Correlation AnalysisGet the two frequent item sets with the combination of Chinese medicine and Western medicine or Chinese medicine and Western medicine by association analysis.(2) Construction of complex networksConstruct drug complex network with the two frequent item sets with Chinese medicine and Western medicine by association analysis. There are Chinese medicine and Western medicine as nodes in the network, and the edges represent connecting two different drugs together, and the edge weight means the number of patients uses two drugs at the same time, and the node degree is the digit sum of all edges weight connects with the node. If a node has a high node degree, then the node will living in the network center.(3) Extracting the core subnetsGet the total number of drug item set (N), the total frequency of 2-drug item set (SN) and the whole data set in descendent frequency order from database. Extract the first-level core herb combination sub-network:①Get the top K 2-drug item sets, which satisfy, in which 5K is the sum frequency of top K 2-drug item sets;②Store the top K 2-drug item sets in Ucinet software;③Use graph package to visualize the sub-networks from Ucinet.3.3 Correlation AnalysisAdopting to association analysis to obtain three frequent item sets, four frequent item sets, and five frequent item sets of core Chinese and Western medicine in one day,2-3 days,4-7 days and 8-14 days of Chinese Medicine Hospital patients, select to usage rate more than 1% frequent item sets, to divide different functions of Chinese medicine and Western medicine group module in ischemic stroke acute phase.4 Results4.1 Subgroup ConstructionCalculated the admission condition have the maximum information gain is 0.0264, it is the most important factor to impact the outcome, age is the second factor, information gain of 0.0001, that may impact on the outcome but the effect is very small. Gender information gain is 0 for the outcome had no effect. So construct three subgroups of the "urgent", "critically", and "general" groups with the ischemic stroke patients hospitalized patients.4.2 The distribution characters of core Chinese medicine and Western medicine4.2.1 All patientsThe core Chinese medicine and Western medicine distribution characters of "urgent" patients is the core use within 14 days after admission to the same species, mainly to blood-activating and stasis-dissolving drugs, such as Shuxuetong injection, Danhong injection, as well as having a refreshing phlegm drugs as Xingnaojing injection, the patient phlegm refreshing gradually reduced drug use as time. The core Western medicine mainly of antiplatelet drugs, improve microcirculation drugs, neuroprotective agents, anticoagulants and dehydration drugs. Edaravone, brain protein hydrolyzate and other neuroprotective drugs in hospitalized patients to reduce the use of 7 days. Chinese and Western medicine combined to antiplatelet drugs+ blood-activating and stasis-dissolving drugs is the most, followed neuroprotective drugs+ blood circulation, improve microcirculation drugs (such as alprostadil, cinepazide)+ blood-activating and stasis-dissolving drugs.Critically patients admitted to hospital admission within 14 days of using the core of medicine is mainly blood-activating and stasis-dissolving drugs (Danhong injection and Shuxuetong injection) and phlegm refreshing drugs (Xingnaojing injection), most patients use phlegm refreshing drug in 2-6 days. The core medicine mainly of antiplatelet drugs, improve microcirculation drugs, neuroprotective agents, anticoagulants and dehydration drugs, dehydration drugs (mannitol) within 14 days of admission were at the core of drug, neuroprotective agents (citicoline, edaravone) only used in seven days, anticoagulant (heparin) at 3 days after admission. The core of Chinese medicine and Western medicine combined to neuroprotective drugs+ blood-activating and stasis-dissolving drugs and antiplatelet drugs+ blood-activating and stasis-dissolving drugs.General condition of patients admitted to hospital within 14 days of the core medicine mainly for blood-activating and stasis-dissolving drugs (Shuxuetong injection, Danhong injection, Ginkgo biloba extract), phlegm refreshing drugs and calming liver yang drug medicine. The core medicine mainly of antiplatelet drugs, improve microcirculation drugs, neuroprotective agents, anticoagulants and dehydration drugs, dehydration drugs primarily use in three days of admission, and the use of anticoagulants within 7 days. The core of Chinese medicine and Western medicine combination of antiplatelet drugs+ blood-activating and stasis-dissolving drugs, improve microcirculation drugs+ blood-activating and stasis-dissolving drugs, neuroprotective agents+ blood-activating and stasis-dissolving drugs.Urgent, critically, and general patients core Chinese medicine mainly used in blood-activating and stasis-dissolving drugs and phlegm refreshing drugs, and the patient gradually decreases use phlegm refreshing drug in all types of patients over time. The core and Western medicine mainly used in anti-platelet drugs, improve microcirculation drugs, neuroprotective agents, anticoagulants and dehydration drugs, dehydration drugs for patients at risk of illness hospitalized hospitalized 14 days, and admission for the general condition of the patients admitted to hospital 3 days as the core drug use, neuroprotective agents in patients admitted to hospital for 7 days use declined. A combination of Chinese and Western medicine mainly for neuroprotective drugs+ blood circulation drugs, antiplatelet drugs+ blood-activating and stasis-dissolving drugs, improve microcirculation drug+ blood-activating and stasis-dissolving drugs; phlegm refreshing drug in hospitalized patients with urgent patients and general primary and neuroprotective drugs used in combination, the risk of illness and hospitalization in patients with multi-drug used in combination with dehydration.4.2.2 Patients in Chinese Medicine HospitalUrgent hospitalized patients with consistent with core proprietary Chinese medicine efficacy in all patients, mainly mainly to blood-activating and stasis-dissolving drugs, within 14 days of the change is not significant, effect core medicine mainly antiplatelet drugs, anticoagulants and improve microcirculation drugs, neuroprotective and dehydrated powder does not enter the core medicine, anticoagulant drugs only 7 days of hospitalization among as the core medicine, the type of other drugs in acute period, no significant change. Chinese and Western medicine combined to antiplatelet drugs+ blood-activating and stasis-dissolving drugs is the most, followed by improve microcirculation drug+ improve microcirculation blood circulation drugs, neuroprotective agents+ blood-activating and stasis-dissolving drugs, anticoagulants + blood-activating and stasis-dissolving drugs.Critically patients hospitalized core medicine consistent with efficacy in all patients, no significant changes in the acute phase, core medicine in the use of anticoagulation in all patients early, dehydration drug use in hospitalized 7 days more, neuroprotective agents did not appear. The core of Chinese medicine and Western medicine in combination with antiplatelet drugs+ blood-activating and stasis-dissolving drugs, dehydration drugs+ phlegm refreshing medicine for more.General condition of the patients is consistent with the core of medicine efficacy in all patients, but more than all the specific types of patients, the core of medicine efficacy and significantly less than all types of patients, anticoagulant, neuroprotective and dehydrated powder does not appear, the core of Chinese and Western medicine admission, no significant change in 14 days. The core of Chinese and Western medicine combination of antiplatelet drugs+ blood-activating and stasis-dissolving drugs, improve microcirculation blood circulation drugs+ blood-activating and stasis-dissolving drugs.Different admission conditions not significantly different patients within 14 days of the change at the core of Chinese medicine and Western medicine, the core of Chinese medicine for blood-activating and stasis-dissolving drugs and the use of the main drugs phlegm refreshing, core medicine mainly anti-platelet drugs, improve microcirculation blood circulation drugs, anticoagulants and dehydration drugs, A comparison of all patients and the lack of neuroprotective drugs, anticoagulants and dehydration in drug use also less than all of the patients, mainly Chinese and Western medicine combination is consistent with all patients.4.3 Core Evolution characteristics of the syndrome elementsThere are the core syndrome elements of blood stasis syndrome, phlegm, endogenous wind, yin deficiency, qi deficiency, heat, hyperactivity of liver yang, liver, kidney, and its composition is mainly of phlegm-blood stasis, endogenous wind-phlegm-blood stasis, qi deficiency-blood stasis, liver-kidney-yin deficiency, liver-hyperactivity of liver yang, phlegm-heat. During 8-14 days hospitalized the core syndrome elements of blood stasis, phlegm, yin deficiency, qi deficiency, endogenous wind, hyperactivity of liver yang, liver, kidney, the combination mainly about phlegm-blood stasis, endogenous wind-phlegm, qi deficiency-blood stasis, liver-kidney-yin deficiency, liver-hyperactivity of liver yang.Node degree analysis showed that patients admitted to hospital within 14 days, within the core syndrome elements of the syndrome of endogenous wind, heat and other excess syndrome elements’ importance were decline, and yin deficiency, qi deficiency syndrome elements increased the importance. The syndrome elements network presents " excess syndrome elements module" and "deficiency syndrome elements module".4.4 core Western medicine group moduleAdopting correlation analysis to research the various types of hospitalized patients at different time to analyze the core of Chinese and Western medicines, for each type of patients formed multiple three, and four, and five Chinese and Western medicine combination. Different Chinese and Western medicine combination have different efficacy and functional. So it formed dynamic Chinese and Western medicine group modules have different functions with different syndrome elements, condition and times.4.4.1 Admission core Western medicine program in 7 daysAccording to the patient syndrome elements distribution, urgent admission patients in TCM hospital the core of Chinese and Western medicine module within 7 days mainly "blood-activating and stasis-dissolving module", and mainly consist of" antiplatelet drugs+ improve microcirculation medicine+ blood-activating and stasis-eliminating drugs ", "antiplatelet+ anticoagulants+ blood-activating and stasis-eliminating drugs" module, high support module is aspirin+ heparin+ Ligustrazine, aspirin+ vinpocetine+ Ginkgo biloba extract and something like that; "stasis-dissolving and reduce phlegm module" constitute mainly for the "antiplatelet drugs+ improve microcirculation medicine+ phlegm refreshing drug" such as aspirin+ vinpocetine+ Xingnaozaizao capsule and the like.General patients of the core Chinese medicine and Western medicine module is similar as urgent patients, except that does not appear the "antiplatelet drugs+ anticoagulants+ blood-activating and stasis-eliminating drug" module.We were not found critically patients admitted to hospital more than 1% of the utilization of three or more Chinese medicine and Western medicine module. None of the above modules appear yiqi, fuzheng, and benefit Yin medicine used.4.4.2 In 8-14 days admission core Western medicine programUrgent patients hospitalized using the core module of Chinese medicine and Western medicine module in 8-14 days as "blood-activating and stasis-dissolving module", specifically configured to "antiplatelet drugs+ improve microcirculation medicine+ blood-activating and stasis-eliminating drug", "antiplatelet drags+ anticoagulants+ blood-activating and stasis-eliminating drug", high support module is aspirin+ vinpocetine+ aspirin+ Ginkgo biloba extract, aspirin+ heparin+ TMP and the like. Critically patients hospitalized using the core module of Chinese medicine and Western medicine module mainly as "blood-activating and stasis-dissolving module ", specifically "antiplatelet drugs+ defibrase medicine+ blood-activating and stasis-eliminating drugs", "antiplatelet drugs+ anticoagulants+ blood-activating and stasis-eliminating drugs". High support module for the aspirin+ Lumbrokinase+ Ginkgo biloba extract, aspirin+ heparin+ Ginkgo biloba extract and the like.General patients hospitalized using the core module of Chinese medicine and Western medicine module mainly as "blood-activating and stasis-dissolving module," specifically "antiplatelet drugs+ improve microcirculation medicine+ i blood-activating and stasis-eliminating drugs" module, high degree of support programs for the aspirin+ vinpocetine+ Ginkgo biloba extract, aspirin+ cinepazide+ Ginkgo biloba extract.None of the above modules appear yiqi, fuzheng, and benefit Yin medicine used.5 Conclusion5.1 The complex network is scale-free network constructed by Chinese medicine and Western medicine of ischemic stroke acute phase based on medical electronic data, and each core node are connected tightly. Adopting the hierarchical core structure algorithm combines associated analysis to find different functions Chinese medicine and Western medicine module group. It is to provide methodological reference for the study of traditional Chinese medicines and Western medical using big medical data.5.2 The core Chinese medicine of patients mainly for blood-activating and stasis-dissolving drug, and refreshing resuscitation drug, and the core Western medicine mainly used improve circulation drugs and neuroprotective drugs by guidelines recommend. The neuroprotective drugs, anticoagulant drug and dehydration drug using less than all patients in Chinese medical hospital patients. There no yiqi, fuzheng, and benefit Yin medicine used with drug used in acute phase. This research provides evidence for understanding the characteristics of ischemic stroke patients’Chinese medicine and Western medicine using in real-world.5.3 The syndrome elements network in acute ischemic stroke syndrome mainly shows the "excess syndrome elements module" and "deficiency syndrome elements module". The excess syndrome elements’importance is declining, and the deficiency syndrome elements importance is rising. It provides new evidence for the syndromes research of acute ischemic stroke.5.4 Patients admitted to hospital in seven days of Chinese medicine and Western medicine module for the "blood-activating and stasis-dissolving module" and " stasis-dissolving and reduce phlegm module", and in 8-14 days admission primary use "blood-activating and stasis-dissolving module". The research provides the basis for in-depth study of the efficacy, the safety and the mechanism of Chinese medicine and Western medicine combined used. |
PDF Full Text Request