A Clinical Retrospective Study Of TCM Syndrome Factors And Medication Rules In Patients With Hypertension Complicated With Non-valvular Atrial Fibrillation

Objective:Through the methods of data mining and data analysis,the general information,syndrome elements,traditional Chinese medicine rules of patients with hypertension and non-valvular atrial fibrillation are analyzed and mining,so as to provide references and ideas for clinical treatment of traditional Chinese medicine.Methods:In this study,patients with hypertension and non-valvular atrial fibrillation who were hospitalized in the Department of Cardiology,Guang’anmen Hospital,China Academy of Chinese Medical Sciences from January 2016 to July 2020,were the subject of a retrospective analysis;Use SPSS 23.0 to analyze the patient’s general data,clinical signs,and syndrome elements;The first prescription taken by the patient is entered into the traditional Chinese medicine inheritance auxiliary platform software(V2.5),and data mining and analysis are carried out on the analysis methods of frequency,association rules and complex system entropy clustering of traditional Chinese medicine.Results:1.A total of 217 patients with hypertension and non-valvular atrial fibrillation were enrolled,including 85 males and 122 females.The male to female ratio was 1:1.28.The youngest was 39 years old,the oldest was 91 years old,and the age>75 years old was the most,accounting for 54.4%of the total.Followed by 65-74 years old,accounting for 28.6%of the total.Among them,52 cases were smoking patients,accounting for 24.0%of the total number,and 42 cases were drinking patients,accounting for 19.4%of the total number.The duration of hypertension was the largest in 5-14 years,accounting for 30.4%of the total number,followed by 15-24 years,accounting for 23.5%of the total number of patients,with an average course of 18.3±13.4 years;while atrial fibrillation has a shorter course,with an average course of 5.3±7.5 years.Most patients have a course of less than 5 years,accounting for 63.1%of the total.The common complications in descending order are hyperlipidemia(184,84.8%),arteriosclerosis(164,75.6%),coronary heart disease(114,66.4%),cerebral infarction(107,49.3%),and cardiac function Insufficiency(85,39.2%),diabetes(83,38.2%),hyperhomocysteinemia(83,38.2%),etc.2.The symptoms of patients with hypertension and non-valvular atrial fibrillation include palpitations(173,79.7%),chest tightness(134,61.8%),insomnia(113,52.1%),dizziness(90,41.5%),fatigue(84,38.7%),dry mouth(70,32.3%),shortness of breath(56,25.8%),etc.are mainly involved,involving 10 types of tongue,10 types of moss,and 12 types of pulse.The distribution of TCM syndrome elements from high to low is qi deficiency(130,59.9%),Yin deficiency(55.3,120%),phlegm(53.9,117%),blood stasis(104,53.9%),and yang deficiency(33,15.2%),fluid retention(32,14.7%),Fire-heat(30,13.8%),and stagnation of qi,blood deficiency,dampness,and yang hyperactivity are rare;3.The results of the stratification analysis of syndrome elements showed that the older the age,the higher the frequency of yang-deficiency syndrome(P<0.05);the proportion of patients with paroxysmal atrial fibrillation with qi-deficiency syndrome was higher than that of non-paroxysmal AF(P<0.05),but The proportion of patients with non-paroxysmal atrial fibrillation with fluid retention syndrome is higher than that of patients with paroxysmal atrial fibrillation(P<0.05);The correlation coefficients of fluid retention syndrome and blood stasis syndrome with CHA2DS2-VASc scores were 0.148 and 0.143,respectively(P<0.05),which was statistically significant;the correlation coefficient between fluid retention and HAS-BLED scores was 0.179(P<0.05).The difference is statistically significant.4.The commonly used drugs in the Department of Cardiology of Guang’anmen Hospital for the treatment of hypertension with non-valvular atrial fibrillation include Glycyrrhizae Radix(Gancao),Poria Cocos(Fuling),Cinnamomum Cassia Presl(Guizhi),Pinellia Ternata Breit(Banxia),Atractylodes Macrocephala Koidz(Baizhu),Ophiopogon Japonicus(Maidong),Codonopsis Pilosula(Dangshen),Ostrea Gigas Thunberg(Muli),and Astragalus propinquus Schischkin(Huangqi).The efficacy of drugs with a frequency of use>20 are classified,with Qi-tonifying drugs,blood-activating drugs,phlegm and cough-relieving drugs,qi regulating drugs,heat-clearing drugs,Yin tonifying drugs,and soothing drugs,etc.The five flavors are sweetness the most,followed by bitterness and pungency;the main spleen meridians and heart meridians are the main channel tropism.The support 30 is set,the confidence is set to 0.8,to give,to obtain a high-frequency group 56 and pharmaceutical compositions found 9 pharmaceutical association rules,the core formulation Glycyrrhizae Radix(Gancao),Cinnamomum Cassia Presl(Guizhi),Poria Cocos(Fuling),Atractylodes Macrocephala Koidz(Baizhu),Fossilia Ossia Mastodi(Longgu),Ostrea Gigas Thunberg(Muli),Pinellia Ternata Breit(Banxia),Citrus Reticulata Blanco(Chenpi),Ophiopogon Japonicus(Maidong),Codonopsis Pilosula(Dangshen)and Schisandra chinensis(Wuweizi);Set the correlation degree to 5 and the penalty degree to 2.Based on the entropy clustering method,6 new prescriptions are obtained:①Caulis Bambusae(Zhuru)_Citrus Reticulata Blanco(Chenpi)_cPinellia Ternata Breit(Banxia)_Schisandra Chinensis(Wuweizi),②Lepidium Apetalum Wild(Tinglizi)_Perillafrutescens(Zisuzi)_Morus Alba L(Sangbaipi)Dalbergia odorifera(Jiangxiang)_Amomum villosum Lour(Sharen)_Semcraphani(Laifuzi),③Armeniaca Vulgaris Lam(Xingren)_Aster tataricus L(Ziwan)_Tussilago Farfara L(Kuangdonghua)_Ephedra Sinica Stapf(Mahuang)_Gypsum(Shigao),④Uncaria Rhynchophylla Miq(Gouteng)_Taxillus Sutchuenensis Danser(Sangjisheng)Eucommia Ulmoides Oliver(Duzhong)_Haliotis Diversicolor Reeve(Shijueming),⑤ Citrus Medica Sarcodactylis(Foshou)_Spatholobus Suberectus Dunn(Jixueteng)_Plantago Asiatica L(Cheqiancao)_Hordeum Vulgare L(Maiya),⑥Ostrea GigasThunberg(Muli)_Fossilia Ossia Mastodi(Longgu)_Cinnamomum Cassia Presl(Guizhi)_Beauveria Bassiana Vuillant(Jiangchan)_Cryptotympana Pustulata Fabr(Chantui).Conclusion:1.The syndrome element distribution of hypertension combined with non-valvular atrial fibrillation is qi deficiency,yin deficiency,phlegm turbidity and blood stasis,followed by fluid retention,fire-heat,stagnation of qi,blood deficiency,and so on.2.The older the age,the higher the frequency of yang deficiency.Patients with qi deficiency are mostly found in paroxysmal atrial fibrillation,while those with fluid retention are mostly found in non-paroxysmal atrial fibrillation.Patients with qi deficiency and fluid retention have a larger left atrium.The risk of thrombosis with fluid retention and blood stasis is higher,and the risk of bleeding with fluid retention is also higher.3.Department of Cardiology,Guang’anmen Hospital,treats hypertension with non-valvular atrial fibrillation,mainly for replenishing qi and nourishing yin,promoting blood circulation and removing blood stasis,regulating qi,clearing away heat and soothing the nerves.The core drugs are Glycyrrhizae Radix(Gancao),Cinnamomum Cassia Presl(Guizhi),Poria Cocos(Fuling),Atractylodes Macrocephala Koidz(Baizhu),Fossilia Ossia Mastodi(Longgu),Ostrea Gigas Thunberg(Muli),Pinellia Ternata Breit(Banxia),Citrus Reticulata Blanco(Chenpi),Ophiopogon Japonicus(Maidong),Codonopsis Pilosula(Dangshen)and Schisandra chinensis(Wuweizi):Six new prescriptions were obtained based on the entropy clustering method,and further clinical verification is required.