Study On The Distribution Of Stage Types And Treatment Of Pulmonary Nodules And Target Drugs Based On The Theory Of Stage-target Differentiation And Treatment

ObjectiveModern medicine lacks effective intervention methods in the follow-up period of pulmonary nodules.Through clinical practice and relevant literature,TCM diagnosis and treatment of pulmonary nodules shows certain advantages.Asymptomatic pulmonary nodules are common in clinical practice.Traditional TCM syndrome differentiation and treatment cannot provide appropriate medication strategies.Simple syndrome-based treatment is not enough to build a complete TCM diagnosis and treatment system for pulmonary nodules.A mature and systematic TCM diagnosis and treatment that can be implemented clinically Programs are lacking.The theory of Stage-target Differentiation and Treatment is a brand-new diagnosis and treatment strategy proposed by Academician Tong Xiaolin by combining traditional clinical differentiation and treatment methods with modern medical knowledge.It makes up for the limitations of traditional syndrome differentiation and is widely used in clinical diagnosis and treatment of chronic diseases.Guided by the Theory of Stage-target Differentiation and Treatment,this study summarizes and explores the law of stage type and treatment of pulmonary nodules.In order to provide ideas and reference for the TCM diagnosis and treatment of pulmonary nodules.Methods1 Clinical study on exploring the state pattern of pulmonary nodules based on the Theory of Stage-target Differentiation and TreatmentThe State Target Information Collection Form was formulated by consulting relevant literature and books.The collected information was input into the Epidata to establish the state target information database,and the corresponding values were calculated and classified according to the "state target typing calculation table".According to the relevant guidelines on pulmonary nodules and the relevant information of Peking University lung cancer model,the CT Information Collection Form was formulated,the information involved general patient data(including gender,age,smoking history,personal tumor history,family tumor history,sleep duration,past history,etc),and CT imaging related information(including pulmonary nodule diameter,density,location,boundary,etc).The model program was written by Matlab R2016a software.The probability value of Peking University lung cancer model was calculated,and according to the standard of Experts in the Diagnosis and Treatment of Pulmonary Nodules(2018 edition)<5%,[5%,65]and>65%classified into low,medium,and high-risk pulmonary nodules.Finally,SPSS 29.0 was used for data analysis and processing,to summarize the specific pattern distribution of patients with pulmonary nodules,and to explore the regular relationship between the pattern pattern of pulmonary nodules and the risk value of pulmonary nodules.2 Data mining technology is used to explore the target drugs of pulmonary nodulesThrough literature search and screening,the relevant literature was included and famous prescription data set(data set 1),pulmonary nodule empirical prescription data set(data set 2)were established.Apply the R.4.2.2 to analyze the prescription association rules for Dataset 1.Apply the to R.4.2.2、SPSS Modeler 18.0、SPSS 29.0 analyze the association rules of Traditional Chinese medicine and cluster analysis for Dataset 2.Results1 Clinical study on exploring the state pattern of pulmonary nodules based on the Theory of Stage-target Differentiation and Treatment①A total of 300 patients with pulmonary nodules were included in this study,including 210 women and 90 men,with a male to female ratio of 3:7.The mean age of the patients was 52.85 years.Among the 300 patients,199 patients had nodules at other sites,accounting for 66.33%.②The imaging findings of pulmonary nodules were multiple pulmonary nodules,214 cases(71.33%);208 cases(69.33%);165 cases(55.00%)in the upper lobe of 200%;the diameter was[5,10]mm,233 cases(77.67%).Of the 300 patients with pulmonary nodules,9(3.00%)had burrs,5(1.67%)with calcification,47(15.67%)with blurred boundary,8(2.67%)with leaflets,7(2.33%)with vacuoles,and 17(5.67%)with vessel collection.③300 patients with pulmonary nodules were finally divided into 11 types,the total distribution of each type was gloomy state 220 times(73.33%)>weak state 165 times(55.00%)>dryness state 146 times(48.67%)>cold state 134 times(44.67%)>blood stasis state 119 times(39.67%)>sputum and wet state 96 times(32.00%)>obstruction state 92 times(30.67%)>aging state 77 times(25.67%)>heat state 56 times(18.67%)>balanced state 13 times(4.33%)>barren state 11 times(3.67%).④Cluster analysis of 10 "consistent" configuration types(no balanced state)found that a close relationship between sputum and wet state and dryness state,gloomy state and weak state,while the rest states were relatively independent.⑤The female patients’ frequent state types were gloomy state(100,48%)and weak state(72,34%),and the male patients’ frequent state types were gloomy state(24,80%)and cold state(13,43%).The most common pattern in the youth group,middle age group and middle-aged group was gloomy state,with the frequency distribution of 42(34%),38(31%)and 44(29%),and the most common pattern in the elderly group was cold state(3 times,23%).⑥ Among 300 patients with pulmonary nodules,moderate-risk pulmonary nodules(236patients,78.67%)>high-risk lung nodules(411patients,3.67%)>low-risk pulmonary nodules(23patients,7.67%).⑦The overall distribution of various state patterns in patients with high,moderate and low risk pulmonary nodules did not show significant statistical differences(P>0.05).In patients with weak state,dryness state,aging state,heat state and balanced state,The distribution of risk grades for each lung cancer was statistically different(P<0.05).2 Data mining technology is used to explore the target drugs of pulmonary nodules① Data set 1:A total of 55 articles were included,and 128 traditional prescriptions were mined.The cumulative frequency of prescriptions was 325 times.The highest statistical frequency was Erchen Tang,with 19 times.The 33 first prescriptions with a use frequency of 5%were classified according to their efficacy,and the tonic agent(72 times,22.15%)and the expectorant(38 times,11.69%)were used more frequently;and the tonic(60 times,18.46%)had the highest proportion,and the expector(33 times,10.15%)had the highest proportion.Apply to R.4.2.2 According to the analysis of association rules,a total of 31 effective association rules were obtained.The strongest prescription correlation were Erchen Tang,Si gentleman Tang,with an improvement degree of 7.86.②Data set 2:A total of 28 articles were included,and 28 empirical prescriptions of pulmonary nodules were excavated,including 139 herbs,354 times.The Chinese medicine with the highest statistical frequency was Fritillariae Thunbergii Bulbus,Astragalus and licorice,and the frequency was 13 times.The 45 traditional Chinese medicines with use frequency of 10%were classified,and the deficiency drugs(74 times,30.96),and the phlegm(48 times,20.08%)were used;the tonic drugs(66 times,20.31%)had the highest proportion;and the expectorant(34 times,10.46%)had the highest proportion.AppIy to R.4.2.2 For the association rule analysis,a total of 88 association rules were obtained.The strongest drug correlation is divine tune→Ligusticum wallichii、rhizoma atractylodis→Ligusticum wallichii,with an promotion degree of 5.6.Through SPSS Modeler 18.0,draw the TCM network diagram,It suggests the strong association of[fritillaria verticillata-pinellia ternata-astragalus mongholicus-liquorice].Through cluster analysis of high-frequency applied Chinese medicine by SPSS 29.0,a total of 6 core prescriptions were obtained,which were:Set 1——sculellaria barbata,herba hedyotis,adenophora tetraphylla,lilyturf root,curcuma zedoary,turtle shell.Set 2——poria cocos,rhizoma dioscoreae,white atractylodes rhizome,fritillaria verticillata,pericarpium citri reticulatae.Set 3——astragalus mongholicus,the root of red-rooted salvia,codonopsis pilosula,liquorice,fructus aurantii immaturus,pinellia ternata,ligusticum wallichii,ternate buttercup root,selfheal.Set 4——rhizoma cyperi,radix curcumae.Set 5——semen coicis,platycodon grandiflorum.Set 6——fructus aurantii,scutellaria baicalensis,ostracean,radix bupleuri.Conclusions1 The multiple state types of patients with pulmonary nodules are successively:gloomy state,weak state,dryness state,cold state,blood stasis state,sputum and wet state,obstruction state.The infrequent forms of patients with pulmonary nodules are aging state,heat state.2 Among the patients collected,the medium-risk pulmonary nodules were the most widely distributed,followed by high-risk nodules and the lowest number of low-risk nodules.3 The low-risk lung nodules were the most widely distributed in the weak state patients.The high-risk lung nodules were the most widely distributed in the dryness state,aging state.The medium-risk pulmonary nodules were the most widely distributed in the heat state.There is no distribution of high-risk nodules in the balanced state.4 Through the data mining of the traditional name prescription and the empirical prescription of pulmonary nodules applied in the literature,the types of prescriptions with higher frequency of use are tonic agent and expectorant,and the prescription with the highest frequency of use is Erchen Tang;the types of Chinese medicine with high frequency are tonic deficiency medicine,relieving cough and reducing sputum medicine,and the highest frequency is Zhejiang fritillary,astragalus and licorice;and through the cluster analysis to obtain 6 core prescription.