| Objective:This project was based on the large database platform, to build disease information database information platform for large-scale comprehensive Chinese medicine hospital for 10 years, and integrated the data mining technology、information technology、statistics、evidence-based medicine and other methods. We mainly discovered the diagnosis information of diabetes and complication patients to construct the knowledge in the diagnosis process, in order to provide scientific basis for clinical diagnosis and prognosis of the disease.Methods:According to the inclusion criteria,11421 type2 diabetes and complications inpatients were included, these patients from different departments of hospital from2003 to 2014. The western medicine diagnosis were unified specification and main referenced 《practical medicine》, in a rough dimension specification for the principle to standardized all involved western medicine diagnosis. The diseases that had stage and classification were unified, if the diseases were not clear, we need to make clear in the medical record by the hospital system according to medical record number, and cleaned the extracted case data. The western medicine diagnosis was replaced by the current national, industry standards. The TCM patterns were standard according to 《Diagnostics of TCM》that editor in chief was Zhu Wen-feng、《Clinical diagnosis and treatment of TCM-TCM syndrome study on specification》、《Study of TCM syndrome》, the not involving syndromes shall be maintained. According to the concept and characteristics of syndrome factors that were put forward by professor Zhu Wen-feng, also combined with the 《Diagnostics of TCM》 《Clinical diagnosis and treatment of TCM-TCM syndrome study on specification》 and 《Study of TCM syndrome》 to splitthe composite syndromes. At the time of split, in case of ambiguity or uncertainty, we consult the higher team qualification experts, if it was not sure in the end; we kept the original syndrome name. Using SQL server data mining software, SPSS 17.0 statistical analysis software, etc, and using the frequency analysis、association rule、 clustering analysis、correspondence analysis and factor analysis to study the basic situation of type2 diabetes and complications patients, infection situation, the regularity of disease and syndrome differentiation and the law of syndrome elements, etc.Results:1. General situation:11421 patients were included, among the 11421 patients, the maximum age was 90, the minimum age was8 years old, the mean age was63.53 ±12.80, the most concentrated distribution was 45-yearsold, the followed was more than 70years old, but the people of<30 years old has some percentage; Gender difference was statistically significant difference (χ2=237.09, P <0.001)2. The analysis of hospitalization days> hospitalization times and hospitalization expense:The mean hospitalization days was 13.03±7.49 days, diverse gender hospitalization days was significant difference(P<0.05), and showed a slow decline trend from 2003 years to 2014 years-, The mean hospitalization times was 2.83±3.46 times, diverse gender hospitalization times wasno significant difference (P>0.05); The mean hospitalization expense was 11456.07yuan, and increased year by year, but the trend was not so obvious.3. The distribution of main diagnosis:The most primary diagnosis were type 2 diabetes(72.5%), followed by the type 2 diabetic nephropathy(7.9%), type 2 diabetes with neurological complications was 7.5%, type 2 diabetes with foot disease was 5.2%, type 2 diabetes with eye complications was 3.2%, diabetic ketoacidosis (DKA) was 2.9%. The correspondence study of main diagnosis and age showed that DKA were mainly displayed<30and more than 30years old crowd, type 2 diabetes with eye complications mainly occurred in more than 45years old, type 2 diabetes with neurological complications-. type 2 diabetic nephropathy and type 2 diabetes were 65-, more than 70 years old crowd, and type 2 diabetes also usually occurred in more than 30 years old crowd, type2 diabetic foot disease was generally more than 70 years old.4. The morbidity of diabetes complications:3946 cases were type 2 diabetes with neurological complications(34.55%),3444 cases were type 2 diabetes with eye complications (30.15%),3402 cases were type 2 diabetic nephropathy (29.79%),829 cases were diabetic foot disease (7.26%),749 cases were DAK (6.56%),718 cases were diabetic peripheral vascular disease (6.29%),212 cases were diabetic neurogenic bladder inflammation (1.86%),30 cases were diabetic hypoglycemic coma (0.26%),28 cases were diabetic heart (0.25%),6 cases were diabetic charcotarthropathy (0.05%).The correlation analysis of diabetes complications showed that diabetic nephropathy、type 2 diabetes with neurological complications were closely to the eye complications, type 2 diabetic peripheral vascular disease was closely related to neurological complications, type 2 diabetes foot disease and DAK had a more lower correlation with other complications.5. The department distribution of 11421 patients:These patients were hospitalized mainly through endocrinology department (accounted for 78.9%), and kidney department secondly (accounted for6.5%), cardiovascular department thirdly (accounted for 2.6%). The different main diagnosis had different hospital departments. The patients that type 2 diabetes as the main diagnosis were mainly distributed in endocrinology and kidney department, the patients that neurological complications as main diagnosis were mainly distributed in endocrinology and neurology department, the patients that type 2 diabetic nephropathy as main diagnosis mainly distributed in endocrinology and kidney department, the patients that eye complications as primary diagnosis were mainly distributed in ophthalmology and endocrinology, and the patients that type 2 diabetic foot disease as primary diagnosis were mainly distributed surgery and endocrinology.6.The study of TCM diagnosis:We extracted 60 TCM diagnosis from these 11421 patients, the top ten frequency were xiaoke、jinbi、xiaoke mortification、 edema、diabetes nephropathy、blurred vision、stranguria (disease)、impotent soft stupor、coma, lumbago. According to different main western diagnosis, the TCM diagnosis was diverse. The TCM diagnosis of type 2 diabetes in turn were:xiaoke、xiaokejinbi、edema (disease)、xiaoke mortification waist pain; The TCM diagnosis of type 2 diabetes with neurological complications in turn were:xiaokejinbi、impotent soft numbness、xiaoke、deep faint atto、retention of urine; The TCM diagnosis of eye complications mainly included blurred vision、 xiaoke、xiaokejinbi、blindness、edema (disease); The TCM diagnosis of DKA mainly included xiaoke、xiaokejinbi、vomiting、coma、dizziness;The TCM diagnosis of type 2 diabetic nephropathy had edema (disease), diabetes kidney disease、 xiaoke、stranguria (disease)、lumbago; The TCM diagnosis of type 2 diabetes foot disease mainly included xiaoke gangrene、xiaoke、xiaoke jinbi、JueTuo certificate(disease)、furuncle.7. The analysis of western medicine disease and syndrome differentiation: There were 187 TCM patterns after regulated, the top five patterns were Qi and Yin deficiency and blood stasis(17.6%)、Qi and Yin deficiency, hot and damp stasis resistance(14.8%)、Qi and Yin deficiency(7.5%)、Qi deficiency pattern(7.4%)、Qi and Yin deficiency, damp turbidity stasis resistance(7.3%). The syndromes that type 2 diabetes as main diagnosis in turn were Qi and Yin deficiency and blood stasis (19.5%)、Qi and Yin deficiency, hot and damp stasis resistance (13.8%)、Qi and Yin deficiency, wet and turbidity stasis resistance (13.8%)、Qi and Yin deficiency (7.4%), Qi deficiency syndrome (7.4%). The syndromes that type 2 diabetic nephropathy as main diagnosis in turn were Qi deficiency syndrome (9.4%), spleen and kidney deficiency, dampness stasis resistance (9.2%)、spleen and kidney deficiency (9.0%)、Qi and Yin deficiency, hot and damp stasis resistance(8.7%)、Qi and Yin deficiency (8.6%);The syndromes that type 2 diabetes with neurological complications as main diagnosis in turn were Qi and Yin deficiency and blood stasis (24.2%)% Qi and Yin deficiency, hot and damp stasis’ resistance (19.0%)、Qi and Yin deficiency, wet and turbidity stasis resistance (13.7%)、Qi and Yin deficiency, phlegm and blood stasis resistance (6.1%)、Qi deficiency and phlegm and blood stasis blocking collaterals (4.3%); The syndromes that type 2 diabetes with foot disease as main diagnosis.in turn were Qi and Yin deficiency, hot and damp stasis resistance (40.5%)% Qi and Yin deficiency (7.9%)、Qi deficiency syndrome(5.4%)、Qi and Yin deficiency and blood stasis (4.0%)、Qi deficiency and phlegm and blood stasis blocking collaterals (3.5%); The syndromes that DKA as main diagnosis in turn were Qi and Yin deficiency (17.4%)、Qi and Yin deficiency, hot and damp stasis resistance(16.5%)、Qi deficiency syndrome(12.8%)、Qi and Yin deficiency and blood stasis (11.0%)、Qi and Yin, phlegm heat and blood stasis resistance (10.7%); The syndromes that with eye complications as main diagnosis in turn were Qi and Yin deficiency and blood stasis (24.0%)、Qi and Yin deficiency (12.5%)、Qi deficiency syndromes (12.0%)、 Qi and Yin deficiency, phlegm and blood stasis resistance (11.2%), spleen and stomach deficiency (5.2%).8. The research of traditional Chinese medicine and syndrome differentiation:The syndromes that xiaoke as diagnosis were Qi and Yin deficiency and blood stasis (20.7%)、Qi and Yin deficiency, hot and damp stasis resistance (14.9%)、Qi and Yin deficiency, wet and turbidity stasis resistance (8.2%)、Qi deficiency (7.9%)、Qi and Yin deficiency, phlegm and blood stasis resistance (5.7%); The syndromes that xiaoke jinbi as diagnosis were Qi and Yin deficiency (27.0%)、Qi and Yin deficiency and blood stasis (15.4%)、 Qi and Yin deficiency, damp heat and blood stasis resistance (12.7%)、Qi and Yin deficiency, wet and turbidity stasis resistance (9.1%)、Qi and Yin deficiency, phlegm and blood stasis resistance (3.9%). The syndromes that diabetes gangrene as diagnosis were Qi and Yin deficiency, hot and damp stasis resistance (42.1%)、Qi and Yin deficiency (7.7%)、Qi and Yin deficiency and blood stasis (3.7%)、Qi deficiency, phlegm and blood stasis resistance (3.5%)、 Qi and Yin deficiency, wet and turbidity stasis resistance (3.3%); The syndromes that edema (disease) as diagnosis were spleen and kidney deficiency(22.7%)、 Qi and Yin deficiency (14.1%)、spleen and stomach deficiency (13.5%)、Qi deficiency(10%)、spleen and kidney deficiency, dampness and blood stasis resistance (3.8%); The syndromes that diabetes kidney disease as diagnosis were Qi and Yin deficiency, hot and damp stasis resistance (17.3%)、spleen and kidney deficiency, wet and turbidity stasis resistance (15.6%)、Qi and Yin deficiency, wet and turbidity stasis resistance(11.3%)、spleen and kidney deficiency, hot and damp stasis resistance (9.1%)、Qi and Yin deficiency, blood stasis (6.2%)。9. The analysis of syndrome factors:We extracted 41 syndrome factors, spleen was the most disease location factor(15.81%), the other in turn were kidney、meridians、liver、stomach and lung;Qi deficiency was the most disease syndrome factor (79.06%), the other in turn were blood stasis、Yin deficiency、 wet、hot、phlegm、Yang deficiency and water retention; According to the study of syndrome factors combination that three syndrome factors, four syndrome factors and five syndrome factors combinations were the more common. The correlation analysis showed that Qi deficiency、blood stasis、Yin deficiency and wet form four core networks, influenced other syndrome factors, and between each other. Yin deficiency、 blood stasis、dampness、phlegm、heat、spleen and kidney were closely related to Qi deficiency; Dampness、phlegm、hea、yin deficiency, kidney and spleen were closely related to blood stasis; The kidney and spleen has close relationship each other.10. The analysis of TCM syndrome differentiation factors of type 2 diabetes patients:The differentiation factors of type 2 diabetes patients can be divided into four components, the first component was composed of blood stasis, dampness, heat, the second component was composed of Yang deficiency and water stop, has negative correlation with Qi deficiency, the third component was composed of Yin deficiency, Qi deficiency, has negative correlation with Qi stagnation, The fourth component was phlegm; The differentiation factors of type 2 diabetic nephropathy patients can be divided into four components, the first component was composed of blood stasis, dampness, water stop, the second component was composed of Yang deficiency, and has negative correlation with Qi deficiency, the third component was composed of Yin deficiency, heat, phlegm, and has negative correlation with water stop, the fourth component was composed of Qi stagnation; The differentiation factors of type 2diabetic patients with neurological complications can be divided into four components, the first component was composed of dampness, heat, The second component was composed of Qi deficiency and Yin deficiency, has negative correlation with Yang deficiency, The third component was blood stasis, the fourth component was water stop; The differentiation factors of type 2 diabetic foot disease can be divided into five elements, the first component was composed of blood stasis, dampness, heat, the second component was composed of Qi deficiency and Yin deficiency, has negative correlation with Yang deficiency, the third component was phlegm, the fourth component was Qi stagnation, the fifth component was water stop.11. The results of combined disease:we researched the top 35 in the involved 834 combined diseases, the highest frequency was hypertension、 hyperlipidemia、 fatty liver disease、cataract. The ratio of arteriosclerosis、cysts、renal failure、coronary heart disease、urinary tract stones、digestive tract polyps、 arrhythmia、refractive error、sequel of cerebral infarction-. acute cerebrovascular disease、chronic viral hepatitis、gouty arthritis、occlusive arterial stiffness in male patients were higher than female patients. And the ratio of high uric acid hepatic、gallbladder stones、hypertensive heart disease、 chronic gastritis、cervical spine lesions、cerebral blood supply insufficient、 pneumonia、anemia、osteoporosis、goiter、valvular heart disease、cardiac insufficiency in women were higher than male patients. The analysis of different age showed that gastrointestinal disease were mainly distributed under the age of 45 years old patients, the incidence of hypertension and renal failure increased slowly start from the age of 45, the incidence of heart disease such as coronary heart disease (CHD), hypertensive heart disease arrhythmia also increased, over the age of 70 that the incidence of urinary tract infections, pneumonia and cerebrovascular disease increased. The association rules analysis showed that hypertension was a risk factor and concurrent disease for much disease.Conclusion:Type 2 diabetesshowedaincreasedtrendyear by year, and mainly were elderly patients, women were more elder than men. Type 2 diabetes had varietycomplications, and influenced each other. The statistical results of this study show that the six top incidence of complications in turn were type 2 diabetes with neurological complications、type 2 diabetes with eye complications、type 2 diabetic nephropathy、type 2 diabetic peripheral vascular disease、type 2 diabetes foot disease、type 2 diabetic ketoacidosis, these made endocrinology department with nephrology、ophthalmology、neurology, surgery, cardiology and the emergency department form a group. Symptoms and pathogenesis of diabetes were complex、diversity、concealment and lack of specificity, clinical diagnosis lacked unified standard, western medicine diagnosis and TCM diagnosis had many not correspond, The phenomenon of same disease had many name was serious. This study based on big data platform, to build knowledge of diabetes diagnosis information that from comprehensive hospital, to provide clinical guidance for the future and clinical dialectical knowledge specification, and play an reference standard exemplary role for the future of traditional Chinese medicine of diabetes. We extracted187syndromes, a single system of syndrome differentiation theory may not be enough to fully represent the onset characteristics, Disease syndrome differentiation of TCM and disease syndrome differentiation of western medicine were different, but after factor analysis, clustering analysis and association rules analysis, dialectical elements mainly were Qi deficiency^ Yin deficiency、dampness、blood stasis,these elements form a core. The disease mainly in the spleen, kidney, liver, stomach, lung, and make flexible syndrome factor combination with other elements. Qi deficiency was closely related to Yin deficiency、blood stasis、dampness、phlegm、heat、spleen and kidney; Blood stasis was closely related to dampness, phlegm, heat, Yin deficiency, kidney and spleen; kidney and spleen had a closely relationship... |
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