Design And Construction Of A Clinical Decision Aid System For Diabetic Nephropathy Based On Case-based Reasoning

From the perspective of methodology,this research takes the data of the diagnosis and treatment of diabetic nephropathy by Chinese medical experts as an example and explores a research model that combines the experience exploration of TCM experts with the construction of traditional Chinese medicine system.This study mainly includes two parts.The first part is the exploration of expert experience in the treatment of diabetic nephropathy by Chinese medicine.Through combing the experience of experts,it tries to explore the evolution rules of diabetic nephropathy pathogenesis,the dynamic evolution of clinical symptoms and the corresponding herbal application regularities.The research content of this part will lay a foundation for the rational design of a case-based system for diabetic nephropathy based on traditional Chinese medicine theory and clinical practice.The content of the second part is the case-based reasoning design and construction of the case-based clinical assistant decision-making system for the treatment of diabetic nephropathy based on case-based reasoning.It is mainly based on the data characteristics of the treatment of diabetic nephropathy in Chinese medicine,and a case-based reasoning clinical decision-making support system is designed and constructed.1.The Detection of Experts' Experience in Diagnosis and Treatment of Diabetic Nephropathy Treated by Chinese medicine1.1 PurposeThe purpose of the study is to sort out the TCM experts' experience of dialectical diagnosis and treatment of diabetic nephropathy and the rules of drug use,and find out the evolution rules of diabetic nephropathy pathogenesis,the dynamic evolution of clinical symptoms and the corresponding herbal application regularities,and therefore lays a theoretical foundation for the design of a clinical decision support system for diabetic nephropathy based on case-based reasoningmethod to make it more consistent with the clinical characteristics of traditional Chinese medicine.1.2 MethodsData extraction and collation:Retrieve the literature related to the experience of diabetic nephropathy of Chinese medicine from the core Chinese databases;select literature that meets the requirements of the study and extract literature data based on the criteria of literature exclusion.Data standardization:According to the national standardization specification and other reference documents,the expression of the terminology of TCM in the data is standardized.Statistics:The frequency of corresponding symptoms under each syndrome,the frequency of using traditional Chinese herbs,and the correlation between statistical syndromes and symptoms,syndromes and traditional Chinese medicines are counted,and the results are expressed as frequency and degree of correlation,and finally formed frequency and the associated statistical tables.Complex network mapping:Based on the standardized data,complex network maps between syndromes and symptomsas well as between syndromes and traditional Chinese herbs were drawn by using Gephi.Combined with statistical data and diabetic nephropathy pathogenesis,the dynamic evolution of clinical symptoms and the corresponding herbal application regularities of diabetic nephropathy were explored from complex networks.1.3 ResultsThrough literature screening,a total of 73 expert experience articles were included,and 128 pieces of information on syndrome differentiation and treatment were extracted.After standardized data processing,39 kinds of clinical syndromes of diabetic nephropathy were obtained.After analysis of clinical pathology,a total of 7 syndrome types were obtained.After 39 specific syndromes were grouped under 7 syndrome types,a total of 7 syndromes-symptom statistics,7 syndromes-Chinese medicine statistics,7 syndromes-symptom complex network diagrams and 7 syndromes-Chinese medicine complex network diagrams were obtained throughstatistics and complex network mapping.From the results,it can be observed that as the disease progresses,various types of syndromes are gradually beingexperienced,and the process of iterative evolution between different symptom groups can also be seen clinically.With the change of the syndrome type and symptoms of the disease,the usage of traditional Chinese medicine by experts in each stage of the diabetic nephropathy has also shown corresponding adjustments.1.4 ConclusionDiabetic nephropathy is a complication of diabetes development to a certain stage.The clinical manifestations are complex and the patterns of syndromes are variable.However,the evolution of pathogenesis has a certain regularity,which can be summarized as kidney-centered withdeficiency of yin which leads to deficiency of yang,and therefore caused the deficiency in both yin and yang,whereas the deficiency caused excess syndromes,and eventually the body possessorgan deficiency with turbid dampness and blood stasis.With the evolution of the pathogenesis of diabetic nephropathy,its clinical symptoms have also undergone dynamic changes.From the record of expert experience,it can be seen that there are many clinical symptoms of diabetic nephropathy,but during the progress of the disease,there are certain core symptoms in various stages of syndromes.From the expert's experience in the differentiation and treatment of diabetic nephropathy,the dynamic and hierarchical herbal application regularities can be found.With the appearance of different symptoms,the experts will dynamically add and subtract herbsin the prescription.At the same time,with the development of the disease and the overall state of the patient,the experts' selection of herbs for the addition and subtraction for the same type of syndrome or symptom is not static but hierarchical2.The Design and Construction of the TCM Case-based Reasoning Clinical Decision-Making Support System of Diabetic Nephropathy2.1 PurposeTo constructed a case-based reasoning clinical decision-making assisting system suitable for clinicians based on typical medical records and experiences of TCM experts.2.2 System DesignTo build a core medical case base and an auxiliary knowledge base,and complete collection and collation of related data.To design case representation pattern and cases searching methods based on the design points and reasoning process of case-based reasoning combining the characteristics of data of TCM medical records and experts experience of diabetic nephropathy,and therefore complete system inference design.Combine the database with reasoning design and build a clinical decision support system that meets the characteristics of diagnosis and treatment of diabetic nephropathy in TCM.2.3 System ConstructionBased on the design of the system,this study completed the establishment of the TCM case-based reasoning clinical decision-making support system of diabetic nephropathy.The results presented by the system are basically satisfactory with the expectations of the design and realize the functions of medical records storage,experience storage,medical record retrieval,experience retrieval,and auxiliary correction assistance.And in the stage of reuse of medical records,this system provides a convenient way of association for clinicians,allowing them to understandand study expert medical cases from multiple perspectives so as to better judge and analyze clinical diagnosis and treatment.2.4 ConclusionMachine reasoning is one of the research directions of modernization of traditional Chinese medicine,but the reasoning of traditional Chinese medicine machines cannot be reasoned mechanically,and it needs to fit TCM clinical practice.In its flexible,dynamic,multi-dimensional model of diagnosis and treatment,Chinese medicine practitioners treat each patient according to the patient's own conditions and formulate individual treatment plans.Therefore,the research on machine reasoning of traditional Chinese medicine must be as close as possible to this diagnosis and treatment idea and take the multi-dimensional and multi-level dynamic conditions of the disease into the consideration.Case-based reasoning is good at solving semi-structured or unstructured problems lacking of rules with difficulty in establishing models.This happens to make up for the inadequacy of rule-based reasoning and prevent simplification of reasoning.The study of the case-based reasoning system will help lay the foundation for the development of a more intelligent TCM expert inference system in the future.