| ObjectiveClinical Information Database of Traditional Chinese and Western Medicine Integrated Treatment for Chronic Gastritis is established in this study to help store and manage the chronic gastritis(CG)cases in scientific and standardized way.Retrospective analysis and researches are carried out not only to explore the laws in the CG treatment but also find the connection of diagnosis and treatment between Chinese medicine and modern medical and objective basis for TCM syndrome differentiation.Methods1.Establishment of the database:Through preliminary research and learning of previous literatures,referring to the expert consensus and the diagnosis and treatment plan of the dominant diseases in our hospital,combined with the needs of clinical and scientific research,a standard database field as well as a template for case information collection are developed.Basic information,information about the four diagnosis,medical history,related auxiliary examinations,Chinese and Western medicine diagnosis,treatment plans of CG patients are all gathered by going through patients’ medical records.After data cleaning,we build the clinical information database of traditional Chinese and western medicine integrated treatment for chronic gastritis using R Shiny developed by the company of R Studio.Data of 4546 cases of chronic gastritis are all well stored and managed in this database.2.Application of the database:(1)2312 cases of chronic gastritis patients from January 2018 to October 2019 is collected via database.Using computer machine learning algorithm and human-machine combination to construct knowledge graph and learn the prescription rules of TCM doctors in syndrome differentiation and treatment of CG.(2)To find objective basis for the differentiation,190 cases of CG patients with Hp infection are collected via database and retrospective analysis method is used to find correlations between TCM syndromes,CYP2C19 gene polymorphisms and Hp resistance genes.Results1.Clinical information database of traditional Chinese and western medicine integrated treatment for chronic gastritis is established and it stores a total of 20,323 visits records of 4,546 CG outpatients so far.Basic information and details about the four diagnosis,medical history,related auxiliary examinations,Chinese and western medicine diagnosis,treatment plans of CG patients are all gathered.The database not only has functions of data storage,retrieval,viewing and other case management but also data cleaning and data visualization analysis based on natural semantics,which meets the needs of carrying out clinical and scientific research work related to the diagnosis and treatment of CG in traditional Chinese medicine efficiently.2.Database is applied to carry out scientific researches in order to test the feasibility and explore the application prospect of it.Researches show that:(1)The clinical information database of traditional Chinese and western medicine integrated treatment for chronic gastritis has comprehensive information and simple operation.It can provide accurate and reliable data for statistical work in scientific research applications.It is a practical tool to improve the efficiency and quality of clinical and scientific research work.(2)The most common symptoms of the 2312 CG patients who visited the doctors of chronic gastritis dominant disease group from January 2018 to October 2019 were epigastric distension,belching,epigastric pain,acid reflux,and inappetence.The types of TCM syndromes that occurs most often were spleen and stomach qi deficiency,spleen deficiency and damp heat resistance syndrome,liver depression and spleen deficiency syndrome,stomach yin deficiency syndrome,and spleen and stomach deficiency cold syndrome.7,796 TCM prescriptions involved 192 traditional Chinese medicines.Among them,radix codonopsis,radix glycyrrhizae,radix aucklandiae,rhizoma pinelliae preparatum,citrus reticulata blanco,fructus amomi,rhizoma corydalis,magnoliae officmalis cortex,poria,macrocephalae rhizoma were used most often.The computer extracted a total of 10,985 total knowledge elements,of which 248 were core knowledge elements.Core knowledge elements were divided into 6 clusters.It can be learned from the knowledge map that for patients with qi deficiency and weak complexion and chlorosis,clinicians mostly chose radix astragali and radix angelicae sinensis.For patients with yin deficiency and constipation,glehniae radix,caulis dendrobii,radix scrophulariae,herba ecliptae,seman platyclade were often used.For patients with anorexia and wasting of spleen and stomach,clinicians mostly chose rhizoma dioscoreae and fructus oryzae germinates.(3)Retrospective research of 190 CG patients with Hp infection shows that CYP2C19*1,CYP2C19*2,CYP2C19*3 genes accounted for 58.7%,33.4%,and 7.9%respectively.The proportion of CYP2C19*1/*1、CYP2C19*1/*2、、CYP2C19*1/*3、CYP2C19*2/*2 and CYP2C19*2/*3 was 41.1%,23.7%,11.6%,19.5%,and 4.1%.The proportion of EM was 41.1%,IM was 35.2%and PM was 23.7%.There were more IM or PM in patients of dampness and heat of spleen and stomach syndrome types or of excess syndrome(P<0.001,P=0.008),The resistance rates of Hp strains from 190 patients with Hp infection to metronidazole,clarithromycin,levofloxacin hydrochloride,tetracycline,furazolidone,and amoxicillin are 100.0%,63.7%,50.5%,31.1%,23.2%,10.0%.Up to 31.1%Hp were dual resistant and nearly 58.9%of them are multi-drug resistant.The mutation rates of gyrA-RDR and parC genes in patients with spleen deficiency and dampness heat syndrome were significantly lower than those of other syndrome types(P=0.050)and the mutation rate of the 16S rRNA gene in patients with spleen and stomach weakness syndrome and spleen-stomach dampness and heat syndrome was significantly higher than that in liver-stomach discord syndrome,cold and heat syndrome,gastric yin deficiency syndrome,and gastric collateral obstruction syndrome(P=0.037).There was no statistical significance in the mutation rates of 23S rRNA PBP1,porD and oorD in patients with different syndrome types(P=0.808、0.894、0.490).Conclusion1.Clinical information database of traditional Chinese and western medicine integrated treatment for chronic gastritis based on R shiny can help to collect and safely store a large amount of case information.The database is easy to operate,which is conducive to the full development and utilization of clinical data and provides great convenience for clinical case management and scientific research.2.The knowledge map revealed the medication rules of the chronic gastritis predominant disease team of Guangdong provincial hospital of Chinese medicine who inherit the thought of Ling-nan Liang’s spleen-stomach academic school.It was found that the treatment of chronic gastritis was mainly to supplement the spleen and stomach,supplemented by conditioning Qi.Nourishing yin,moisturizing,soothing the liver and clearing the stomach were also common treatments for CG.Doctors pay attention to the combination of disease identification and syndrome differentiation,they also take into account the symptoms of patients with different syndromes and added drugs through syndrome differentiation.3.190 patients were mainly EM.The CYP2C19 gene polymorphism has a certain correlation with the distribution of TCM syndrome types.There were more IM and PM among patients with spleen-stomach damp-heat syndrome and excess syndrome.Hp mutation rates associated with resistance to metronidazole,clarithromycin,and levofloxacin hydrochloride all exceeded 50%.More than half of Hp strains are multidrug resistant.TCM syndromes may be related to mutations in the gryA-RDR or parC genes and 16S rRNA genes,but not to 23S rRNA,PBP1,and porD,oorD genes. |
