Real World Study Of TCM Treatment Of Hand,Foot And Mouth Disease Based On His System

Objectives:Hand,foot and mouth disease(HFMD)is a febrile infectious disease commonly seen in young children or adolescents.The incidence of HFMD in Guangdong Province is increasing and has a younger-age trend.HFMD also has the characteristics of strong infectivity,wide transmission routes and fast transmission speed,which has an impact on public health.The analysis of research hotspots of HFMD can provide ideas for its occurrence,transmission and treatment.At present,there is no specific medicine for HFMD in western medicine,and most of the existing methods are antiviral treatment.HFMD belongs to the category of febrile diseases in traditional Chinese medicine(TCM).TCM has rich theoretical and practical experience in warm diseases,but there is no systematic evaluation between the combined treatment of TCM and Western medicine and the treatment of single western medicine.Health Information System(HIS)system is a medical information management system that provides standardized and shareable information for medical institutions and realizes the functions of standard medical management information system such as clinical diagnosis and treatment management.And it also provides sufficient original data for data mining of TCM treatment in HFMD.This study is divided into three parts,part one is visualized analysis of HFMD at home and abroad based on bibliometrics;part two is the analysis of the difference of hospitalization days and expenses between western medicine treatment and integrated TCM and western medicine treatment in HFMD;part three is the study of the drug laws of TCM in the treatment of HFMD based on data mining.Methods:(1)CNKI and Web of Science literatures were retrieved on the topic of "hand,foot and mouth disease".Cite Space,Hist Cite and Vos Viewer were used to conduct visual analysis on the selected literatures of countries,institutions and subject terms in this field.(2)The hospitalized cases of HFMD from January 1,2014 and June 30,2019 were collected from the HIS of three medical institutions,including Guangdong Women and Children Hospital,Guangzhou Women and Children’s Medical Center,and the First Affiliated Hospital of Guangzhou University of Chinese Medicine.The inpatient cases with HFMD as the first diagnosis of were included,and the information was collected including general information,diagnosis,total cost,type of cost,medication cost and medication prescription.SPSS23.0 was used for data analysis.(3)The outpatient cases of HFMD from 2014 to 2019 were extracted from HIS,covering the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangdong Provincial Hospital of Traditional Chinese Medicine and Guangdong Women and Children Hospital,Guangzhou Women and Children’s Medical Center to build HFMD prescription database and explore the drugs law based on data mining.In accordance with inclusion and exclusion criteria to screen the cases,data of prescriptions were extracted.Microsoft Office 2019 was used for frequency statistics,correlation rule analysis were performed by SPSS Clementine 12.0 Apriori block and cluster analysis and factor analysis by SPSS 18.0.Results:(1)The top 3 domestic authors at home were Xu Wenbo from the Chinese Center for Disease Control and Prevention,Du Zengqing from Kunming Children’s Hospital and Deng Huiling from Xi ’an Children’s Hospital.The top 3 international authors were Zhang Y,Li J and Liang ZL.China posted articles heading the list,followed by the United States,Japan,the United Kingdom and Malaysia.Forecast domestic research hotpots at home will focus on the epidemiology and etiology of HFMD and the nurse and treatment in severe HFMD.And the international research will rather focus on disease control,incidence of the disease,the meteorological factors and the main pathogens such as A10 coxsackie virus,enterovirus A71,etc.(2)There was no statistical significance between western medicine treatment and integrated TCM and western medicine treatment in hospitalization days of mild and severe HFMD patients.The cost of integrated TCM and Western medicine treatment was lower than that of western medicine treatment when the hospitalization days≥3 with statistically significance.When hospitalization days≥9,hospitalization days≥10 and hospitalization days≥12,the cost of western medicine treatment was lower than that of integrated TCM and western medicine treatment,and the comparison was statistically significant.In severe patients,except hospitalization days≥10,the inpatient cost M(P25-P75)of integrated TCM and Western medicine treatment was lower than that of western medicine treatment including hospitalization days ≥3,hospitalization days≥4,hospitalization days≥5,and hospitalization days≥6.The comparison of inpatient cost between the two groups was statistically significant.(3)A total of 286 drugs were included in the 2694 prescriptions,and frequency statistics were conducted.The higher frequency involved Qi tonifying drugs,heat clearing drugs,resolving dampness drugs,etc.256high-frequency drug pairs were obtained in association rules analysis,and core drugs under different rules were visualized according to frequency statistics and association rules analysis.Cluster analysis extracted 6 groups of homogeneous herbal groups,6 common factors were obtained by factor analysis.The TCM drug types of HFMD prescriptions mainly include Qi tonifying drugs,heat clearing and antidote drugs,and resolving dampness drugs.The key drug-pair is Glycyrrhiza Radix Et Rhizoma-Phragmitis Rhizoma.The network diagram of association rule analysis involves seven principles: releasing the exterior with pungent-cool,heat-clearing and detoxic,clearing heat and cooling blood,heat-clearing and fire-purging,heat-clearing and dampness-drying,fortify the spleen and drain dampness,and inducing diuresis to drain dampness.They are respectively Menthae Haplocalycis Herba-Cicadaeperiostracum,Forsythiae Fructus-Belamcandae Rhizoma,Rehmanniae Radix-Moutan Cortex,Phragmitis Rhizoma-Lophatheri Herba,Scutellariae Radix-Dictamni Cortex,Coicis-Semen-Poria,pogostemonis Herba-Amomi Fructus Rotundus.Clustering and factor analysis suggested that Sweet Dew Detoxification Pellets and Honeysuckle and Forsythia Powder might be the basic prescriptions for HFMD.Conclusion:(1)HFMD research will focus on epidemiological characteristics,etiological characteristics,and its treatment.(2)Integrated TCM and western medicine treatment has a potential advantage in the treatment of severe HFMD,which is similar to the efficancy of western medicine,but can significantly reduce the hospitalization cost.Due to the wide scope of inclusion in this study,it is necessary to narrow the scope of clinical diagnosis in further study to reduce data bias.(3)The treatment of TCM in HFMD mainly involves clearing heat,detoxifying toxin and reducing dampness.Sweet Dew Detoxification Pellets and Honeysuckle and Forsythia Powder may be the basis for the treatment of hand,foot and mouth disease.