基于复杂网络的特发性肺纤维化病证结合人群分型研究＊

目的 特发性肺纤维化（Idiopathic Pulmonary Fibrosis,IPF）是一种病因不明的复杂性、致死性肺疾病,预后极差。不同的IPF患者往往具有不同的临床症状,根据其不同临床症状进行IPF分型,可以了解不同症状所代表的IPF人群的特征,以帮助临床更好的进行诊疗。方法 利用5574例IPF住院患者的中医临床电子病历（Electronic Medical Records,EMRs）,根据相似症状构建患者相似性网络（Patient Similarity Network,PSN）,采用BGLL的社团划分方法将IPF划分为不同模块（即亚型）,并对典型模块的表型特征进行富集分析。结果 将纳入的IPF患者划分为337个不同模块,发现IPF患者的临床表型特征具有复杂性和多样性,各模块内的症状、诊断、证型及中药具有一致性。如M90中的人群多以口渴、咽干、口干等阴虚症状为其特异性症状,症候方面则以气阴两虚证为其典型证型,在诊断方面也以乳房恶性肿瘤、贫血等易出现气虚、阴虚的疾病为主,同时在中药的使用方面也多使用沙参、桑寄生等补益药。结论 通过症状划分所得的各模块同时具有与该模块代表症状相符的中医证型,且各模块的症状、诊断、证型和中药具有一致性,侧面反映了中医证型具有一定的科学性。说明我们通过症状对IPF人群进行划分是合理的,其结果可以为临床医师提供一定的参考价值。

Study on Population Typing of Idiopathic Pulmonary Fibrosis Based on Complex Network with Disease-Syndrome Combination

Objective Idiopathic Pulmonary Fibrosis (IPF) is a complex, fatal lung disease of unknown etiology with a poor prognosis. Different IPF patients often have different clinical symptoms, IPF classification according to its different clinical symptoms can understand the characteristics of IPF population represented by different symptoms, so as to help clinical diagnosis and treatment better.Methods With 5574 TCM clinical electronic medical records (EMRs) of patients admitted with IPF, the Patient Similarity Network (PSN) was constructed based on similar symptoms, the community division method of BGLL was used to classify IPF into different modules (i.e. subtypes), and the clinical characteristics of typical modules were enriched for analysis.Results The included IPF patients were divided into 337 different subtypes, and it was found that the clinical characteristics of IPF patients were complex and diverse, and the symptoms, diagnosis, syndromes and Chinese medicinals were consistent within each module. For example, the population in M90 mostly had yin deficiency symptoms such as thirst, dry throat, and dry mouth as their specific symptoms, and the symptoms were characterized by qi and yin deficiency syndrome as their typical syndromes, and in terms of diagnosis, diseases prone to qi and yin deficiency such as breast malignancy and anemia were also predominant, as well as the use of tonic medicinals such as Radix Glehniae and Herba Taxilli.Conclusions Each subtype classified by symptoms also contains a TCM syndrome that corresponds to the symptom of the subtype, and the symptoms, diagnosis, syndrome and TCM of each subtype are consistent, which reflects the scientific nature of the TCM syndrome. This indicates that it is reasonable to classify the IPF population by symptoms, and the results can provide some reference value for practitioners.