慢性阻塞性肺疾病共病网络构建与临床用药现状分析

Construction of comorbidity networks and analysis of current clinical medication status in chronic obstructive pulmonary disease

摘要

目的 探讨慢性阻塞性肺疾病(COPD)患者的共病模式及临床用药规律,为多维度干预策略和医保政策优化提供数据支持。方法 基于烟台市蓬莱人民医院2014年4月-2024年12月512例COPD住院患者电子病历数据,构建共病网络与用药关联模型。采用Apriori算法(支持度≥8%,置信度≥50%)挖掘疾病共现规律,结合Gephi进行网络拓扑分析;通过药物关联规则(支持度≥32%,置信度≥80%)解析临床用药特征。结果 COPD患者共病以心血管疾病为主,高血压病(7.12%)、冠状动脉粥样硬化性心脏病(5.02%)共现频率最高;三元共病关联规则显示“高血压+冠状动脉粥样硬化性心脏病+心功能Ⅲ级”为核心模式。临床用药中,静脉糖皮质激素(甲泼尼龙琥珀酸钠,1 791次)使用率高于吸入制剂(布地奈德,1 287次)。芪苈强心胶囊(264次)是高频使用的中成药,但与西药协同规则未达显著性(置信度<30%)。结论 COPD患者需突破单一疾病管理模式,构建“心血管-呼吸-代谢”整体干预路径;建议通过阶梯激素治疗、复方吸入制剂推广及中西医靶向协同优化用药策略,同时将治疗高频共病药物纳入动态医保目录以降低经济负担。

Abstract

Objective To analyze the comorbidity patterns and medication characteristic in chronic obstructive pulmonary disease (COPD) patients,providing evidence for multidimensional interventions and healthcare policy optimization. Methods Using electronic medical records of 512 COPD inpatients from Penglai People′s Hospital (from April 2014 to December 2024),we constructed comorbidity networks and medication association models. The Apriori algorithm (support≥8%,confidence≥50%) was applied to mine disease co-occurrence patterns, while Gephi visualized network topology. Medication rules were extracted with support≥32% and confidence≥80%. Results Cardiovascular comorbidities dominated in COPD patients,with hypertension (7.12%) and coronary artery disease (5.02%) showing the highest co-occurrence. A triadic association rule revealed "hypertension+coronary artery disease+cardiac function class Ⅲ" as the core pattern. Intravenous glucocorticoids (methylprednisolone sodium succinate,1791 counts) were overused compared to inhaled corticosteroids (budesonide,1287 counts). Qili Qiangxin capsule (264 counts) was the most frequent traditional Chinese medicine but lacked synergistic rules with Western drugs (confidence<30%). Conclusions COPD management requires a shift from single-organ treatment strategies to integrated "cardiovascular-respiratory-metabolic" interventions. Optimizing strategies should include stepwise glucocorticoid therapy,promoting ICS/LABA combinations,and targeted Chinese-Western drug synergy. Dynamic reimbursement policies covering high-frequency comorbidities are critical to reduce economic burden.

关键词

慢性阻塞性肺疾病 / 共病网络 / 临床用药 / Apriori算法 / 电子病历

Key words

Chronic obstructive pulmonary disease / Comorbidity network / Clinical medication / Apriori algorithm / Electronic medical records

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基金资助

2024年济宁医学院大学生创新训练计划项目(cx2024069z)

2025年济宁医学院大学生创新训练计划项目(cx2025149)