The Distribution Of TCM Syndromes Of Multiple Sclerosis And The Exploration Of Key Syndrome Treatment Mechanisms

ObjectiveThe information of four diagnoses of multiple sclerosis in 308 patients was analyzed retrospectively to explore the distribution and regularity of TCM syndromes of multiple sclerosis,and the mechanism of TCM treatment of MS was explored based on network pharmacology.Verify the feasibility of EDSS Telephone Rating Scale.Chinese version,and explore a new follow-up mode for multiple sclerosis patients;It provides new ideas for the clinical and scientific research of the treatment of multiple sclerosis with traditional Chinese medicine.Methods1.The information of four diagnoses of 308 patients with multiple sclerosis was collected regressively,and the investigation results were analyzed by combining factor analysis and cluster analysis to explore the distribution rule of TCM syndromes of MS.2.Application of the theory of network pharmacology method,commonly used to treat MS kidney medicine of rehmannia glutinosa-cornel and wet medicine for "turmeric-stone calamus" as an example,through the "drug active ingredient-a disease-therapeutic targets"the construction of a network diagram and visualization,target protein interaction network(PPI)build,GO enrichment and KEGG pathway enrichment analysis function,looking for traditional Chinese medicine key targets and pathways for the treatment of MS.3.Will be included in 20 cases of RRMS patients using the Chinese version of "the EDSS telephone scale score and body EDSS score comparison,face to face with intraclass correlation coefficient,correlation test and analyze the consistency between the kappa coefficient,verify the feasibility of the Chinese version of the EDSS telephone scale,so as to explore the new way of follow-up of MS.Results1.Through principal component analysis of 28 TCM diagnostic data,a total of 11 principal components were obtained.According to the load factor of each TCM diagnostic data,four diagnostic data with factor coefficient>0.4 were selected and distributed into 11 principal components.Then cluster analysis was carried out on the results of principal component analysis to obtain the five types of TCM syndromes and their distribution proportions.According to the differentiation of syndromes of TCM according to professional knowledge,the results were spleen and kidney Yang deficiency(32.46%),qi and blood deficiency(24.03%),dampness-heat infiltration(21.42%),liver and kidney deficiency(12.34%),and dampness-pollution accumulation(9.74%).2.Veen software was used to determine the intersection of drug targets and disease-related targets,and a total of 26 common targets were obtained.Two kinds of active ingredients of cooked rehmannia root and 20 kinds of active ingredients of dogwood were screened out,and 22 active ingredients were obtained.The PPI network diagram was used to obtain 25 key target proteins.Through GO functional enrichment analysis,84 items were obtained,mainly involving receptor activity,ion binding,ion transport activity,protein binding and catalytic activity.The KEGG pathway enrichment analysis was used to identify 71 enrichment pathways involved in apoptosis,inflammation,angiogenesis and immune response,including il-17 signaling pathway,NF-B signaling pathway,HIF-1 signaling pathway and p53 signaling pathway.Four active ingredients of Acorus tatarinowii and 15 of turmeric were screened out.A total of 30 key target proteins were obtained through PPI network.Through GO functional enrichment analysis,a total of 84 GO items were obtained,mainly involving receptor activity,cell apoptosis,enzyme receptor activation and RNA transcription.KEGG pathway enrichment analysis identified a total of 94 enrichment pathways,involving apoptosis,virus infection,inflammation and immune response.3.Intra-group correlation coefficient(ICC)was 0.933,confidence interval was 0.726-0.952,P<0.001,statistically significant;Spearman method was used to analyze the bivariate correlation.The correlation coefficient(RHO)was 0.700 and the P value was 0.001,which was statistically significant.Kappa=0.467,with a medium consistency and a P value of 0.000,showing statistical significance.Conclusion1.There are 5 basic TCM syndromes of multiple sclerosis,including deficiency of spleen and kidney Yang,deficiency of qi and blood,dampness-heat immersion,deficiency of liver and kidney,and dampness and turbidness.Among them,deficiency of spleen and kidney Yang accounts for the highest proportion,and 44.81%is involved in locating to the kidney in each principal component.The proportion involved in dampness and evil was 31.17%,which was mainly humid and hot.Thus,it can be seen that MS pathogenesis is based on deficiency and solid,kidney deficiency as the basis,and dampness and turbidity as the standard.In the clinical treatment process,kidney tonifying should be the main treatment,and at the same time,dampness and turbidity should be treated as well as symptoms and root causes.2.The mechanism of "cooked rehmannia glutinosa-Fructus corni" in the treatment of MS is realized through multiple targets,functions and pathways,among which PRKCA,NR3C1,NOS2,CASP8,BAX and other key targets are closely related to MS.Il-17 and NF-B signaling pathways are important pathways of MS,which may be the mechanism of "cooked rehmannia glutinosa-Fructus Corni" in the treatment of MS.The key targets of turkin-acorus gramineus are CASP3,MAPK8,RELA,ESR1,CASP8,VCAM1,CASP9,etc.,and the il-17 signaling pathway,NF-B signaling pathway,HIF-1 signaling pathway and p53 signaling pathway are the key pathways for the treatment of MS with this drug..3.The EDSS Telephone Rating Scale · Chinese version has a good consistency with the EDSS score obtained by face-to-face physical examination,which can reflect the degree of disability of MS patients.The new method of telephone follow-up can meet the purpose of remote follow-up of MS patients,so it can be tried out and promoted.