| Objective:To evaluate the clinical efficacy of Yiqimingmu Granules in the treatment of POAG with Qi deficiency and blood stasis after IOP control through clinical research.Use network pharmacology to study Yiqimingmu Granules,including Huangqi,Danggui,Chishao,Honghua etc.Discuss the effective ingredients and targets of Yiqimingmu Granules in the treatment of the disease,and provide a material basis for clinical research.Part Ⅰ Clinical observation of Yiqimingmu granule in treating primary open-angle glaucoma after IOP controlObjective:To evaluate the clinical efficacy of Yiqimingmu Granules in the treatment of primary open-angle glaucoma with Qi deficiency and blood stasis type controlled by IOP.Methods:Using prospective randomized control method,32 patients meeting the criteria were randomly divided into treatment group and control group.The treatment group took Yiqimingmu granules orally,1 bag once,twice a day for 3 months,and the control group was given intraocular pressure control.Results:32 cases were included in this study,including 16 cases(32 eyes)in the Yiqi Mingmu granule treatment group and 16 cases(32 eyes)in the control group.There is no significant difference in gender,age,BCVA,intraocular pressure,RNFL,MD,PSD,TCM syndrome,type A behavior scale,visual impairment scale and quality of life scale between the two groups(P>0.05).1.The effective rate of improving visual field defect in the treatment group was 78.13%,46.43%in the control group,the difference was statistically significant(P<0.05);There were significant differences in MD and PSD before and after treatment in the treatment group(P<0.05);In the control group,there was no significant difference in MD(P>0.05),but there was significant difference in PSD(P<0.05);After treatment,the differences between the two groups were statistically significant(P<0.05).2.The average thickness of optic nerve fiber layer in the treatment group was significantly different from that in the control group(P<0.05);There was no significant difference in the average thickness of optic nerve fiber layer between the control group and the control group(P>0.05);After treatment,the difference between the two groups was statistically significant(P<0.05).3.There was no significant difference in IOP between the treatment group and the control group(P>0.05);There was no significant difference in IOP between the two groups after treatment(P>0.05).There was significant difference in BCVA before and after treatment(P<0.05);There was no significant difference in BCVA before and after treatment in the control group(P>0.05);After treatment,the difference between the two groups was statistically significant(P<0.05).4.There was no significant difference in th,CH,th+CH between treatment group and control group(P>0.05);After treatment,there was no significant difference between th and th+CH groups(P>0.05),but there was significant difference between CH groups(P<0.05).5.There were statistically significant differences in life restriction,peripheral vision,visual adaptation,stereopsis and overall score before and after treatment in the treatment group(P<0.05).In the control group,there were significant differences in life restriction,peripheral visual field and overall score before and after self-control(P<0.05),but there were no significant differences in visual adaptation and stereopsis(P>0.05).After treatment,there were significant differences in life restriction,peripheral vision and overall score between the two groups(P<0.05),but there were no significant differences in other aspects between the two groups(P>0.05).6.There were statistically significant differences in symptoms,visual function,physical function,social activities,mental and psychological status,overall score and self score of quality of life in the treatment group before and after treatment(P<0.05).There were statistically significant differences in the overall score and self life score of the control group before and after self-control(P<0.05),but there were no statistically significant differences in other aspects(P>0.05).After treatment,there was significant difference in the self score of quality of life between the two groups(P<0.05),but there was no significant difference in other aspects between the two groups(P>0.05).7.The effective rate of TCM symptom improvement in the treatment group was 93.75%,and the control group was 21.43%,the difference is statistically significant(P<0.05);There were statistically significant differences in the scores of various syndromes and total scores before and after treatment in the treatment group(P<0.05).In the control group,there were statistically significant differences in eye distension discomfort and total score before and after self-control(P<0.05),but there were no statistically significant differences in other aspects(P>0.05).After treatment,there were significant differences in shortness of breath,lazy speech,dizziness,headache and total score between the two groups(P<0.05),but there were no significant differences in other aspects between the two groups(P>0.05).Conclusions:1.Yiqi Mingmu granule can improve the thickness of optic nerve fiber layer,visual field defect and visual acuity of POAG patients with Qi deficiency and blood stasis.2.Yiqimingmu Granules can significantly improve the TCM symptoms of POAG patients with Qi deficiency and blood stasis.3.Yiqimingmu Granules can improve the psychological state,visual function and self-evaluation of quality of life of POAG patients with Qi deficiency and blood stasis.Part Ⅱ Predict the mechanism of Yiqimingmu granule in treating POAG of Qi deficiency and blood stasis type based on network pharmacologyObjective:Use the network pharmacology method to predict the molecular mechanism of Yiqi Mingmu granule in the treatment of POAG with Qi deficiency and blood stasis type.Methods:TCMSP,GeneCard,CTD and PubMed databases were used to collect the information of Yiqimingmu Granules compounds and their corresponding targets and POAG targets of Qi deficiency and blood stasis type,and to construct a multidimensional network of "Yiqimingmu Granules-main components-core targets-diseases".With the help of cytoscape3.7.1 cluego plug-in,GO function analysis and KEGG pathway enrichment analysis were carried out to seek the relationship between traditional Chinese medicine component,target and pathway.Results:1.Yiqimingmu Granules contain 77 compounds and 236 predicted targets;2.The POAG of Qi deficiency and blood stasis type involves 8575 targets;3.Yiqimingmu Granules treatment of Qi deficiency and blood stasis type POAG involves 189 related target genes;4.Yiqimingmu Granules can act on VEGFA/VEGF,Jun,CASP3,AKT1,TP53,MAPK1,PTGS2,IL6,TNF and other 15 core targets through 37 core chemical components including quercetin,kaempferol,baicalein,formononetin,catechin and isorhamnetin,etc.play a role in treating of POAG with Qi deficiency and blood stasis.5.Yiqimingmu Granules mainly regulate the cellular response to reactive oxygen species,positive regulation of neuron apoptotic process,negative regulation of cysteine-type endopeptidase activity involved in apoptotic process,glial cell activation,muscle cell proliferation,smooth muscle cell proliferation and other processes play a biological role;6.Yiqi Mingmu Granules play the role in treating Qi deficiency and blood stasis POAG mainly by intervening in TNF signaling pathway,HIF-1 signaling pathway,T cell receptor signaling pathway,Toll-like receptor signaling pathway,AGE-RAGE signaling pathway in diabetic complications,etc.Conclusion:Yiqimingmu Granules may act on 15 key targets such as VEGFA,TNF and CASP3 through 37 core components such as quercetin,kaempferol,baicalein and formononetin,and interfere in 17 possible pathways such as TNF signal pathway and HIF-1 signal pathway,so as to achieve the effect of treating POAG of Qi deficiency and blood stasis type.The mechanism of it’s action may be to regulate the response of cells to cell viability,affect the activation of keratinocytes,and regulate the process of neuronal apoptosis and other. |
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