| Objective:(1)Through retrospective analysis of the clinical data of patients with idiopathic membranous nephropathy in our center in the past five years,observe the influence of TCM syndrome differentiation and treatment(the Jianpi Yishen therapy)on the clinical efficacy of idiopathic membranous nephropathy;(2)Evaluate the compatibility law of traditional Chinese medicine for intervention in idiopathic membranous nephropathy based on data mining methods;(3)Study and predict the effect mechanism of core prescriptions in the treatment of idiopathic membranous nephropathy based on network pharmacology methods.Methods:(1)Retrospective analysis was conducted to collect 152 patients with idiopathic membranous nephropathy in the outpatient department and ward of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine who met the standards of sodium discharge.The changes of 24 h urinary protein(UTP),serum albumin(ALB),creatinine(SCR),total cholesterol(TC)and triglyceride(TG)were observed before treatment and at the 2nd,4th and8 th week after treatment.SPSS 26.0 was used to establish a database and conduct statistical analysis of relevant data.According to the P value obtained from the test,P < 0.05 was considered statistically significant,and P < 0.01 was considered statistically significant.(2)With the aid of the traditional Chinese medicine inheritance auxiliary platform system(V2.5),the first-diagnosed prescriptions of patients with definite curative effects were collected.Descriptive statistical method was used to analyze drug efficacy and frequency,and association rule analysis and cluster analysis were used to analyze the association rules of prescription drugs to dig out the core prescription.(3)In the core prescription network pharmacology analysis part,the effective ingredients and predicted targets of the core prescription were screened out from the TCMSP database and Batman-TCM database;Gene Cards and OMIM databases were used to screen IMN disease targets,and the obtained target proteins were further standardized into gene names by Uniprot database.Venn was used to map the two targets to screen out the potential targets of the core prescription for IMN treatment.The mapped targets were imported into the String online platform to draw the Network diagram of key protein interaction,and its plug-in "Network Analyze" was used to Analyze the Network topology parameters.The core target was screened according to node degree value and betweenness.The GO function and KEGG pathway enrichment analysis of potential targets were carried out by R 3.6.3 software,and the compound-disease-target regulatory network was established by Cytoscape 3.7.1.Results:(1)Through retrospective analysis,from January 1,2015 to June 1,2020,regular outpatient and inpatient visits at the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,a total of 152 IMN patients met the criteria for inclusion and exclusion.Treat symptomatically under the intervention of traditional Chinese medicine to “the Jianpi Yishen therapy”(for patients who have been treated with hormones and immunosuppressants,follow the original regimen,and regularly reduce the dose to the principle of stopping the drug),and continue to observe for 8 weeks.After 2 weeks,4 weeks,and 8 weeks of treatment,24-hour urine protein quantification,serum total cholesterol,and serum triglycerides were significantly reduced;serum albumin was significantly increased(P<0.01);after 2 weeks of treatment,there was no statistical change in serum creatinine for academic significance,blood creatinine decreased significantly after 4 and 8 weeks of treatment(P<0.01).Western medical efficacy indicators: after 2 weeks,4 weeks,and 8 weeks in the high-risk group,the effective rates were 14.29%,19.00%,and 65.71%,respectively;after 2 weeks,4 weeks,and 8 weeks in the middle-risk group,the effective rates were 33.93.%,42.86%,53.57%;after 2 weeks,4weeks,and 8 weeks of treatment in the low-risk group,the effective rates were 80.49%,85.37%,and 90.24%,respectively.TCM syndrome scores were significantly reduced after 2weeks,4 weeks,and 8 weeks of treatment(P<0.01).(2)Through the traditional Chinese medicine inheritance auxiliary platform system,for the first-diagnosed prescriptions of 128 patients with spleen-kidney deficiency IMN patients who are indeed effective,entropy clustering sets different degrees of support to screen out the core prescriptions,which are mainly composed of the top 13 high-frequency drugs: astragalus,atractylodes,licorice,andgolden cherry Seed,Gorgon,Weilingxian,Fangji,Eucommia,Cyclobalanopsis,Cicada,Salvia,Poria,Euonymus vulgaris.(3)In exploring the effect mechanism of core prescriptions for the treatment of idiopathic membranous nephropathy based on network pharmacology,a total of 259 active compounds were screened,1424 predicted targets,and 210 common targets with IMN.GO analysis(FDR<0.05)enriched a total of 2194 biological process(BP)items,164 molecular function(MF)items,and cell composition(CC)101 items.In terms of enrichment analysis of KEGG-related pathways(FDR<0.05),a total of 172 pathways related to the treatment of idiopathic membranous nephropathy were screened.Conclusion:(1)The method of "Jianpi Yishen" has a significant effect on reducing 24-hour proteinuria,serum creatinine,serum total cholesterol,serum triglyceride and improving plasma albumin in patients with idiopathic membranous nephropathy.(2)The core prescription mainly treats IMN from five aspects:(1)invigorate the spleen and kidney,and treat it from the root;(2)activate blood circulation and remove blood stasis s;(3)reduce the penetration of dampnes;(4)eliminate the cause of the disease and treat it from the wind;(5)dredging collaterals with rattan and insect medicine.(3)Based on network pharmacology,the mechanism of action of modern pharmacology of the core prescription was studied.The results showed that the core prescription may play a role in the treatment of IMN through anti-oxidative stress,anti-apoptosis,anti-fibrosis,free radical scavenging,immune regulation and other aspects. |
PDF Full Text Request