Clinical Observation On The Treatment Of Kidney Deficiency And Dampness Renal Anemia With CKD Stage 3-5 Without Dialysis By Xiezhuoyangxue Prescription And Network Pharmacology Research

Objective: 1.Explore the possible mechanism of action of Xie zhuo yang xue Prescription in the treatment of renal anemia(RA)based on network pharmacology,and construct drug-component-target-disease network by using traditional Chinese medicine gene targets and disease gene targets in the network database.2.The effectiveness and safety of Xie zhuo yang xue Prescription in the treatment of CKD stage 3-5 patients with renal anemia without dialysis were confirmed through clinical studies,and the legislative basis and medication characteristics of the supervisor were thoroughly discussed,so as to provide scientific basis for clinical application.Method: The first part: Through TCMSP、TCMID database search and " Xie zhuo yang xue Prescription " formula related active ingredients of TCM,the targets,find drug gene,the Unipro in Gene Cards,OMIM and Drug Bank database search " renal anemia" target genes,and map Wayne to find drugs and disease related target gene,Cytoscape software was used to construct the composition-target network diagram and analysis;Strin online database was used to construct protein interaction network map.GO and KEGG enrichment analysis of associated targets was performed using David online database.The second part: RA patients meeting the inclusion criteria were randomly divided into treatment group and control group,44 cases in each group.All patients adopt foundation treatment,the control group to the polysaccharide iron compound capsule,restructuring and promote red injection,the treatment group on the basis of this combined with drainage turbidity and blood,after 12 weeks of treatment,respectively,before treatment,1 month,3 months treatment record patients’ TCM syndrome integral and related laboratory indicators(red blood cell count,hemoglobin,serum creatinine,blood urea nitrogen,glomerular filtration rate,urine trace albumin,cereal third transaminase,aspertate aminotransferase,etc.),record adverse reactions and adverse events in the process of treatment,and using SPSS22.0 data statistics analysis,analysis of the clinical curative effect.Result: The first part: According to OB≥30% and DL≥0.18,a total of 144 active ingredients and 323 possible protein targets of the formula for removing turbidity and nourishing blood were screened.And 1145 disease targets were screened through the database.Eighty associated gene targets were analyzed.Through analysis,the top 10 active ingredients of drug activity Degree were quercetin,kaempferol,luteolin,formononetin,ivy,phytosterol,arachidonic acid,isorhamnetin,naringin,sesamin,Diosgenin,stigmastol,xanthocyanin,isobifucoside,3,9-meidrosandaline.Main associated genes were obtained by PPI network analysis: STAT3,AKT1,VEGFA,MAPK1,IL-6,TNF,TP53,FOS,EGFR,EGF;Article 633 enrichment results GO analysis,according to the P < 0.01 as a result,the choice of the enrichment process is mainly related to gene expression regulation,regulating apoptosis,cell hypoxia response,RNA polymerase Ⅱ promoter of transcription regulation,regulation of cell proliferation,inflammation and other biological processes;98 KEGG pathways were enriched,and the top 20 signaling pathways were screened.Most of the genes were significantly enriched in the cancer signaling pathway,HIF-1 signaling pathway,TNF signaling pathway and PI3K-Akt signaling pathway.The second part: After 3 months of treatment,the total effective rate of western medicine was 86.36% in the treatment group and 56.82% in the control group,showing a significant difference(P<0.01).The total effective rate was 93.18%in the treatment group and 84.09% in the control group,with significant difference(P<0.01).RBC count,hemoglobin and urinary microalbumin were all improved after 1 month and 3 months of treatment,with statistical significance(P<0.05).Comparison between groups showed that the erythrocyte count,hemoglobin and urea nitrogen in the treatment group were better than those in the control group after 1 month and 3 months of treatment(P<0.05).There was no statistical significance in the changes of AST and ALT values before and after treatment(P>0.05).In the course of treatment,4 cases of respiratory tract infection occurred,which had nothing to do with the treatment drugs.After symptomatic treatment,they all got better and recovered.Conclusion: 1.The treatment of RA by Xie zhuo yang xue Prescription is a combination of multiple active ingredients,which may improve renal interstitial fibrosis and protect renal function by interfering with multiple pathways such as cancer signaling pathway,HIF-1signaling pathway,TNF signaling pathway and PI3K-Akt signaling pathway.2.The formula for relieving turbidity and nourishing blood can improve hemoglobin,renal function and other laboratory indicators in patients with chronic kidney disease at stage 3-5 without dialysis,improve the quality of life of patients,delay the progression of kidney disease,and has certain safety.