| Purpose:Through clinical observation,to explore the benefits and safety of Wangbi capsule in the treatment of rheumatoid arthritis（liver and kidney deficiency）.At the same time,using the method of network pharmacology,this paper expounds the mechanism of Wangbi capsule in the treatment of rheumatoid arthritis（liver and kidney deficiency type）,in order to provide a more scientific theoretical basis for clinical application or later research.Methods:60 patients with rheumatoid arthritis with liver and kidney deficiency（October 2020 to September 2021）in huayuanshan District of Hubei Hospital of traditional Chinese medicine were randomly divided into observation group and control group,with 30 cases in each group.The control group was treated according to the western medicine treatment scheme（methotrexate,once a week,four tablets at a time）in the diagnosis and treatment guide for rheumatoid arthritis,while the observation group was treated with Wangbi capsule（5 capsules/time,three times a day）on the basis of Western medicine treatment（the same as the previous scheme）.After 4 and 12 weeks of treatment,the values of safety related indicators（vital signs,blood routine,urine routine,liver and kidney function and adverse reactions）and efficacy related indicators（tender joints count,swollen joints count,erythrocyte sedimentation rate,pain visual score and DAS28-ESR）were recorded,analyzed and evaluated.Then,tcmsp,tcm-id,Swiss,CNKI and other databases and platforms are used to collect and screen the effective chemical components of various traditional Chinese medicines in ffangbi capsule,collect the target genes corresponding to the effective components,and then use UniProt database to screen the species sources of the above target genes and give standardized names;The disease target genes of rheumatoid arthritis were screened by using OMIM,TTD,genecards,drugbank and other disease and drug databases;Take the intersection of drug target set and disease target set through draw Venn diagram to obtain the intersection target;The network diagram of "drug component target disease" is used by Cytoscape 3 9.1 software drawing and topological analysis;The relationship between intersecting targets is determined by string database and Cytoscape3.9.1 software to draw PPI network diagram of protein-protein interaction;Finally,the metascape data platform is used for enrichment analysis,and the analysis results are displayed in charts.Results:The observation group and the control group were comparable in demographic characteristics（age,gender）,course of disease and curative effect indexes（tender joints count,swollen joints count,pain visual score,erythrocyte sedimentation rate and DAS28-ESR）（P>0.05）.After 4 weeks of treatment and observation,（1）the safety related indexes such as liver and kidney function of the two groups were not abnormal,and there were no adverse reactions;（2）After treatment,the number of tender joints count,swollen joints count,pain visual score,erythrocyte sedimentation rate and DAS28-ESR in the two groups were improved,and the difference was statistically significant（P<0.05）;（3）The number of swollen joints count,tender joints count and erythrocyte sedimentation rate in the observation group were slightly better than those in the control group,but the difference was not statistically significant（P>0.05）;（4）It was observed that the improvement of pain visual score and DAS28-ESR in the observation group were better than those in the control group,and the difference was statistically significant（P<0.05）.After 12 weeks of treatment,（1）one patient in the control group had leucopenia,which returned to the normal range after symptomatic treatment,and the safety indexes of the other patients were not abnormal and had no adverse reactions;（2）After treatment,the number of tender joints count,swollen joints count,pain visual score,erythrocyte sedimentation rate and DAS28-ESR in the two groups were improved,and the difference was statistically significant（P<0.05）;（3）The improvement of efficacy related indexes in the observation group after treatment was better than that in the control group,and the difference was statistically significant（P<0.05）.The research results of network pharmacology are as follows:through the search and screening of various databases and platforms,176 effective chemical components of traditional Chinese medicine in Wangbi capsule were collected.According to topological analysis,quercetin and palmitoleic acid have the highest correlation with diseases and play an important role in treatment.446 drug target genes and 1505 disease target genes;A total of 209 intersection targets were obtained.Among them,the top 30 genes led by anti-tumor necrosis factor（TNF）,interleukin-6（IL-6）,protein kinase 1（AKT1）,Interleukin-1B（IL-1B）and vascular endothelial growth factor（VEGFA）may be the key targets for the treatment of rheumatoid arthritis;The results of go function enrichment analysis suggest that there are 119 cell components,248 molecular functions and 2097 biological processes.It can be found that the biological processes are mainly concentrated in the reaction to lipopolysaccharide,hormone,nitrogen compounds,bacterial derived molecules,inorganic substances and inflammatory reactions,and the cell components are mainly concentrated in membrane raft Membrane microdomains,receptor complexes,dendritic membranes,neuronal projection membranes,transcriptional regulatory complexes,etc.the molecular functions are mainly concentrated in oxidoreductase activity,transcription factor binding,lipid binding,nuclear receptor activity,neurotransmitter receptor activity,etc;The results of KEGG pathway enrichment analysis suggest that there are 220 pathways,and multiple pathways led by lipid,atherosclerosis and cancer pathways are the intervention pathways of Wangbi capsule in the treatment of rheumatoid arthritis.Conclusion:The curative effect of Wangbi capsule in the treatment of rheumatoid arthritis（deficiency of liver and kidney）is significant,safe and reliable.It can reduce the degree of joint pain,reduce swollen joints count,reduce the level of inflammatory indicators and improve the quality of life of patients with rheumatoid arthritis.Yanbi capsule can break through the limitations of traditional single or combined immunosuppressant treatment of diseases by means of "multi-component,multi-target and multi-channel",which is worthy of clinical promotion. |
PDF Full Text Request