| Objective:Through meta-analysis,analyze the relevant randomized controlled trials of Jianpi Yishen formula combined with western medicine in the treatment of myasthenia gravis,evaluate the clinical efficacy and safety of Jianpi Yishen formula combined with western medicine in the treatment of myasthenia gravis,and compare it with simple western medicine.Using the method of network pharmacology,from the perspective of multi-component,multi-target and multi-channel,taking Jianpi Yishen jukeng decoction as the core drug,this paper comprehensively predicts and explains the possible mechanism of Jianpi Yishen jukeng Decoction in the treatment of MG,so as to provide reference for further basic research.Methods: Meta analysis,using the computer to search the relevant six databases,using the corresponding search strategies,import the relevant documents obtained from the search and screening into the document management software,screen the documents that meet the research conditions in strict accordance with the set inclusion and exclusion criteria,and extract the clinical efficacy and relevant indicators in the included documents.Enter the Review Manager 5.3software for correlation analysis and get the results.Network pharmacology,find the core drug of Jianpi Yishen jukeng Decoction on the relevant active components of "Astragalus Rehmannia",screen the potential action targets and myasthenia gravis related targets,get the intersection between the effective component related targets of Astragalus rehmannia and the disease related targets of myasthenia gravis,and draw the network diagram of the intersection targets and relevant active components with Cytoscape.Use the built-in network analysis tool of Cytoscape to analyze the topological attributes of the network to evaluate the importance of nodes,and screen out the important components and related key targets of Astragalus and Radix Rehmanniae in the treatment of Mg.Flexibly use relevant software and key packages to construct protein-protein interaction network,go enrichment analysis and KEGG enrichment analysis for relevant important targets,and draw the map at the same time.Results:Based on meta-analysis: 1.A total of 10 literatures on the treatment of myasthenia gravis by Invigorating the spleen combined with Tonifying the kidney combined with western medicine were retrieved,and 1018 patients were included.2.In terms of literature quality,the analysis results of Cochrane bias evaluation tool suggest that the quality of RCTs included is relatively low,and there are deficiencies in the reporting of random sequence hiding and the implementation of blind method,and most of them do not mention the hiding and blinding of random distribution.3.As for the evaluation of clinical efficacy,whether using Xu’s relative score method,QMG score method or TCM symptom score method,traditional Chinese medicine for strengthening the spleen and kidney combined with conventional western medicine can significantly improve the clinical efficacy of mg compared with simple western medicine.4.In terms of recurrence rate,the included studies show that traditional Chinese medicine for strengthening the spleen and kidney combined with conventional western medicine can reduce the recurrence rate of patients with myasthenia gravis.5.In terms of the incidence of adverse reactions,the included studies showed that the integrated traditional Chinese and Western medicine group did not show obvious advantages compared with the simple western medicine group.Based on network pharmacology: 1 19 active compounds and 201 potential targets of the core drug of Jianpi Yishen jukeng Decoction on "Astragalus Radix Rehmanniae" were screened.2.686 MG related targets were screened.3.The compound intersected with the disease,and 47 common targets were obtained,that is,the potential target of Astragalus and Radix Rehmanniae in the treatment of Mg.4.Using the network analysis tool to analyze the topological properties of the network,eight key active components were obtained,including quercetin,kaempferol,formononetin,stigmasterol,isorhamnetin,etc.5.Construct protein interaction network and obtain six core targets: ESR1,Mapk14,Jun,AKT1,TNF and CASP3.6.In GO enrichment analysis,2121 items were enriched in biological process（BP）,179 items in molecular function（MF）and 51 items in cell composition（CC）.7.KEGG enrichment analysis obtained 206 relevant action pathways,including IL-17 signaling pathway,TNF signaling pathway,endocrine resistance,T cell receptor signaling pathway,TLR signaling pathway,etc.Conclusion: The results of meta-analysis interestingly show that compared with the simple western medicine treatment group,the traditional Chinese medicine for strengthening the spleen and tonifying the kidney combined with conventional western medicine has certain advantages in improving the clinical efficiency and reducing the recurrence rate.Surprisingly,there was no significant difference in safety compared with the simple western medicine group.Considering that the quality of the original RCT included in this time is relatively low,and the quality of the systematic evaluation evidence depends on the quality of the original research,coupled with the subjective bias of the researchers,these may affect the objectivity and accuracy of the report of the research results.This conclusion suggests that it is worth noting that the methodological design of many existing randomized controlled trials of integrated traditional Chinese and Western medicine in the treatment of myasthenia gravis is far from rigorous.In the future,we need more large sample,prospective and high-quality randomized controlled trials to verify the results.Network pharmacology research suggests that the monarch drug "Astragalus cooked land" of Jianpi Yishen jukeng decoction may target the treatment of Mg mainly through the anti cholinesterase activity,anti-inflammatory,immune regulation and other effects of quercetin,kaempferol,anthocyanin,stigmasterol,isorhamnetin and other effective active ingredients,which proves that they have a great research space,It may provide a material basis for the research and development of drugs for the treatment of Mg.However,this part of the study can only play a predictive role,and the exact therapeutic target and component action pathway need to be further verified by pharmacology and animal experiments. |
PDF Full Text Request