| Objective:meta-analysis was used to systematically analyze the randomized controlled trial(RCT)articles concerning the treatment of ankylosing spondylitis(AS)due to impediment of damp-heat with the method of clearing heat,dampness and dredging collaterals in order to evaluate its clinical efficacy and safety.Using the method of network pharmacology,the relationship between the components of traditional Chinese medicine and diseases was explored from multi-components,multi-paths,multi-targets and other aspects on the core drugs of heat-clearing and dampness-removing and collateral-dredging method in the treatment of ankylosing spondylitis due to damp-heat impediment,to reveal the possible mechanism of heat-clearing and dampness-removing and collateral-dredging traditional Chinese medicine in the treatment of ankylosing spondylitis due to damp-heat impediment,to provide reference for clinical treatment and further research.Method:The meta-analysis part covered the published randomized controlled trial articles in the domestic and foreign countries concerning the treatment of ankylosing spondylitis with the method of clearing heat and removing dampness based on domestic and foreign databases such as CNKI,Wanfang Database,VIP,China Biomedical Literature Database,Medline,Pub Med,and Web of Science from inception to December 2022.Then,according to the established inclusion criteria and exclusion criteria,the literature was strictly screened,and the extracted literature and related data were cross-checked to ensure the accuracy of the included literature and extracted data.Then,the evaluation criteria were classified and summarized,and a data extraction table was prepared.Finally,the obtained Meta were subjected to meta-analysis using Rev Man 5.3 statistical software,and conclusions were drawn.In the core Chinese medicine screening part,the Chinese medicine prescriptions in the included articles were organized using the EXEL table function and the operations of the simplified matrix were performed.Subsequently,the obtained matrix was analyzed for correlation using SPSSModeler18.0software.The more ranked drug combinations were screened based on the percentage of support,percentage of confidence between drug combinations,and examples.For the network pharmacology part,we searched the active ingredients of core Chinese medicines in the TCMSP database,and then screened the active ingredients that met the conditions according to the principles of pharmacokinetic systems.Target information of active components obtained by using Uni Prot database;The Gene Cards database obtains the targets of related AS diseases,and then uses the disease targets to match and intersect with the core drug targets to obtain the potential targets of the core drugs for the treatment of AS diseases.The STRING database was entered and the core target disease-drug target interaction network was constructed using,and the Cytoscape 3.8.2 was adopted for visualization.Finally,GO and KEGG enrichment analysis was performed using DAVID database,and conclusions were drawn.Result:In the meta-analysis part,12 articles were screened according to the established inclusion criteria and exclusion criteria,and the total number of enrolled subjects was 891,including 447 in the experimental group and 444 in the control group.The quality of articles included in the study was on the low side,with 3 high-quality articles and 9 low-quality articles.The results of the meta-analysis showed that heat-clearing and dampness-removing therapy had good clinical efficacy and high safety in the treatment of ankylosing spondylitis,and the adverse reactions meta lower than those in the control group.The obtained core chinese medicinal materials are cortex phellodendri,coicis semen,achyranthis radix,and radix stephaniae tetrandrae.In network pharmacology,64 active drug components and 522 potential drug action targets were screened out from the four core traditional Chinese medicines.There were 50 potential targets of core drugs for the treatment of AS disease,and the key components were quercetin,berberine,berberine,palmatine,and carvedilol.The GO enrichment analysis had 726 entries for the biological process,368 P-value values < 0.01,154 Molecular Function and 91P-value values < 0.01.There were 42 Cellular component with 81 P-value values < 0.01.We obtained 108 KEGG pathways,including L-17 signaling pathway,TNF signaling pathway,HIF-1 signaling pathway,T cell receptor signaling pathway,NF-κB signaling pathway,and VEGF signaling pathway.Conclusion:The results of the meta-analysis showed that heat-clearing and dampness-removing therapy had good clinical efficacy in the treatment of ankylosing spondylitis with high safety,and the adverse reactions were lower than those in the control group.It could better improve the disease functional index,disease activity index,morning stiffness,lumbar spine activity,thoracic spine activity,occipital-wall distance and alleviate the pain symptoms of patients.For the improvement of inflammatory indicators,the method of clearing heat and promoting diuresis can better reduce the indicators such as C-reactive protein and erythrocyte sedimentation rate.Network pharmacology results showed that the core traditional Chinese medicines(cortex phellodendri,radix stephaniae tetrandrae,achyranthis radix,and coicis semen)might exert the effects of anti-inflammation,analgesia,and anti-oxidative stress through their active components: quercetin,berberine,berberine,palmatine,and carvedilol.There were some shortcomings in this study,and further animal cells and clinical practice were needed to verify the authenticity of the treatment of ankylosing spondylitis due to damp-heat impediment by using heat-clearing and dampness-removing method. |
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