Network Meta-Analysis Associated Network Pharmacology To Explore The Efficacy Evaluation And Mechanism Of Xuefu Zhuyu Decoction Combined With Western Medicine In The Treatment Of Angina Pectoris

Objective:To evaluate the clinical effect of Xuefuzhuyu decoction combined with western medicine on angina pectoris of coronary heart disease by using meta-analysis and network pharmacology research methods,and to explore the mechanism of Xuefuzhuyu decoction in the treatment of angina pectoris of coronary heart disease.Methods: Part I: Following the PICOS principle,the literature search strategy is designed and the corresponding standards are formulated.Through computer retrieval and manual retrieval,eight Chinese and English databases including CNKI,WF,VIP,CBM,Pub Med,Embase,Cochrane Library and Web of Science were comprehensively searched.The retrieval time range was set from the establishment of the database to December 31,2022.All RCTs related to the subject were downloaded,and the literature was screened according to the established criteria and the required baseline data and related data were extracted.During the whole research process,Endnote software was used for literature management,the improved Jadad scale was used to evaluate the quality of the final included literature,Rev Man5.4 was used for Meta analysis,and forest map was used to show the final analysis results.Part II: The research object of this study is Xuefu Zhuyu Decoction.Firstly,the effective components and target information of traditional Chinese medicine and western medicine are obtained by querying TCMSP,STITCH and Drug Bank databases,and the effective components are converted into standard gene names by using Swiss Target Prediction database.Then,we draw a network diagram of "combined drugs-components-targets" by using Cytoscape software.In order to further study the therapeutic effect of Xuefu Zhuyu decoction combined with western medicine,we searched the target genes related to angina pectoris in Gene Cards database,and drew a Wayne diagram using Venny2.1.0 website,from which the drug-disease intersection target was extracted.Finally,we screened out the core target of treating angina pectoris of coronary heart disease.In order to further study the biological pathways involved by different targets,we used GO and KEGG pathways in DAVID database.Results:Part I: 23 articles were included,with a total of 2300 patients,including 1128 cases in the control group and 1172 cases in the observation group.Meta-analysis showed that the clinical effect of Xuefu Zhuyu decoction combined with western medicine in treating angina pectoris of coronary heart disease was significantly improved compared with that of western medicine alone: the clinical effect of angina pectoris: OR=3.68,95%CI = [0.75,10.33],P < 0.00001;Total cholesterol(TC): MD =-1.09,95%CI=[-1.67,-0.51],P < 0.00001;Triglyceride(TG): MD =-1.38,95% CI =[-2.31,-0.46],P< 0.00001;High density lipoprotein(HDL-C):MD=0.26,95%CI=[0.19,0.33],P < 0.00001;Low density lipoprotein(LDL-C): MD=-0.84,95%CI=[-1.20,-0.49],P<0.00001;Plasmaviscosity:MD=-0.43,95%CI=[-0.58,-0.27],P<0.00001;Fibrin: MD=-0.65,95%CI=[-0.96,-0.33],P < 0.0001.Part II: Using the method of network pharmacology,148 active components of Xuefuzhuyu decoction and 45 active components of western medicine were screened out,and 9 targets of their joint action on coronary artery vessels were determined.GO analysis revealed 36 items of Biological process(BP),6 items of Cell component(CC)and 10 items of Molecular function(MF),while KEGG analysis revealed 12 signal pathways.These results preliminarily reveal the molecular mechanism of Xuefu Zhuyu decoction combined with western medicine in treating angina pectoris of coronary heart disease.After further analysis,this study found that the main functions of the combined regimen in treating angina pectoris of coronary heart disease involve cell differentiation,oxidative stress,enzyme pathway,response to foreign substance stimulation,enzyme activity,protein binding,aging and other mechanisms to achieve therapeutic effect,among which the active components mainly involve quercetin,β-sitosterol,stigmasterol, kaempferol,7-methoxy-2-methyl isoflavone,etc.These components act on different targets through different channels.Conclusion(s):(1)In terms of clinical total effective rate,hemorheology and blood lipid,Xuefu Zhuyu decoction combined with western medicine is more effective than simple drug treatment in preventing and treating angina pectoris of coronary heart disease.(2)Based on network pharmacology,this paper explores the multi-components,targets and pathway mechanisms of Xuefuzhuyu decoction in treating angina pectoris of coronary heart disease,and preliminarily reveals that Xuefuzhuyu decoction mainly achieves therapeutic effect on angina pectoris of coronary heart disease through active components such as quercetin,β-sitosterol,stigmasterol,kaempferol and 7-methoxy-2-methyl isoflavone,involving aging,oxidative stress,protein binding,cell differentiation and other mechanisms.