Clinical Efficacy And Network Pharmacology Prediction Of Zhibai Dihuang Decoction Flavored In The Treatment Of Advanced Cervical Cancer With Liver And Kidney Yin Deficiency

Objective:Clinical research:To observe the clinical efficacy of Zhibai Dihuang decoction flavored in the treatment of advanced cervical cancer with liver and kidney yin deficiency;Network Pharmacology:Using the network pharmacology to explore the molecular mechanism of Zhibai Dihuang decoction flavor in the treatment of cervical cancer.Methods:Clinical research part:60 patients with advanced cervical cancer with liver and kidney yin deficiency type who attended the outpatient clinic of the oncology department of our hospital from January 2022 to January 2023 were given the treatment with flavor of Zhibai Dihuang,using the clinical research method of self-controlled before and after,taking four cycles in three weeks as a cycle,to evaluate the tumor size,TCM syndrome scores,tumor markers,immune indexes,KPS score and drug safety before treatment,after two cycles of treatment,and after four cycles of treatment.The results were analyzed by SPSS26.0 statistical software to evaluate the clinical efficacy of Zhibai Dihuang flavor.Network pharmacology part:obtain the active ingredients and targets related to the flavor of Zhibai Dihuang in the TCMSP database and related literature,use Cytoscape 3.8.2 to build an "ingredient-target"network and screen out the core components,collect cervical cancer-related disease targets in GeneCards,OMIM,and DrugBank databases,take the intersection targets of drugs and diseases,and enter them into the STRING library for protein interaction(PPI)analysis and obtain core targets.GO and KEGG enrichment analysis of intersecting targets was performed in the DAVID database.Results:Clinical research part:A total of 60 cases that met the criteria were included in this clinical observation,of which 4 cases were shed and 56 cases were actually observed.1.Evaluation of the efficacy of solid tumors:Compared with before treatment,the objective response rate and disease control rate of solid tumors increased after 2 cycles of treatment,and the objective response rate of solid tumors increased after 4 cycles of treatment,and the difference was not statistically significant(p>0.05).2.TCM syndrome scores:Compared with before treatment,after 2 cycles of treatment(5 out of 7 individual points),after 4 cycles of treatment(7 individual points)and total points decreased,the difference was statistically significant(P<0.05).3.KPS score:Compared with before treatment,the difference was statistically significant after 2 cycles of treatment and 4 cycles after treatment(p<0.05).4.Tumor markers:compared with before treatment,tumor markers SCC and CEA were reduced after 2 cycles of treatment and 4 cycles of treatment,and the difference was not statistically significant(p>0.05).5.Immune indexes:Compared with before treatment,the levels of CD3+,CD4+,CD4+/CD8+were increased,and CD8+levels were reduced,and the difference was statistically significant(p>0.05).6.Safety:After treatment,there were no abnormal changes in the patient’s basic vital signs,blood routine,liver and kidney function,etc.Network Pharmacology Section:1.There are 103 active ingredients in 11 flavored Chinese medicines in Zhibai Dihuang Decoction,which have the potential to act on cervical cancer through 130 targets.According to network pharmacology analysis,the top 10 target genes were selected as TP53、AKT1、ALB、ESR1、MYC、VEGFA、CASP3、TNF、EGFR.The key active ingredients are:quercetin,β-sitosterol,stigmasterol,kaempferol,luteol.2.GO analysis using David database yielded a total of 394 GO function enrichment entries,including 266 biological processes,42 cellular composition,and 86 molecular functions.The signaling pathways related to cervical cancer in KEGG mainly include Pathways in cancer、PI3K-Akt、Kaposi sarcoma-associated herpesvirus infection、Human papillomavirus infection、MAPK etc.Conclusion:Clinical observation section:1.The flavor of Zhibai Dihuang can control tumor growth and reduce tumor markers SCC and CEA.2.The flavor of Zhibai Dihuang can reduce the medical syndrome score of patients,improve KPS score,reduce clinical symptoms and improve quality of life.3.The flavor of Zhibai Dihuang decoction can improve the immune indicators such as CD3+,CD4+,CD4+/CD8+in patients with advanced cervical cancer,improve immune function,and have good safety.Network Pharmacology Section:The flavor of Zhibai Dihuang can play a role in the treatment of cervical cancer through multi-component,multi-target and multi-pathway.