Meta-analysis And Data Mining On The Pattern Of Medication Use In The Treatment Of Angina Pectoris In Coronary Heart Disease With Zhishixiebaiguizhitang And Its Addition And Subtraction Formula

Objective:To systematically evaluate the efficacy and safety of Zhishixiebaiguizhitang and its additive and subtractive formula combined with western medicine in the treatment of angina pectoris in coronary heart disease through Meta-analysis,and to summarize the dosing pattern of Zhishixiebaiguizhitang additive and subtractive formula in the treatment of angina pectoris in coronary heart disease through data mining,so as to guide the clinical use of angina pectoris in coronary heart disease.Methods:1.Using computerized full network search of Chinese and English databases such as China Knowledge Network(CNKI),Vipshop Chinese journals,Wanfang,China Biomedical Literature Database(CBM),pubmed,cochrane library,EMBASE,etc.,relevant literature since the establishment of the database up to 2023 was selected for screening,using the terms including "coronary heart disease"," angina pectoris","Z hishixiebaiguizhitang","clinical","clinical "randomized controlled trial","CHD","angina pectoris","Randomized ControlledTrial" and other key words in English and Chinese.Total clinical efficiency was used as the primary outcome indicator,and randomized controlled trials were selected by adhering to specific inclusion and exclusion criteria,and the quality of eligible randomized controlled trials was evaluated by applying the Cochrane Risk of Bias Assessment Form;statistical plots for risk of bias assessment and Meta-analysis were produced using RevMan 5.4,and sensitivity analysis and/or subgroup analysis were performed when necessary.Sensitivity analysis and/or subgroup analysis will be performed when necessary to judge the relevance and stability of the results.The final results will be presented as forest plots for outcome indicators and funnel plots for publication bias.2.Computer searches were conducted on the databases of China Knowledge Network(CNKI),Vipshop Chinese Journal Database,Wanfang Data Service Platform,Cochrane,PubMed,etc.The Chinese search terms were "Z hishixiebaiguizhitang","coronary heart disease","angina pectoris" and "angina pectoris"."CHD","Zhishixiebaiguizhi",etc.The search terms in English were "HD" and"Zhishixiebaiguizhi".The time limit was from database creation to February 2023.The retrieved literature was screened with the established inclusion criteria,and the literature that did not meet the inclusion criteria was excluded using the relevant software,and the literature that met the inclusion criteria was unified using an Excel sheet,and then the core drugs were explored using SPSS Modeler 18.0 in combination with Cytoscape 3.9.1 software,using RStudio 4.2.1 Apriori algorithm for association rule analysis,and RStudio4.2.1 for clustering and drug dose analysis of the core drugs.The final results are presented in the form of images.Results:1.Meta-analysis:37 eligible randomized controlled trials were included and all were in Chinese,published from 1998 to 2022,with a total of 3221 study subjects,including 1721 in the experimental group and 167 6 in the control group.The results of the Meta-analysis were:(1)There were 26 studies reporting the results of the total efficiency of TCM evidence,OR=3.1 8,95%CI=[2.53,3.99],Z=10.00,P<0.00001;(2)Chinese medicine evidence score was reported in 10 studies,MD=-4.37,95%CI=[-4.69,-4.05],p=0.23,z=26.38,p<0.00001;(3)Total ECG efficacy was reported in 17 studies,p<0.0001,OR=2.58,95%CI=[2.03,3.30];(4)The total effective rate of angina pectoris was reported in 10 studies,P<0.00001,OR=5.71,95%CI=[3.70,8.83];(5)SAQ was reported in 4 studies,P<0.00001,SMD=1.25,95%CI=[0.84,1.66];(6)SF-36 score reported in 3 studies,P<0.00001,MD=5.31,95%CI=[2.98,7.64];(7)Angina points reported in 3 studies,P<0.00001,SMD=1.56,95%CI=[-2.18,-0.93];(8)Number of angina attacks reported in 8 studies,P<0.00001,MD=-1.99,95%CI=[-2.84,-1.15];(9)Duration of angina attacks reported in 4 studies,P<0.00001,MD=-2.37,95%CI=[-2.93,-1.82];(10)Nitroglycerin consumption was reported in 4 studies,P=0.0001<0.05,MD=-2.38,,95%CI[-3.60,-1.16];(11)Nitroglycerin discontinuation rate was reported in 3 studies,P=0.006<0.05,OR=2.10 95%CI=[1.24,3.56];(12)Total cholesterol was reported in 4 studies,P=0.0002<0.05,MD=-0.93,95%CI=[-1.42,-0.44];(13)A total of 6 studies were reported for TC,P=0.02<0.05,MD=-0.97,95%CI=[-1.82,-0.13];(14)TG was reported in a total of 10 studies,P<0.00001,MD=-0.43,95%CI=[-0.59,-0.26];(15)LDL-C was reported in 9 studies,P=0.0006<0.05,MD=-0.64,95%CL=[-1.00,-0.27];(16)HDL-C was reported in 7 studies,P<0.0001,MD=0.23,95%CI=[0.12,0.34];(17)IL-6 was reported in 4 studies,P=0.003<0.05,SMD=-1.46,95%CI=[-2.43,-0.49];(18)hs-CRP was reported in 10 studies,P<0.00001,MD=-1.90,95%CI=[-2.64,-1.15];(19)ET-1 was reported in 4 studies,P<0.00001,MD=-12.72,95%CI=[-17.45,-7.99];(20)NO was reported in 5 studies,P<0.00001,MD=8.84,95%CI=[7.67,10.01];(21)MMP-9 was reported in 2 studies,P<0.00001,MD=-88.42,95%CI=[-102.44,-74.40];(22)Hcy was reported in 7 studies,P<0.0001,MD=-5.17,95%CI=[-7.54,-2.80];(23)Left ventricular ej ection fraction was reported in 3 studies,P<0.00001,MD=8.07,95%CI=[6.17,9.96]:(24)Blood rheology This index was reported in 2 studies and both reported high cut viscosity,low cut viscosity and plasma viscosity,all with low heterogeneity(P>0.1)and showed statistically significant differences(P<0.05)after combining statistics by fixed effects model;(25)12 studies were evaluated for safety,of which a total of 5 studies clearly reported the occurrence of adverse reactions,but all showed that the occurrence of adverse reactions was not statistically significant(P>0.05).2.Data mining:49 cases were included through data mining,and 5 2 prescriptions were extracted,involving 72 herbs,and the following results were obtained:(1)The top 4 cases involving symptoms were:phlegm blocking the heart and veins(16 times,3 0.77%),phlegm stagnating the ligaments(9 times,17.3 1%),phlegm-heat internal obstruction(5 times,9.62%),and yin-cold stagnation(5 times,9.62%).(2)The top 5 herbal medicines in terms of efficacy were:qi regulators(112 times,23.68%),deficiency tonics(80 times,16.91%),phlegm-relieving and cough-relieving medicines(60times,12.68%),epithet-relieving medicines(57times,12.05%),and blood-stasisactivating medicines(52 times,10.99%).(3)The top ranking of the nature and ascriptions of herbal medicines are:(1)drug nature:warm(246 times,5 2.01%),cold(159 times,3 3.62%),with a cumulative percentage of 85.63%;(2)drug taste:pungent(293 times,33.30%),bitter(288 times,32.73%),sweet(215 times,24.43%),with a cumulative percentage of 90.46%(3)Drug meridians:lung meridian(284 times,19.82%),stomach meridian(264 times,18.42%),heart meridian(231 times,16.12%),and spleen meridian(228 times,15.91%)were dominant,with a cumulative percentage of 70.27%.(4)Core drugs:In addition to the base formula of Citrus Aurantium Allium and Allium Gui Zhi Tang,the core drugs also include Dan Shen,Gan Cao,Chuan Xiong,Roasted Gan Cao,Hong Hua,Radix et Rhizoma Paeoniae,Radix et Rhizoma Paeoniae,Poria,Radix Paeoniae,Peach kernel,Radix Astragali,Dragon bone,Medlar,and Angelicae.(5)Core drug rule association analysis:Screening with support degree>20%and confidence degree>90%,68 core association rules were obtained,and the enhancement degree was greater than 1,suggesting that the drug association degree was high.(6)Drug dosage analysis:the dosage of white peony,red peony,Salvia miltiorrhiza,guahua,safflower,huperzine and astragalus fluctuated more than 5g,while the dosage of the remaining drugs fluctuated within 5g.In addition,the prescriptions are heavy with Salvia,Astragalus and Astragalus,with dosages above 20g;the dosages of the remaining drugs are mostly between 5 and 15g,with about 10g being the majority.Conclusion:1.Zhishixiebaiguizhitang was superior to the control group in the total effective rate of TCM syndrome,TCM syndrome integral and total effective rate of angina pectoris,it can increase the nitroglycerin rate,reduce the consumption of nitroglycerin,improve the attack of angina pectoris and improve the quality of life of patients.Its mechanism may be related to regulation of lipid metabolism,inhibition of inflammatory factors release,improvement of vascular endothelial function and other mechanisms,and less adverse reactions.2.RCT literature has high heterogeneity and may have publication bias.3.The compound prescription of Zhishixiebaiguizhitang for treating angina pectoris of coronary heart disease is mostly the prescription of resolving phlegm,promoting blood circulation and warming yang,the four-qi attribute of medicine is mainly warm and cold,and the five-flavor attribute is mainly acrid,bitter and sweet Multi-channel,such as lung,stomach,heart,and more with Wenyang Huayin,Huoxue Huayu drugs used.