| Object:To systematically evaluate the effects of 5 kinds of Chinese patent medicines commonly used in nephrology department of a hospital on inflammation and oxidative stress indexes of diabetic nephropathy and rank the efficacy,so as to provide reference for early application of anti-inflammatory treatment,monitoring of oxidative stress and inflammation indexes and clinical selective medication;In order to clarify the effect of single Chinese patent medicine on inflammation and oxidative stress indexes in patients with diabetic nephropathy,taking Uremic Clearance Granules as the research drug,in order to promote the application of Chinese patent medicine in oxidative stress and inflammation of diabetic nephropathy,and provide reference for clinical anti-inflammatory treatment of diabetic nephropathy;To further explore the possible anti-inflammatory and oxidative stress mechanism of Uremic Clearance Granules in the intervention of diabetic nephropathy,and to provide reference for further clinical research.Methods:(1)Computer search of CNKI,Wan Fang,VIP,CBM,Pub Med,the Cochrane Library,Embase and other databases,dated from the date of establishment to August 1,2022 for randomized controlled trials of five proprietary Chinese medicines for the treatment of diabetic nephropathy,using Rev Man 5.3 to evaluate the quality of the included literature,applying Open BUGS and stata 17.0 to process and visualize the data,respectively.(2)Using the above databases to search the literature,dated since the establishment of the database to July 1,2021,were collected for randomized controlled trials of Uremic Clearance Granules combined with ACEI/ARB class drugs for the treatment of stage III diabetic nephropathy,and Two researchers cross-checked and screened the included literature,and then extracted the data to evaluate the quality of the literature,and performed meta-analysis using Rev Man 5.3.(3)The active ingredients and action targets of uremic clearance granules were collected and screened in the TCMSP database,and the literature was reviewed as a supplement,and the targets related to diabetic nephropathy were screened through TTD,OMIM,Gene Cards,drugbank and Dis Ge NET platforms,and intersected with drug targets;protein interactions were obtained through STRING platform,and protein interactions were obtained through Cytoscape-v3.8.0 was used to visualize and analyze the key targets for the extraction of uremic clearance granules for the treatment of diabetic nephropathy;DAVID 6.8 was used to perform GO and KEGG enrichment analysis;Auto Dock Tools and Pymol were used to verify the molecular docking of the main active ingredients with the key targets.Results:(1)Finally,55 articles and 6 interventions were included.The order of total effective rate probability is:Jinshuibao > Uremic clearance granules > Huangkui capsule > Shenshuaining > Bailing capsule >conventional western medicine treatment;the probability of reducing UAER was ranked as follows:Shenshuaining > Bailing capsule > Jinshuibao > Huangkui capsule > Uremic clearance granules >conventional western medicine treatment;the probability of reducing 24 h UTP was ranked as follows:Shenshuaining > Huangkui Capsule > Bailing Capsule > Jinshuibao > Western medicine routine treatment;the probability of reducing Scr was ranked as follows: Huangkui capsule > Bailing capsule > Shenshuaining >Jinshuibao > Uremic clearance granules > conventional western medicine treatment;the probability of reducing BUN was ranked as follows: Bailing capsule>Shenshuaining>Jinshuibao > Huangkui capsule >Uremic clearance granules > conventional western medicine treatment;(2)The probability of reducing hsCRP was ranked as follows: Bailing capsule > Huangkui capsule > Uremic clearance granules > Jinshuibao >conventional western medicine treatment;the probability of reducing IL-6 was ranked as follows: Bailing capsule > Jinshuibao > Huangkui capsule > Shenshuaining > conventional western medicine treatment;the order of increasing SOD probability is: Bailing capsule > Shenshuaining > Huangkui capsule > Jinshuibao >Uremic clearance granules > conventional western medicine treatment;the probability of reducing MDA was ranked as follows: Shenshuaining > Bailing Capsules > Huangkui Capsules > Jinshuibao > Uremic clearance granules > Western medicine routine treatment;the probability of reducing TNF-α was ranked as follows:Huangkui capsule > Shenshuaining > Jinshuibao > Bailing capsule > Uremic clearance granules >conventional western medicine treatment.A total of 10 studies involving 658 patients were included.Compared with conventional western medicine treatment,Uremic clearance granules combined with ACEI/ARB drugs can improve the clinical efficacy of stage III DN [ RR = 1.24,95 % CI(1.16,1.32),P <0.00001].It reduced hs-CRP [ MD =-2.03,95 % CI(-2.83,-1.23),P < 0.00001],IL-18 [ MD =-17.33,95 %CI(-21.54,-13.12),P < 0.00001],TNF-α [ MD =-3.15,95 % CI(-5.65,-0.65),P = 0.01],MDA [ MD =-0.81,95 % CI(-1.17,-0.44),P < 0.00001] increased SOD [ MD =-8.54,95 % CI(5.76,.92),P < 0.00001 ]..Reduce inflammation and oxidative stress.(3)A total of 248 active components of Uremic clearance granules were obtained,among which the main active components were quercetin,luteolin,β-sitosterol,kaempferol,etc.There were 1813 potential targets of DN and 156 intersection targets.Network topology analysis obtained17 key targets,and JUN,SRC and MAPK1 were selected as core targets.The biological processes analyzed by GO functional enrichment mainly involved cellular regulation of signal transduction,reactive oxygen species and apoptotic process;the KEGG pathway enrichment analysis included fluid shear stress and atherosclerosis,AGE-RAGE pathway,TNF pathway,Toll-like receptor pathway and MAPK pathway.Molecular docking results showed that quercetin,lignan,β-sitosterol and kaempferol had good binding activities with the three core targets.Conclusion:(1)On the basis of conventional Western medical therapy,the combination of proprietary Chinese medicines can enhance the clinical efficacy of diabetic nephropathy.Overall,it reflected that renal failure and Bailing capsule had more advantages in overall efficacy,and the combination of Bailing capsule and Huangkui capsule had the greatest effect on oxidative stress and inflammation indexes in western conventional therapy,which can provide some reference for the early application of anti-inflammatory therapy and monitoring of oxidative stress and inflammation indexes and clinical selective drug use.(2)The combination of ACEI/ARB drugs with uremic clearance granules can significantly improve the clinical efficacy,inflammation and oxidative stress in patients with stage III diabetic nephropathy,but the number of included studies is small and the effects on inflammation and oxidative stress need to be further verified.(3)Uremic clearance granules may act on different targets through active ingredients such as quercetin,lignocaine,β-sitosterol and kaempferol,which are involved in regulating multiple pathways,exerting antiinflammatory,anti-oxidative stress and inhibition of apoptosis to play a role in protecting renal function and treating diabetic nephropathy. |
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