A Systematic Review And Study On The Mechanism Of Action Of Traditional Chinese Medicine In The Treatment Of T2DM Combined With NAFL

Purpose:Through the system evaluation method to explore the traditional Chinese medicine in the treatment of T2DM with NAFLD clinical curative effect,excavate its core reagent dosage and formula of drugs,and based on the network pharmacology methods to analyze the core mechanism of action of drugs,for clinical treatment of this disease to provide new ideas and theoretical support to clinical.Material and method:The beginning and end time of retrieval was set as January 2011 to December 2021,and reasonable retrieval method was established to search CNKI,CBM,Wanfang Medicine,VIP,Pubmed,The Cochrane Library,Embase and other Chinese and English databases.Stata SE16.0 and Revman Manger5.3 were used for data statistical analysis and literature quality evaluation.The main outcome index was total response rate;Secondary outcome measures included blood glucose,islet function,blood lipids,liver function,body mass index and incidence of adverse reactions.TCMISS V2.5 was used for analysis of prescription rules and mining of core drugs.Targets and main chemical components of core drugs were screened out from TCMSP database.Disease targets of T2DM with NAFLD were obtained from Gene Cards,OMIM and Pharm Gkb databases,key intersection targets of disease target and drug target can be obtained by R language.The network diagram of"core drug-active component-key target"is constructed by Cytoscape3.8.0,and the key target is imported into String database platform for PPI analysis and Cytoscape3.8.0 software for visual analysis.The core target is mined by analyzing the degree value of each node with Cyto NCA plug-in.GO and KEGG analyses were performed.Results:1.Meta-analysis resultsA total of 37 literatures,38 groups of clinical studies and 3333 patients wer e included in this study,and all the studies met the inclusion criteria.(1)The tot al efficacy of TCM in the treatment of T2DM patients with NAFLD was signifi cantly better than the control group:[Chi~2=46.62,P=0.134,I~2=20.6%,RR=1.281,P<0.00001].(2)The improvement of blood glucose in T2DM patients with NAFL D treated by TCM was significantly better than that in the control group:FPG:[SMD=-0.932,P<0.00001];2h PG:[SMD=-0.635,P<0.00001];Hb A1c:[SMD=-0.791,P<0.00001].(3)Islet function of T2DM patients with NAFLD was significantl y better than that of control group:FINS:[SMD=-1.109,P<0.00001];HOMA-IR:[SMD=-1.066,P<0.00001].(4)The improvement of blood lipid in T2DM patient s with NAFLD treated by TCM was significantly better than that in the control group:TG:[SMD=-1.087,P<0.00001];TC:[SMD=-1.031,P<0.00001];LDL-C:[S MD=-0.778,P<0.00001];HDL-C:[SMD=0.777,P<0.00001].(5)The improvement of liver function in T2DM patients with NAFLD treated by TCM was significant ly better than that in the control group:ALT:[SMD=-0.910,P<0.00001];AST:[S MD=-1.022,P<0.00001];GGT:[SMD=-0.727,P<0.00001].(6)The improvement of BMI in T2DM patients with NAFLD treated by TCM was significantly better th an that in the control group:BMI:[SMD=-0.479,P<0.00001].(7)There was no s tatistical significance in the incidence of adr in the treatment of T2DM with NA FLD compared with the control group[Chi~2=11.98,I~2=0.00%,OR=0.577,P=0.010].2.Analysis results of medication lawsThe prescription data of 38 TCM treatments for T2DM with NAFLD were systematically extracted,including 103 drugs.The drugs with high frequency were huanglian,fuling,baizhu,danshen and caihu through"frequency statistics".Analysis of the four qi and five flavors of Traditional Chinese medicine showed that bitter,sweet and spicy drugs were the most frequently used,while cold drugs were the most frequently used,and most of the drugs were used into the spleen meridian.Analysis of association rules of Traditional Chinese medicine showed that common drug pairs were"danshen-huangqi","huangqin-huanglian","danshen-chaihu","baizhu-fuling","danshen-z exie".Streamline drug network,get effect on T2DM combined NAFLD core drugs as"danshen"and"huangqi.3.Results of network pharmacology analysisQuercetin,Luteolin,kaempferol,Tanshinone IIA and Formononetin were suc cessively"danshen"and"huangqi"as the main active components of T2DM with NAFLD,and JUN,STAT3,AKT1,TP53 and MYC were the core targets of acti on.It may mainly affect lipid and atherosclerotic signaling pathways,PI3K-Akt s ignaling pathway and other biological processes.Conclusion:1.The traditional Chinese medicine in the treatment of T2DM with NAFLD total curative effect was better than control group;2.Chinese medicine treatment of T2DM with NAFLD merger can improve blood sugar,islet function,blood fat,liver meritorious service is associated with BMI index,and clinical application of relatively safe;3.The core of traditional Chinese medicine in the treatment of T2DM with NAFLD prescription drugs for"danshen"and"huangqi",its main effective components in Quercetin,Luteolin,kaempferol,Tanshinone IIA and Formononetin,handle,effect on T2DM with NAFLD core targets for JUN,STAT3,AKT1,TP53,MYC,The main biological processes involved are lipid and atherosclerotic signaling pathway,PI3K-Akt signaling pathway,etc.