| Objectives:The purpose of this study is to uncover the laws of prescription prescriptions in this field through quantitative statistical analysis and decision tree modeling.A meta-analysis method will be conducted on the efficacy of Classical Prescriptions being intervention method.Based on this,further use of Network Meta-analysis and Addable Network Meta-analysis will be used to find the intervention with the best efficacy.Finally,through bioinformatic tools,the potential target gene of the best prescription on blood glucose control is going to be predicted.Method:Two researchers independently searched the online Chinese and English database from inception to the May 2019.All randomized controlled clinical trials(including self-reported prescriptions of a certain prescription and addition and subtraction)with Classical Prescriptions being the treatment group were included,and case reports and doctors' experience summary of relevant prescriptions were also conducted,as well as relevant conference reports.Using R software,a decision tree analysis model was used to classify the combination regularity of medications.I used R and Revman software for common meta-analysis.Based on the method of frequentist,a network-meta analysis model was established and the effect amount and probability ranking were calculated.Based on this model,an addable network-meta analysis model was further constructed,and the effect value of the standard network-meta analysis was compared to explore its potential interaction.In this way,to find out the best prescriptions or add-subtract drugs with positive interaction.The main active components of Gegen Qinlian Decoction and corresponding target genes were searched by TCMSP database.Relevant target genes for type 2 diabetes glycemic control are obtained through the Gene Cards,and the target of the drug active ingredient is mapped to the diabetes target,and the intersection target is the predicted target of Gegen Qinlian decoction on diabetes.Cytoscape 3.7.1 software was used to construct a drug active ingredientintersection target network model,and the key active ingredients of Gegen Qinlian Decoction were selected.Use the STRING website to construct an intersection target protein interaction network(PPI)and select key target genes.Use Metascape online tools to perform pathway enrichment and biological function enrichment analysis on intersection targets,especially gene function(GO)analysis and pathway enrichment analysis based on the Kyoto Encyclopedia of Genes and Genomes(KEGG).Finally,the related pathways of the biological function and influence of Gegen Qinlian Decoction in the treatment of diabetes as potential gene targets are obtained.Result:In the early stage,2540 documents were retrieved through the search,and were screened into the general meta-analysis,mesh meta and component mesh meta-analysis.The results are as follows:In the general meta-analysis,after screening,10 articles were included in the meta-analysis of Jinguishenqi pills combined with Western medicine conventional treatment,a total of 911 people;5 articles were included in the Baihu Plus ginseng decoction combined with Western medicine conventional treatment,a total of 340 people;5 articles A meta-analysis of gegenqinlian decoction combined with Western medicine conventional treatment,a total of 448 people;4 meta-analysis of Wumei pills combined with Western medicine conventional treatment,a total of 398 people;3 meta-analysis of Wuling powder combined with Western medicine conventional treatment,a total of 228 people.?General meta-analysis results:(1)For FBG,Jingui Shenqi Pill,Baihu Plus Ginseng Decoction,Gegen Qinlian Decoction,Wuling Powder and Wumei Pill are more advantageous in reducing FBG after combined with Western medicine conventional treatment,and have significant statistical differences.The effect sizes are [MD=-0.91,95%CI(-1.14,-0.68),P<0.00001],[MD=-0.84,95%CI(-1.04,-0.64),P<0.00001],[ MD =-1.69,95% CI(-2.29,-1.10),P<0.00001],[MD=-0.81,95% CI(-1.01,-0.62),P<0.00001],[MD=-1.47,95%CI(-1.93,-1.02),P<0.00001];(2)For P2 BG,the above 5 first classic prescription combined with conventional Western medicine treatment is also better than Western medicine treatment alone,the effect sizes are [MD=-2.03,95%CI(-2.41,-1.65),P<0.00001],[MD=-2.14,95%CI(-3.76,-0.52),P<0.05],[MD=-2.34,95%CI(-2.73,-1.95),P<0.00001],[MD=-1.45,95%CI(-2.51,-0.38),P<0.05],[MD=-2.25,95%CI(-2.68,-1.82),P<0.00001];(3)For Hb A1 c,the efficacy of Jingui Shenqi Pill,Baihu Plus Ginseng Decoction,Gegen Qinlian Decoction after combined conventional Western medicine treatment is better than that of simple Western medicine treatment,the effect sizes are [MD =-0.75,95% CI(-0.97,-0.53),P < 0.00001],[MD =-0.33,95% CI(-0.46,-0.20),P < 0.00001],[MD =-1.30,95% CI(-2.54,-0.06),P < 0.05];(4)In terms of adverse reactions,Jingui Shenqi Pills combined with conventional Western medicine treatment can significantly reduce the incidence of adverse reactions(RR = 0.25,95% CI(0.09,0.73),P = 0.01 <0.05),but for adverse reactions Interpretation also needs more literature support.It shows that the curative effect of the above five prescriptions is worthy of further study,and it can provide evidence with more reference value by clarifying the comparative curative effect between each other.The network and component network meta-analysis involved a total of 48 documents,4120 people,and 16 classics.Because the component mesh meta-analysis is performed on the basis of the mesh meta-analysis,it is another analysis method used for the same data,so the two parts of the literature screening and data extraction are completely consistent,only the results are different.Mesh meta-analysis results:In terms of reducing FBG,the difference between the 7 interventions and conventional Western medicine treatment was statistically significant;according to the results of the cumulative probability ranking,Gegen Qinlian Decoction + Western medicine conventional treatment(SUCRA = 86%)was the best effective in reducing FBG.In terms of reducing P2 BG,the difference between the eight interventions and conventional Western medicine treatment was statistically significant;according to the probability area,Guizhi plus Longgumuyu Decoction + Western medicine conventional treatment(SUCRA = 82%)was the most effective in reducing P2 BG.In terms of reducing Hb A1 c,there were 3 interventions that were statistically significant compared to conventional Western medicine treatment alone;sorted according to probability area,Wuling Powder + Western medicine conventional treatment(SUCRA = 86%)was the best treatment for reducing Hb A1 c.In terms of adverse reactions,Jingui Shenqi Pills + Psyllium and Achyranthes + Western Medicine Conventional Treatment [OR = 0.21,95% CI =(0.04,0.83)] and Wumei Pills + Western Medicine Conventional Treatment [OR = 0.15,95% CI =(0.02,0.89)] can reduce the incidence of adverse reactions;according to the results sorted by cumulative probability,Wumei Wan + conventional Western medicine treatment(SUCRA = 76%)is the best intervention to reduce adverse events.The results of the component mesh meta-analysis:In reducing FBG,the efficacy of each classical prescription is better than that of simple Western medicine treatment,of which Gegen Qinlian Decoction has the best effect on reducing FBG [MD =-1.7219,95% CI(-2.4137;-1.0302),P < 0.001];In reducing P2 BG,the efficacy of each classical prescription is better than that of Western medicine alone.Guizhi plus Longgu Oyster Decoction is the best medicinal recipe for reducing P2 BG [MD =-2.89,95% CI(-5.2714;-0.5086),P < 0.05];In reducing Hb A1 c,only the curative effects of Wuling San [MD =-1.5384,95% CI(-2.6623;-0.4145),P < 0.05],Gegen Qinlian Decoction [MD =-1.3082,95% CI(-2.0963;-0.5202),P < 0.05],Jingui Shenqi Pills + Psyllium and Achyranthes [MD =-0.8470,95% CI(-1.6099;-0.0841),P < 0.05] are better than conventional Western medicine treatment,the rest curative effects are worse than that of conventional Western medicine.At this point,it can be found that whether Gegen Qinlian Decoction is used in combination with conventional Western medicine treatment or used alone,the blood glucose control effect is better than that of the control group,and the results are more stable than other Jingfang prescriptions.Therefore,the potential mechanism of action of Gegen Qinlian Decoction on blood glucose control Further analysis has more practical significance.Through network pharmacology tools,Gegen Qinlian Decoction has been found to have 65 effective chemical components,such as puerarin,baicalin,berberine,and glycyrrhizin.Compared with the related gene targets of "type 2 diabetes blood sugar control",32 common genes were obtained.The analysis found that Gegen Qinlian Decoction may play the role of anti-diabetes through the following aspects:(1)improving insulin resistance;(2)antiinflammatory and antioxidant damage;(3)Promote ? cell proliferation and enhance islet function;(4)interfere with the signal transduction process of Helicobacter pylori infection epithelial cells,improve intestinal flora.Conclusions:(1)Common meta-analysis shows that in terms of blood sugar control,Jingui Shenqi pill,Baihu plus ginseng decoction,Gegen Qinlian decoction,Wumei pill and Wuling powder combined Western medicine conventional treatment have better efficacy than Western medicine alone treatment,it is worth further Study the comparative efficacy of each.(2)Reticulated and component reticulated meta-analysis showed that Gegen Qinlian Decoction reduced FBG,Guizhi Plus Longgu Oyster Decoction decreased P2 BG and Wuling Powder decreased Hb A1 c,which was more effective than other traditional prescriptions and conventional Western medicine.Among them,Gegen Qinlian Decoction has the best control effect on FBG and Hb A1 c when it is used in combination with Western medicine or alone,and it has outstanding control effect on Hb A1 c and P2 BG,and there is less possibility of heterogeneity and credibility in the results Gao,this study is considered to be the most effective prescription for controlling type 2 diabetes in the included studies.(3)Through network pharmacological analysis,Gegen Qinlian Decoction may control blood sugar by improving insulin resistance,anti-inflammatory and anti-oxidative damage,promoting ? cell proliferation,interfering with the signal transduction of Helicobacter pylori infection epithelial cells,etc.The clear mechanism of action needs further experimental verification. |
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