| Background:Due to changes in people's diet and lifestyle,the incidence of ischemic stroke increases year by year,coupled with its high disability,recurrence and mortality,it brings to patients and their families The double burden of spirit and economy.At present,conventional Western medicine treatments include thrombolysis,thrombectomy,and antiplate therapy,which have achieved certain results,but the disability rate is still high.The recovery of patients' self-care ability in life is not ideal,and there are certain limitations in treatment.Ischemic stroke belongs to the category of "stroke" in Chinese medicine.Chinese physicians have a long history in exploring the etiology and pathogenesis,syndrome differentiation,treatment and prognosis of the disease.Most of them think that the disease is qi and blood rebellion,which is offended by the brain and brain.Caused by the misuse of Shenming,clinical treatment methods such as calming the liver and removing wind,clearing away phlegm heat,removing phlegm and heat,promoting blood circulation and relieving collaterals,awakening the mind and invigorating qi,etc.,among which Xiaoxuming Decoction is a classic prescription for the treatment of stroke,often used in acute stroke period.However,Xiaoxuming decoction combined with conventional Western medicine treatment can significantly improve the symptoms and prognosis of patients with acute ischemic stroke.Some clinical trials have compared the efficacy of Xiaoxuming decoction combined with conventional therapy and conventional therapy alone in the treatment of acute ischemic stroke Differences with security have achieved certain results.Therefore,it is necessary to systematically evaluate the efficacy and safety of Xiaoxuming Decoction in the treatment of acute ischemic stroke.The basic research of Xiaoxuming Decoction in treating ischemic stroke has already begun,but its potential pharmacological mechanism and material basis are still unclear.The second part of this study is based on network pharmacology theory and methods,through mining and analysis of Xiaoxu The medicinal components and related targets of Mingtang decoction against ischemic stroke,explore the mechanism of Xiaoxuming decoction in treating ischemic stroke,and provide evidence-based evidence for clinical medication.Methods:(1)Systematic review and meta-analysis of Xiaoxuming Decoction in the treatment of acute ischemic strokeRetrieved 8 Chinese and English databases from China HowNet,Wanfang Data Knowledge Service Platform,Weipu Chinese Sci-tech Journals Database,Chinese Biomedical Literature Database,Pubmed,Embase,the Cochrane library and ClinicalTrial.A randomized controlled clinical trial study of prescription treatment of acute ischemic stroke.The search time range is from the establishment of the above platform to December 31,2019.According to the inclusion and exclusion criteria,the search literature was screened,a flow chart of literature screening was drawn,and the method of "Cochrane HandBook 5.1.0" was used to evaluate the risk of bias in the included literature,which is represented by a bias risk assessment chart.Collect the data results of the National Institutes of Health Stroke Scale score,clinical effectiveness rate and TCM syndrome score,modified Rankin score and adverse reaction outcome evaluation indicators included in the literature,and select the corresponding statistical model for meta-analysis according to the size of heterogeneity.High-heterogeneity results are separately identified and processed.Methods include subgroup analysis,meta-regression,and digital-driven heterogeneity identification.Sensitivity analysis and funnel charts are used to assess publication bias.Two methods are used to determine whether the final statistical results are Stable,comprehensive evaluation of the efficacy and safety of Xiao Xuming Tang in the treatment of acute ischemic stroke.(2)Research on anti-ischemic stroke mechanism of Xiaoxumingtang based on network pharmacologyBased on existing data platforms such as drug target database and drug set database,search and read literature to find the effective ingredients of Xiaoxuming decoction,screen the therapeutic targets of the ingredients,predict the target protein of ischemic stroke,and construct the effective ingredient-target Dot-disease network topology map,through protein interaction and enrichment analysis,explored the pharmacological mechanism of Xiaoxuming decoction against ischemic stroke.Results:(1)Systematic review and meta-analysis of Xiaoxuming Decoction in the treatment of acute ischemic strokeAfter literature search and screening,a total of 26 qualified Chinese literature studies were included,involving a total of 1994 patients,including 1017 patientsin the experimental group and 977 patients in the control group.The meta-analysis found that compared with simple conventional therapy,Xiaoxu Tang decoction and conventional The combination of therapies is used to improve the neurological deficit score(MD-2.78,95%CI[-3.38,-2.17],z value is-8.99,p<0.01),and improve the overall clinical effectiveness(RR 1.20,95%CI[1.15,1.25],z value is 8.70,p<0.01),lower TCM syndrome score(MD-2.68,95%CI[-3.37,-2.00],z value is-7.65,p<0.01)has statistical and Clinical significance;only two studies mentioned the mRS score,one reported the mRS score on the 10th and 90th days of treatment,no statistical difference,the other showed that compared with the control group,Xiaoxuming decoction ended Can significantly improve the mRS score(P=0.02).Eleven studies conducted safety evaluations during and after treatment,of which 8 studies reported no adverse reactions,and 3 studies showed no statistical difference between the Xiaoxumingtang intervention group and the conventional treatment group.(2)Research on anti-ischemic stroke mechanism of Xiaoxumingtang based on network pharmacologyA total of 221 active ingredients were selected from the drug composition of Xiaoxuming Decoction,including quercetin(Quercetin),naringenol(Naringetol),luteolin(Luteolin),kaempferol(Kaempferol),baicalein(Baicalein)and other ingredients.Obtained 738 component therapeutic targets,matched with 469 disease targets of ischemic stroke,and finally obtained 103 potential synergistic targets of Xiaoxuming decoction for the treatment of ischemic stroke,including the potential treatment of ischemia with quercetin Stroke has the most targets.Through protein-protein relationship interaction network and sub-network analysis,it was found that drug metabolic enzymes and various cytokines are the main targets for therapeutic effects.Gene ontology enrichment analysis showed a total of 1137 biological processes,110 molecular functions and 29 cell components.KEGG enrichment analysis obtained a total of 122 signal pathways,which involved in inflammation,apoptosis and oxidative stress Channel enrichment is high.Conclusion:(1)Systematic review and meta-analysis of Xiaoxuming Decoction in the treatment of acute ischemic strokeBased on the meta-analysis of existing literature studies,Xiaoxuming Decoction combined with conventional therapy can improve patients' neurological function,improve clinical efficacy,and have better safety in the treatment of acute ischemic stroke than conventional therapy alone.Not sure yet.However,the quality of the literature included in the systematic review is low,and the quality of the outcome indicators is low,and high-quality,high-quality clinical trials are needed.(2)Research on anti-ischemic stroke mechanism of Xiaoxumingtang based on network pharmacologyThe treatment of ischemic stroke with Xiaoxuming Decoction may be through multiple components acting on multiple targets and multiple pathways.Among them,quercetin may play a major role in treating cerebral infarction.Apoptosis is related to multiple pharmacological mechanisms. |
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