Professor Wang Dan’s Medication Characteristics And Network Pharmacology Study Of Core Drugs In The Treatment Of Patients With Diabetic Kidney Disease And Proteinuria

Objective:In this study,by collecting and arranging the medical records of the tutor’s treatment of diabetic kidney disease(DKD)proteinuria,we will further analyze the characteristics and core drugs of their treatment of DKD proteinuria,and through network pharmacology,to explore the mechanism of core drugs in the treatment of proteinuria in DKD.The purpose is to systematically summarize the ideas of differentiation and treatment,so as to learn and inherit the clinical experience of the tutors in the treatment of proteinuria in DKD.Methods:(1)To collect and sort out the medical records of patients with DKD and proteinuria who met the inclusion and exclusion criteria from September 01,2016 to December 30,2021 in the nephrology outpatient clinic and ward of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine.Enter general information,diagnosis,syndromes,and first-visit prescription into Microsoft Office Excel 2019 software to establish a complete medical record database.(2)Use data mining technology to conduct frequency analysis on patients’ gender,age,syndrome,symptoms,tongue and pulse,and prescription drugs;use IBM SPSS Modeler 18.0 software to conduct association rule analysis on drugs-drugs;Drugs were analyzed by systematic clustering;drug characteristics and core drugs were summarized.(3)Use the TCMSP database to screen the active components and targets of core drugs,use GeneCards,DisGeNet,OMIM and other databases to screen the proteinuria targets of DKD,take the intersection of the two targets,and use STRING11.0 to obtain the protein interaction relationship,The PPI network was constructed by Cytoscape 3.8.2,and the GO function and KEGG pathway enrichment analysis was performed on the Metascape website to explore the potential mechanism of core drugs in the treatment of proteinuria in DKD.Results:(1)A total of 173 medical records were included in this study,including 93 males and 80 females.The age distribution was 38-71 years old,of which 29 people were under 50 years old;79 people were 50-59 years old;and 65 people were over 60 years old.(2)Syndrome statistics:78 cases of spleen-kidney deficiency and dampness and blood stasis syndrome,54 cases of spleen-kidney deficiency and damp turbidity syndrome,17 cases of liver-kidney yin deficiency,blood stasis blocking kidney collaterals,qi and yin deficiency,16 cases of dampheat stasis syndrome,5 cases of kidney yin and yang deficiency and damp stasis syndrome,and 3 cases of kidney yin and yang deficiency and dampheat stasis syndrome.Symptom statistics:the top ten are fatigue,foamy urine,sore waist and knees,frequent urination,loose stools,anorexia,dry stool,dry mouth,chest and epigastric fullness and spontaneous sweating.Tongue statistics showed that there were 79 cases of dark purple tongue,41 cases of pale tongue,29 cases of pale and fat tongue,11 cases of dark red tongue,9 cases of pale red tongue and 4 cases of red tongue;87 cases of white and greasy coating,30 cases of yellow and greasy coating,23 cases of thin and white fur,20 cases of thin fur and 13 cases of thick and greasy fur.The pulse condition is followed by a deep pulse,a weak pulse,a deep and thin pulse,a thin pulse and a slow pulse.(3)Medication statistics:Among the 173 first-diagnosed prescriptions,a total of 151 herbs were involved.The categories of medicines are in turn tonic medicines,heat-clearing medicines,blood-activating and stasisremoving medicines,diuresis-dampening medicines,and astringent medicines,etc.The four qi of the medicine are the most warm,the five flavors are the most sweet,and the meridians are the spleen,kidney,liver and so on.The top ten medicines used frequently were astragalus,codonopsis,yam,corn stigma,salvia,leech,ligustrum lucidum,wolfberry,diaphragma juglandis fructus and tuckahoe,of which the top five were the core medicines.Commonly used drug pairs are:corn silk-leech,tangerine peel-pinellia,dogwood-rehmannia glutinosa,red peony-achyranthes,tuckahoe-alisma,ophiopogon japonicus-schisandra,ligustrum lucidum-shayuanzi,eucommia-mulberry;There are:tuckahoe-atractylodes-white peony root,radix ranunculi ternati-euonymus alatus-diaphragma juglandis fructus;drug combination:yam-corn silkcodonopsis-salvia miltiorrhiza-astragalus(core drug).(4)Network pharmacology studies suggest that the main active components of the core drugs are quercetin,kaempferol,formononetin,isorhamnetin,luteolin,tanshinone ⅡA,cryptotanshinone and diosgenin;its potential in the treatment of DKD.The key targets are JUN,RELA,TNF,IL6,IL-1B,CXCL8,IL-1A,CCL2,IL-4 and STAT3;mainly by regulating AGEs-RAGE,IL-17,TNF and MAPK and other signals It plays a role in the treatment of proteinuria by intervening in the pathological process of DKD.Conclusion:(1)DKD proteinuria is inseparable from the spleen and kidney,and it is always a syndrome of deficiency and excess,and deficiency and excess.(2)The instructor’s differentiation and treatment of this disease emphasizes the combination of disease differentiation and syndrome differentiation,making good use of drug pairs and drug strings,emphasizing compatibility to reduce toxicity and increase efficiency,calm down cold and heat,and regulate yin and yang;the core drugs are astragalus,codonopsis,chinese yam,corn silk,and salvia,the medicine skewers include corn silkleeches,radix ranunculi ternati-euonymus alatus-diaphragma juglandis fructus,etc,which reflects my teacher’s emphasis on the foundation of strengthening and protecting the early days,nourishing the kidney and strengthening the spleen,strengthening the essence,removing blood stasis and dredging collaterals and diarrhea.The characteristics of turbidity and detoxification are mutually beneficial.(3)Network pharmacology studies have shown that the core drugs mainly intervene in the pathological damage process of DKD by regulating AGEsRAGE,IL-17,TNF,MAPK and other signaling pathways,confirming that the core drugs of the tutor’s differentiation and treatment of proteinuria in DKD have potential multi-component,multi-target,The mechanism of multichannel characteristics can achieve the clinical effect of reducing urinary protein,protecting renal function and relieving symptoms.