Clinical Cases Study Of Professor Liu Li’s Differentiation And Treatment Of Chronic Heart Failure Based On Integrated Pharmacological Approach

Objective:Data mining of Professor Liu Li’s diagnosis and treatment of CHF clinical cases,extract the characteristics of Prof.Liu’s herbal prescription for CHF,give a comprehensive and objective summary of the professor’s experience and academic thinking in the treatment of CHF;based on the results of this study,analyse and study Prof.Liu’s core prescription for CHF treatment with an integrated pharmacological approach to explore the molecular mechanism of action and explain its scientific connotations,so as to provide reference and guidance for the clinical practice of TCM treatment for CHF and provide a scientific basis for Prof.Liu Li’s academic legacy.Methods:Study 1:Data mining of Professor Liu Li’s diagnosis and treatment of CHF clinical cases,the clinical cases of CHF patients treated by the professor from June 2011 to June 2021 were collected and collated,screened according to the inclusion and exclusion criteria,and a clinical case database was established.With the help of frequency statistics,association rules,and cluster analysis in the TCM heritage platform,the medical cases were mined from multiple perspectives,and Professor Liu Li’s clinical experience and academic thinking in the treatment of CHF were summarised from the mining results in conjunction with the professor’s consultation guidance during follow-ups.Study 2:Using TCMSP database and TCMIP database to screen and collect the main active ingredients and related targets of Professor Liu Li’s core prescriptions for the treatment of CHF;searching OMIM and GeneCards databases to integrate relevant targets of CHF;using Interactivenn platform to obtain intersecting targets;using String databases as a platform to build a target protein interaction(PPI)network,and build a drug-disease-target visualisation network with software,Cytoscope 3.7.2,to screen core targets;conducted enrichment analysis on GO function and KEGG pathway of targets of action with DAVID databases;Using AutoDock software to conduct molecular docking between effective chemical components and core targets.Results:1.Data mining of 605 medical cases shows:among 605 cases of CHF patients,there were 318 male(52.56%)and 287 female(47.44%);87.11%patients aged 50 years or more.The 605 medical cases involved 184 kinds of TCM,among which the warm drugs accounted for 39.56%and sweet drugs 44.01%;17 kinds of effective drugs,mainly tonics for deficiency syndromes;The total frequency of drug use was 11936 times,and the average frequency was 64.8 times.There were 9 drugs that were used more than 400 times,12 drugs that were used more than 300 times,and 14 drugs that were used more than 200 times.the cluster analysis obtains 6 drug combinations.When the number of support degree was 363(60%)and the confidence degree was 0.95,a total of 118 medication patterns and 217 association rules were obtained.Finally,9 core drugs were determined,namely radix astragali,radix pseudostellariae,cassia twig,poria cocos,radix ophiopogonis,schisandra chinensis,salvia miltiorrhiza,tatarian aster,agrimonia pilosa,and the frequency of use was 37.91%.2.The integrated pharmacology study of core prescription for CHF shows:the study obtains 164 chemical compositions,270 drug targets,10,799 CHF targets,260 core targets(mainly ESR1,Akt,MAPK1,STAT3,TNF)in the core prescription.GO enrichment analysis revealed 628 cellular components,1,112 molecular functions and 6,648 biological processes involved.KEGG enrichment analysis obtained 273 signalling pathways(PI3K-Akt signalling pathway,apoptosis pathway,cAMP signalling pathway,HIF-1 signalling pathway,relaxin signalling pathway,RAS,FoxO signalling pathway,MAPK signalling pathway,IL-17 signalling pathway,fluid shear stress and atherosclerotic signalling pathway,etc.)Conclusion:1.Professor Liu Li proposed that CHF is the evidence of deficiency in origin and excess in superficiality.The disease is in the heart,which is related to the liver,spleen,lung and kidney.“Deficiency,blood stasis,water"is the key to the pathogenesis.The heart Qi(Yang)being deficient is the basis of the pathology,which is present throughout the occurrence and development of CHF.Blood stasis is the central stage of pathological changes,while water fluid retention is the eventual result.2.During the treatment,focus on improving deficiency syndromes and subsidiarily promote circulation blood and water,using radix astragali,radix pseudostellariae,cassia twig,poria cocos,radix ophiopogonis,salvia miltiorrhiza,tatarian aster,and agrimonia pilosa as key components.3.The analysis and explanation of core prescriptions based on integrated pharmacology may be regulated and controlled via targets like ESR1,Akt,MAPK1,STAT3,TNF,and pathways like PI3K-Akt signalling pathway,apoptosis pathway,cAMP signalling pathway,HIF-1 signalling pathway,relaxin signalling pathway,RAS signalling pathway,FoxO signalling pathway,MAPK signalling pathway,IL-17 signalling pathway,fluid shear stress and atherosclerosis signalling pathway play a therapeutic role in CHF.