A Meta Analysis And Mechanism Of Zhenwu Decoction In The Treatment Of Adult Primary Nephrotic Syndrome

Objective:This study aims to explore the clinical effect of Zhenwu Decoction in the treatment of primary nephrotic syndrome(PNS)through meta-analysis and network pharmacology,and further analyze the potential target and mechanism of Zhenwu Decoction in the treatment of PNS,so as to provide some evidence and direction for future clinical medication and related empirical research.Methods:1.Search database such as CNKI,Wan Fang,VIP,CBM,Pub Med,web of science and Cochrane,The retrieval time was from the database establishment to January 17,2021,and the retrieval language was limited to Chinese and English,The randomized controlled trials of Zhenwu Decoction in the treatment of PNS were comprehensively collected.Two researchers independently screened the literatures and extracted the data according to the nabai standard,and evaluated and proofread the literatures.The literatures meeting the standard were meta analyzed by Revman 5.4software Subgroups were analyzed according to the intervention measures and the course of treatment.2.59 chemical components of Zhenwu Decoction were retrieved,94 drug related targets and 1778 disease effective targets were obtained.The chemical components with higher drgree value were β-sitosterol,kaempferol,stigmasterol,hederagenin,etc.There were 41 common targets of PNS and Zhenwu Decoction,and39 nodes(2 proteins did not participate in the interaction)and273 edges were obtained.Among them,17 core targets with drgree values greater than the average were AKT1、IL6、CASP3、PTGS2、MAPK8、JUN、CAT、HMOX1、HSP90AA1、ICAM1、RELA、ESR1、CASP8、STAT1、VCAM1、NOS2、CASP9;251 entries were obtained by GO functional enrichment analysis,There were 186 items related to biological process(BP),25 items related to cell component(CC)and 40 items related to molecular function(MF).The enrichment function analysis of KEGG signaling pathway showed that there were a total of 88 signaling pathways,and the pathways with high enrichment results were TNF signaling pathway,toll like receptor signaling pathway,apoptosis,NF-KB signaling pathway,HIF-1 signaling pathway and NOD like receptor signaling pathway.Conclusion:1.Through the meta-analysis of the included literatures,it is found that Zhenwu decoction combined with western medicine has certain clinical efficacy in improving the total effective rate,increasing serum albumin,reducing 24 h urinary protein,serum creatinine,urea nitrogen,blood lipid and TCM syndrome score,and the adverse reactions are relatively safe.2.Through the network pharmacology research,it is found that Zhenwu Decoction works through the synergistic relationship of multi drug taste,multi-target and multi-channel,and its mechanism may be that its effective components are β-sitosterol,kaempferol,stigmasterol and hederagenin,acting on AKT1,IL-6,CASP3 and other targets,and it may also interact with TNF,toll like receptor,apoptosis,NF-KB,HIF-1 and NOD like receptors and other signaling pathways.