| Objective:To evaluate the clinical efficacy and safety of Chinese medicine for Jian Pi Yiqi in the treatment of cancer cachexia based on Meta-analysis,so as to provide evidence-based evidence for clinical practice.At the same time,the possible molecular intervention mechanism of Jian Pi Yiqi herbs in the treatment of cancer cachexia was explored by network pharmacology.Method:1 Meta-analysis on treatment of cancer cachexia with traditional Chinese medicine of Jian Pi YiqiThe databases such as CNKI,Wanfang,Chongqing VIP Database,Cochrane Library,and Pubmed were used to retrieve the randomized controlled clinical trials of cancer cachexia treated with Chinese medicine of Jian Pi Yiqi from January 1,2000 to December 31,2020.The literature outcome indicators included body weight,food consumption,cassette score,adverse reactions,and so on.Finally,Revman 5.3 software was used for meta-analysis of outcome indicators.2 To explore the mechanism of Jian Pi Yiqi herbs in the treatment of cancer cachexia based on network pharmacologyThe active components and related targets of Chinese medicinals for Jian Pi Yiqi were extracted from Chinese medicinals system pharmacology database and analysis platform(TCMSP).Searching the Gene Cards database for cancer cachexia disease targets;The Venny diagram was used to represent the intersection targets between the two.The relationship diagram of the three elements of Jian Pi Yiqi Herbs-Chinese medicine compound components-potential targets was constructed using Cytoscape 3.7.1.Protein interaction network was constructed using String database,and the key among the potential targets were obtained through Cytoscape 3.7.1.Potential targets were analyzed for GO and KEGG enrichment using the R language tool;Molecular docking of compounds with target proteins was processed using the PDB database,Pubchem database,VINA software,and Py MOL software.Results:1 meta-analysis resultsFinally,23 articles were included,and the RR=1.17,95%CI=[1.08,1.27]and P=0.0001 in body weight change indicated that the body weight change in the treatment group was more significant.For the change of food intake,RR=1.27,95%CI=[1.17,1.37],and P < 0.00001 indicated that the change of food intake in the treatment group was more significant.The RR=1.31,95%CI=[1.21,1.41] and P < 0.00001 indicated a more significant change in Karnofsky score in the treatment group.For serum albumin level,MD=1.38,95%CI=[0.23,2.54] and P=0.02 indicated that the improvement in serum albumin level of the treatment group was more significant.MD=15.56,95%CI=[10.64,20.49] and P < 0.00001 for prealbumin level,the improvement of prealbumin level in the treatment group was more significant.MD=0.07,95%CI=[-0.07,0.20],and P=0.33 in the wasting symptom scores,and there was no significant difference in the improvement of the wasting symptom scores between the two groups.In the aspect of fatigue symptom score,MD =-0.24,95% CI = [-0.36,-0.12],P < 0.0001.The improvement of fatigue symptom score in the treatment group was more significant.In the aspect of mental fatigue symptom score,MD =-0.32,95% CI = [-0.46,-0.18],P < 0.00001.The improvement of mental fatigue symptom score in the treatment group was more significant.In the aspect of palpitation symptom score,MD =-0.20,95% CI = [-0.35,-0.04],and P=0.01 indicated that the improvement of palpitation symptom score in the treatment group was more significant.For anorexia symptom scores,MD =-0.10,95% CI = [-0.02,0.22],P < 0.10 indicated that there was no significant difference in improvement of anorexia symptom scores between the two groups.In terms of insomnia symptom scores,MD =-0.20,95% CI = [-0.34,-0.06],and P=0.004 indicated that the improvement of insomnia symptom score in the treatment group was more significant.For adverse reactions,RR=0.26,95%CI=[0.17,0.41],P < 0.00001 indicated that the treatment group had less adverse reactions.2 Network pharmacology researchFour Chinese medicinal materials of Rhizoma Atractylodis Macrocephalae-Radix Glycyrrhizae-Radix Astragali seu Hedysari-Poria were selected for network pharmacology analysis,and TCMSP was retrieved to obtain a total of 98 potential targets for the intersection of active ingredient targets and disease targets of Chinese medicinal materials.The three components of "Rhizoma Atractylodis Macrocephalae-Radix Glycyrrhizae-Radix Astragali seu Hedysari-Poria" Chinese medicine-compound-potential target were imported into Cytoscape 3.7.1software to construct a regulatory network of "medicine-compound-potential target" for visualization.A total of 470 nodes were obtained by importing potential targets into the STRING database,and 10 key targets were finally obtained through parametric analysis by Network Analyzer.GO enrichment analysis was performed on 98 potential targets,and biological process(BP)related cellular response to chemical stress,response to lipopolysaccharide,response to nutritional level,oxidative stress response,aging,etc.were possible.Cellular components(CC)may be related to membrane rafts,membrane domains,membrane regions,components of presynaptic membrane,and components of postsynaptic membrane.Molecular function(MF)may be related to phosphatase binding,protein phosphatase binding,deoxyribonucleic acid binding transcription factor binding,inhibition of transcription factor binding,ribonucleic acid polymerase Il-specific deoxyribonucleic acid binding,etc.The KEGG enrichment analysis was performed on 98 potential targets,involving a total of 166 pathways,which were most likely related to TNF signaling pathway,interleukin-17 signaling pathway,pancreatic cancer pathway,etc.STAT3 in the core targets was selected for molecular docking,and the corresponding small-molecule ligand was licochalcone A.After VINA treatment,the minimum binding energy was selected to be-6.4,and visual display was performed by Py MOL software.Conclusion:In the Meta-analysis,the traditional Chinese medicines for Jian Pi Yiqi mentioned in the present study helped to improve the body weight,food consumption,serum albumin level,prealbumin level indicators and some TCM symptoms of cancer cachexia patients,with less adverse reactions.However,the overall level of the quality of the included studies was low,and there was a risk of bias,which affected the reliability of the conclusions of the meta-analysis.In the aspect of network pharmacology,we preliminarily explored the mechanism of Chinese medicine for Jian Pi Yiqi in the treatment of cancer cachexia,suggesting that the combination of Chinese medicine for Jian Pi Yiqi may have good application prospects in the treatment of cancer cachexia.However,in general,more basic experiments are needed for verification and more high-quality,large-sample,multi-center clinical trials are needed for further verification. |
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