Clinical Observation And Network Pharmacology Study Of Maxingxiapu Decoction In The Treatment Of Postinfectious Cough

ObjectiveProfessor Li Hui has a good clinical effect in the treatment of Postinfectious Cough with Maxingxiapo decoction.Through this pre-clinical control study,we observed the improvement of the symptoms of Postinfectious Cough with Wind phlegm syndrome,objectively evaluated its clinical efficacy,and explored its related targets and mechanisms from the perspective of network pharmacology.Methods1.The clinical study:A randomized parallel controlled study was used,and 82 Patients with postinfectious cough who met the inclusion criteria of this study and visited the respiratory clinic of the second hospital of traditional Chinese medicine of Guangdong Province from June 2020 to January 2021 were randomly divided into two groups:experimental group(n=41)and control group(n=41).The experimental group was treated with Maxingxiapo decoction,and the control group was treated with compound methoxyphenamine capsule.The course of treatment was 10 days.Cough symptoms score(day,night,total score),TCM syndrome scores(cough,expectoration.chest tightness,pharynx itching,asthma/shortness of breath,Pharyngeal foreign body sensation,total score)and cough VAS scores before treatment,on the 6th day and the 11th day,and the days of cough disappearance and the recurrence or aggravation of cough after drug withdrawal or treatment were recorded.Finally,the data were collated and analyzed by SPSS23.0 software package.2.Network pharmacology:The effective compounds of Maxingxiapu Decoction were screened based on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and the related targets of post infection cough were screened from Online Mendelian Inheritance in Man(OMIM)database,The Human Gene Database and National Center for Biotechnology Information(NCBI)database.The common targets of post infection cough and Maxingxiapu Decoction were substituted into string database to obtain the PPI network diagram,Based on PPI network diagram,the key proteins were screened by topology analysis and cluster analysis.The common targets of Maxing xiapu Decoction and Postinfectious Cough were enriched,and the pathway network diagram was drawn by using Cytoscape 3.8.0.Results1.The clinical study:The two groups of patients included in this study had no significant differences in gender,age composition,course of disease,day and night cough symptom score,TCM syndrome,and VAS score before treatment(P>0.05).On the 6th day after treatment,the scores of cough symptoms(day,night,total score),TCM syndrome scores(cough,expectoration,chest tightness,pharynx itching,asthma/shortness of breath,Pharyngeal foreign body sensation,total score)and VAS scores in the two groups were significantly lower than those before treatment(P<0.01,P<0.05),but there was no significant difference between the two groups(P>0.05).On the 11th day,the cough symptom score(day,night.total score),TCM syndrome score of cough,expectoration,pharynx itching,total score,cough VAS score and the score of Pharyngeal foreign body sensation in the experimental group were significantly lower than those before treatment and on the 6th day after treatment(P<0.01).There was a significant difference in the score of Pharyngeal foreign body sensation on the 11th day in the control group compared with that before treatment and on the 6th day(P<0.01,P<0.05).There was significant difference in the score of chest tightness between the two groups on the 11th day(P<0.05),but there was no significant difference between the two groups on the 6th day(P>0.05).In terms of asthma/shortness of breath,the scores of the two groups of patients on the 11th day were significantly lower than before the treatment(P<0.01),compared with the 6th day,there was no significant statistical difference between the two groups(P>0.05).There was no significant difference in the number of days and effective rate of cough disappeared between the two groups of patients(P>0.05),and the therapeutic effect grade distribution of the experimental group was better than that of the control group(P<0.05).The recurrence or aggravation rate in the experimental group was 2.7%after drug withdrawal,and 8.11%in the control group.The recurrence or aggravation rate in the experimental group was lower than the control group after drug withdrawal.During the study,the experimental group had no obvious adverse reactions,2 patients in the control group had dry mouth,and one had constipation,which could be relieved by dietary adjustment,and no other adverse reactions were found.2.Network pharmacology:A total of 175 effective compounds were screened out from Maxingxiapu decoction,and PIC had 2308 targets.172 drug and disease common targets were obtained by making Venn diagram,and 68 core protein targets were screened out by constructing PPI network map,including STAT3,AKT1.Jun,MAPK 1,MAPK3,etc.According to the degree value,quercetin,luteolin,kaempferol.naringenin,quercetin,luteolin,kaempferol and naringenin were selected as the key compounds β Sitosterol,7-methoxy-2-methyl isoflavone.formononetin,licorice chalcone a β-Carotene,etc.Go enrichment analysis indicated that it played a role in the stimulation of chemical reaction,lipopolysaccharide response,bacterial derived molecules response,drug response,oxidative stress,reactive oxygen metabolism process,muscle cell response,smooth muscle cell proliferation regulation and response to mechanical stimulation.KEGG pathway enrichment analysis showed that the main signaling pathways were TNF signaling pathway and IL-17 signaling pathway.ConclusionMaxingxiaPo decoction can effectively relieve the symptoms of cough,expectoration and throat foreign body sensation in patients with PIC.The curative effect grade distribution is better than that of compound methoxyphenamine,the recurrence and aggravation rate of drug withdrawal is low,and the safety is good.Network pharmacology research suggests that Maxingxiapu decoction has effect on post infectious cough through multi-component,multi-target and multi-channel treatment.The specific mechanism may be related to regulating TNF,IL-17 and other signaling pathways through STAT3,AKT1,Jun,MAPK1,MAPK3 and other targets,reducing airway inflammation and airway secretion,thus reducing airway hyperresponsiveness.