Clinical And Network Pharmacological Study Of Hezhong Decoction In The Treatment Of Cancer Cachexia

Objective:To evaluate and improve the efficacy and safety of cancer cachexia by observing and the influence of Hezhong Decoction on appetite,body weight,nutritional status,physical fitness and quality of life of patients with cancer cachexia;at the same time,the network pharmacology prediction and the possible targets of Hezhong Decoction in the treatment of cancer cachexia were used to provide empirical basis for traditional Chinese medicine to intervene cancer cachexia.Methods:(1)From August 2020 to January 2021,patients with pathologically diagnosed malignant tumor with cancer cachexia syndrome were collected from the inpatient ward of the Oncology Department of the affiliated Hospital of Chengdu University of traditional Chinese Medicine.after meeting the inclusion and exclusion criteria,they were divided into two groups: the Hezhong Decotion group and the control group.the two groups were given roughly the same basic treatment such as nutritional support,while the Hezhong Decotion group were given Hezhong decoction-free agent treatment for 4 weeks and followed up for 4 weeks.Before and after treatment the changes of appetite,body weight,nutritional status,physical fitness,quality of life,serum total protein,serum albumin and other laboratory indexes of the two groups were analyzed and statistically analyzed.To evaluate the efficacy and safety of Hezhong Decoction in the treatment of cancer cachexia.(2)The active components and related targets of the Hezhong Decoction were screened by TCMSP,the standard names of the targets were obtained through the Uniprot database,the related targets of cancer cachexia were obtained through the Gene Cards and OMIM databases,and the interaction PPI network of Chinese core target proteins related to cancer cachexia was constructed by using STRING website and Cytoscape3.8.0 software.Then the R4.0.0 language software was used to analyze the GO functional enrichment and KEGG pathway enrichment of the core targets in order to predict the possible targets for Hezhong Decoction intervention in cancer cachexia.Results:(1)The clinical research results showed that the two groups were comparable in gender,age,tumor disease distribution,appetite,weight,nutritional status,physical fitness,quality of life,serum total protein,serum albumin and other baseline analyses before treatment(P>0.05).After 4 weeks of treatment,(1)Appetite:After intervention,appetite improved compared with the Hezhong Decotion group after treatment(P<0.05),and the control group group decreased appetite after treatment(P<0.05);comparison between the groups,the treatment group improved significantly(P<0.05).(2)Weight: After intervention,there was no significant change in body weight between the two groups(P>0.05),and there was no significant difference between the two groups after intervention(P>0.05).(3)Nutritional status: After intervention,there was no significant change in PG-SGA score in the two groups,and there was no significant difference in PG-SGA score between the two groups after intervention.(4)Quality of life:After intervention,the FAACT scores of the Hezhong Decotion group were improved in physiological status,social / family status,emotional status,functional status,cachexia status and so on(P<0.05);In the control group,the functional status of FAACT decreased(P<0 05),but there was no significant change in other conditions(P>0.05).After intervention,there was no significant difference in social / family status between the two groups(P>0.05),but there was significant difference in physiological status and functional status(P<0.05).There were significant differences in emotional status and cachexia additional status between the two groups(P<0.01).(5)Physical ability:After intervention,the Karnofsky score was improved in the Hezhong Decotion group(P<0.05),but there was no significant change in the control group(P>0.05);Significantly improved compared with the Hezhong Decotion group after intervention(P<0.05).(6)Laboratory index:After intervention,serum albumin increased(P<0.05)and serum total protein did not change significantly in the Hezhong Decotion group(P>0.05),while serum albumin and serum total protein did not change significantly in the control group(P>0.05).There was no significant difference in serum albumin and total serum protein between the two groups after intervention(P>0.05).(7)Safety index:After intervention,there was no significant difference in safety indexes such as myelosuppression,hepatotoxicity and nephrotoxicity between the treatment group and the control group(P>0.05).(2)The results of network pharmacology research showed that: 142 effective drug ingredients of Hezhong prescription,227 drug targets,1790 cancer cachexia disease target genes were screened out,and 106 common targets were obtained by taking the intersection of the two targets.By constructing a PPI network and conducting GO analysis and KEGG analysis,it is predicted that its intervention in cancer cachexia may affect PI3K-Akt,MAPK,HIF-1 by targeting AKT1,JUN,MAPK14,ESR1,TP53,MAPK1,and EGFR,JAK-STAT,Fox O,NF-κB,TLR,IL-17,p53,Ras and other signaling pathways regulate tumor proliferation,invasion and metastasis,cancerrelated inflammation,cancer cachexia and skeletal muscle atrophy.Conclusion:Hezhong Decoction has a certain effect in improving appetite,physical fitness,quality of life and other aspects of cancer cachexia,but has no obvious effect in terms of body weight,nutritional status,and laboratory indicators such as serum total protein and serum albumin;Hezhong Decoction’s intervention in cancer cachexia has the characteristics of multiple targets and multiple pathways.It mainly plays a role in regulating tumor proliferation,tumor-related inflammation,energy metabolism,skeletal muscle consumption and other related pathways,providing ideas for subsequent basic research.This study provides ideas for follow-up basic research.