Clinical Observation And Network Pharmacological Study Of Qingteng Tongbi Decoction In The Treatment Of Rheumatism-obstruction Rheumatoid Arthritis

Objective: To observe the clinical efficacy of Qingteng Tongbi Decoction combined with Meloxicam tablets,MTX tablets and LEF tablets in the treatment of patients with rheumatism-obstruction rheumatoid arthritis(RA),to study the mechanism of Qingteng Tongbi Decoction for RA by adopting the method of network pharmacology,and therefore lay the foundation for its further application and clarifying its therapeutic mechanism.Methods: 1.Clinical research: 60 patients comprised of outpatient and inpatient with rheumatic-obstruction RA in the rheumatology department of the First Affiliated Hospital of Guangxi University of traditional Chinese medicine from March 2021 to November 2021 were randomly divided into observation group and control group.The control group was treated with meloxicam tablets,MTX tablets and LEF tablets.The observation group was treated with Qingteng Tongbi Decoction on the basis of the control group.Both groups were treated for 12 weeks.The number of joint tenderness(TJC),the number of joint swelling(SJC),rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),VAS score,DAS28 score,the comparison of TCM symptom scores and the changes of TCM symptom efficacy before and after treatment were observed to evaluate the clinical efficacy of Qing Teng Tongbi Decoction in the treatment of RA patients.2.Network pharmacology research: screen the main active components and action targets of three traditional Chinese medicines in Qingteng Tongbi Decoction by using tcmsp database,standardize and transform the target names by using Uni Prot database,collect RA related disease targets by using Gene Cards and OMIM database,intersect the disease targets with drug targets,and adopt the application Cytoscape 3.7.1 to construct the "traditional Chinese medicine-active ingredient-target-disease" network,and construct the protein interaction network of intersecting targets by using String database;adopt the software RX4.0.5 for go function enrichment and KEGG pathway analysis,and build a "traditional Chinese medicine composition-target-pathway" by applying the software Cytoscape 3.7.1.Results: 60 patients were included in the study.A case of observation group was removed and 2 cases in the control group were removed.57 cases were finally completed.The research results are as follows:1.Clinical research:(1)Compared with the clinical efficacy,the total effective rate of the observation group was 86.2 %,which was significantly better than that of the control group(64.2%)(P < 0.05);The total effective rate of the observation group was 89.7%,which was significantly better than that of the control group(67.9%)(P < 0.05).(2)Compared within the two groups,the scores of TJC,SJC,RF,ESR,CRP,VAS,DAS28,morning stiffness time and TCM symptom scores of the two groups before and after treatment were significantly lower than those before treatment(P < 0.05);Compared between the two groups,the observation group was significantly better than the control group in other aspects,except that there was no significant difference in the number of joint tenderness before and after treatment(P > 0.05).2.Network pharmacology research: 12 active components of Qingteng Tongbi Decoction were obtained after screening,including a common active component of Qingfengteng and Angelica sinensis:β-Beta sitosterol,72 targets of Qingteng Tongbi Decoction;There were 5046 RA disease targets and 41 disease and drug intersection targets.686 biological processes,38 cellular components and 63 molecular functions were obtained by go enrichment analysis;The enrichment analysis of KEGG pathway obtained 75 pathways,which were mainly related to inflammatory response,immune regulation and apoptosis.Conclusions: 1.Qingteng Tongbi Decoction combined with Western medicine has good clinical efficacy in the treatment of rheumatism-obstruction RA patients,which can better reduce the DAS28 score and the total score of TCM symptoms.The total efficacy is better than that of western medicine alone group.2.Through the analysis of network pharmacology,it is found that Qingteng Tongbi Decoction has multi-target effect in the treatment of RA,involving multiple biological processes and signal pathways.It may treat RA by inhibiting inflammatory response,regulating immune function and regulating cell apoptosis.