Clinical Observation And Network Pharmacology Study Of Bu Shen Tong Shi Pill In Treating Femoral Head Necrosis Of Kidney Deficiency And Blood Stasis Type

Part ONE: Clinical observation of Bu Shen Tong Shi Pill in the treatment of femur head necrosis with kidney deficiency and blood stasisObjective:To observe the clinical effect of Bushentongxie pill on femur head necrosis with kidney deficiency and blood stasisMethods: Patients with ONFH with kidney deficiency and blood stasis were selected from the Xianhu District,The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine and divided into two groups.The experimental group was given oral Bushen Tongshi pill,while the control group was given oral Henggu bone wound healing agent.VAS score and Harris score of the two groups at different time points were recorded and compared at the first,third and sixth month after treatment,respectively.Results: Forty-two patients with kidney deficiency and blood stasis type ONFH were screened,including 57 hips in total,including 2 detached cases and 2 detached hips.Finally,the study included 40 patients with 55 hips,with an overall average age of 45.45±12.66 years,and an overall average onset time of 24.85± 19.02 months,with an overall male/female ratio of 27:13.There was no statistical difference in the basic information between the two groups,which was comparable.There was no significant difference in VAS score between the experimental group and the control group at any time point.There was no significant difference in Harris score between the experimental group and the control group before treatment,1 month after treatment and 3 months after treatment,but there was significant difference in Harris score between the two groups at 6 months after treatment.There was no change in TCM syndrome type of patients before and after the experiment,and no adverse reactions were observed in both groups during the study.Conclusion(s):Bu Shen Tong Shi Pill and Henggu bone wound healing agent can improve hip joint function and relieve pain in patients with kidney deficiency and blood stasis TYPE ONFH,and the clinical efficacy is similar.Compared with Henggu bone wound healing agent,Bushen Tongxie pill has a faster effect on the improvement of hip function,and bihenggu bone wound healing agent has a faster effect on the improvement of pain score than Bushen Tongxiepill.Part Ⅱ: Pharmacological study of Bushentongxie Pill on the network of femur head necrosis with kidney deficiency and blood stasisObjective:Pharmacological study of Bu Shen Tong Shi Pill in treating femoral head necrosis network of kidney deficiency and blood stasis.Methods: The active components and targets ofBu Shen Tong Shi Pill were screened by TCMSP platform,and the Uniprot database was downloaded for annotation.Complete ONFH gene data were obtained by Genecards gene database and OMIM database.And using Cytoscape3.8 to construct the component-target-pathway network,the key genes are screened,and the protein interaction(PPI)network map is constructed based on STRING database.And ID transformation and enrichment analysis.Autodock software was used for molecular docking of the main active components in Bushen Tongxie Pill and the core target.Results: A total of 438 active components and 4224 potential targets were screened out.There were 2510 potential targets of femoral head necrosis,201 common genes were obtained from the intersection of Bu Shen Tong Shi Pill and potential targets of femoral head necrosis,and the key gene subsets were CTNNB1,EGFR,ESR1,FOS,AKT 1,RELA,JUN,etc.GO enrichment showed cellular response to chemical stress,response to oxidative stress,response to lipopolysaccharide and other Biological processes Process,BP)2791 related items.There are 123 entries related to cell Component(CC)including transcription regulator complex,raft and membrane microdomain.Protein Serine /threonine kinase activity,DNA-Binding transcription activator activity,193 items related to RNA polymerase IISpecific,DNA-Binding transcription activator activity and other Molecular functions(MF).KEGG functional enrichment analysis found age-rage signaling pathway in diabetic complications,Lipid and atherosclerosis,Hepatitis B,and Prostate cancer,Pancreatic cancer,Kaposi sarcoma-associated Herpesvirus infection,186 signaling pathways.Conclusion:The key genes of ONFH of kidney deficiency and blood stasis type treated by Bu Shen Tong Shi Pill are AKT1,MAPK,RELA,etc.Biological processes include "response to lipopolysaccharides","response to reactive oxygen species","response to oxidative stress","response to oxygen levels","response to steroid hormones" and so on.The key signaling pathways are "age-rage signaling pathway and diabetes complications","TNF signaling pathway","HIF-1 signaling pathway","IL-17 signaling pathway","fluid shear stress and atherosclerosis" and other signaling pathways.Bu Shen Tong Shi Pill may delay or even treat ONFH by inhibiting local inflammation,mediating bone cell metabolism,promoting vascular growth in ischemic focal points,alleviating local edema,and restoring intracranial stability.Molecular docking indicated that the key genes AKT1ESR1 and MAPK had good binding performance with the target.It provides reference for further study of specific mechanism in subsequent experiments.