Network Meta-analysis And Network Pharmacology Study Of Chinese Medicine Injection Combined With Cisplatin In The Treatment Of Malignant Pleural Effusion Of Lung Cancer

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine injection combined with cisplatin pleural perfusion in patients with lung cancer complicated by malignant pleural effusion,and to understand the possible mechanism of its efficacy.Methods:Part I: Chinese Journal Full-text Database(CNKI),VIP,Wanfang,Cochrane Library,Pub Med,EMBASE and Web of were searched by computer Randomized controlled trials(RCTS)related to the treatment of lung cancer pleural effusion by traditional Chinese medicine injection combined with cisplatin before December 1,2021 were searched in Science and other databases.The literature was screened according to exclusion criteria,and the literature quality was evaluated after data extraction.Rev Man 5.3 software was used for direct meta-analysis,and ADDIS1.16.8 software was used for mesh meta-analysis data processing based on the Bayesian framework.The clinical response rate,quality of life score improvement,incidence of gastrointestinal reactions,and incidence of bone marrow suppression were compared.The second part: network pharmacology study of treatment combinations with better efficacy and safety was carried out.Firstly,drug-active component-effective target was screened out,and then the protein interaction network of intersection target was constructed and the core target was screened.Finally,gene bioenrichment analysis and KEGG signal pathway analysis of predicted targets were carried out.Results:A total of 2019 cases were included in 30 RCTs,including Addie injection,compound Radix Flavorae Injection,elemene injection and Brucea javanica oil injection.The results of network meta-analysis showed that:(1)In terms of clinical effectiveness,the highest probability was as follows: Brucea javanica oil injection combined with cisplatin group > Elemene injection combined with cisplatin group > Aidi injection combined with cisplatin group > Compound Matrine injection combined with cisplatin group > cisplatin alone group;(2)In terms of quality of life score improvement,the highest probability order was brucea javanica oil injection combined with cisplatin group > elemene injection combined with cisplatin group > compound Matrine injection combined with cisplatin group > Aidi injection combined with cisplatin group > cisplatin alone group;(3)In terms of gastrointestinal reactions,the order of probability from low to high was as follows: elemene injection combined with cisplatin group > Aidi injection combined with cisplatin group > Brucea javanica oil injection combined with cisplatin group > Compound Sophoginseng injection combined with cisplatin group > cisplatin alone group.(4)In terms of occurrence of myelosuppression events,the order of probability from low to high was as follows: compound Matrine injection combined with cisplatin group >Brucea javanica oil injection combined with cisplatin group > elemene injection combined with cisplatin group > Addie injection combined with cisplatin group > cisplatin alone group.The network pharmacology study of Brucea brucea combined with cisplatin was carried out.Fifteen active components and 142 predicted targets were screened out for Brucea brucea,and 15 key targets were obtained after protein interaction with cisplatin,lung cancer and MPE.Through bioenrichment analysis,the main signaling pathways of BRUCea brucea combined with cisplatin in the treatment of MPE in lung cancer were tumor proteoglycan,Erb B signaling,tumor signaling,Rap1 signaling,tumor micro RNA signaling,etc.The main biological processes include EGFR signaling pathway,peptide-tyrosine kinase phosphorylation,positive regulation of smooth muscle cell proliferation,etc.The main cell components are membrane raft,plasma membrane,cell adhesion and connection.The main molecular functions include: protein tyrosine kinase activity,Ras guanine nucleotide exchange factor activity,transmembrane receptor protein tyrosine kinase activity,etc.Conclusions:Various Traditional Chinese medicine injection combined with cisplatin pleural infusion in the treatment of MPE patients with lung cancer has certain advantages in terms of safety and efficacy compared with cisplatin alone.