Discussion On The Mechanism And Clinical Study Of Xiaoyao Shukun Decoction In The Treatment Of Sequela Of Pelvic Inflammatory Disease With Qi Stagnation And Blood Stasis Based On Network Pharmacology

Objective:(1)To explore the mechanism of Xiaoyao Shukun Decoction in the treatment of sequelae of pelvic inflammatory disease(SPID)based on network pharmacology;(2)To observe the clinical effect of Xiaoyao Shukun Decoction in the treatment of SPID with qi stagnation and blood stasis.Methods:(1)Network pharmacology research:With the help of Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),all drug components and related targets of Xiaoyao Shukun Decoction were obtained.The effective drug components and related targets of Xiaoyao Shukun Decoction were obtained by pharmacokinetic ADME screening.According to Uniprot database and STRING database,the target gene name corresponding to the target protein name was found.Cytoscape(3.9.0)software was used to obtain drug-component network diagram and component-target network diagram.According to the disease database genecards,the disease target genes of SPID were obtained.The intersection of drug target genes and disease target genes was obtained by using the ’intersect’ function of R(4.1.2)software.The protein-protein interaction network(PPI)of the intersection genes was obtained by using the string database.The CytoNCA plug-in in Cytoscape software was used to screen the intersection targets and obtain their core(Hub)targets.Gene Ontology(GO)enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis were performed using the‘clusterProfiler’and‘org.Hs.eg.db’package of R software to find potential related mechanisms.(2)Clinical research:72 patients with SPID of qi stagnation and blood stasis type were divided into treatment group and control group by random number method,36 cases in each group.The treatment group was given oral Xiaoyao Shukun decoction;the control group was given oral Kunfukang capsule.Each course of treatment for four weeks,menstrual withdrawal,the treatment group and the control group were used for 3 courses.The TCM syndrome score,local sign score and VAS score of the two groups before and after treatment were recorded.R software was used for statistical analysis,and the safety of the patients was observed.Results:(1)Network pharmacology research:146 effective components and 276 targets of Xiaoyao Shukun Decoction were retrieved.641 target genes of SPID were retrieved.114 intersection targets were obtained.The PPI network map of intersection target gene was obtained,which contained 114 nodes with a total Degree of 9956.A total of 17 core targets were obtained,namely IL1B,PTGS2,CASP3,IL6,CCL2,MAPK3,EGF,TP53,PPARG,CXCL8,CTNNB1,JUN,MMP9,HIF1A,VEGFA,IL10,EGFR.GO results such as oxidative stress,antioxidant response,endoplasmic reticulum cavity and chemokine activity were significantly enriched.KEGG signaling pathways such as IL-17 and TNF were significantly enriched.(2)Clinical research:In terms of overall efficacy,the healing rate of the treatment group was 80.56%,with an overall effective rate of 97.22%;the healing rate of the control group was 5.56%,with an overall effective rate of 75.00%,and the healing rate of the treatment group was significantly better than that of the control group after comparison(p<0.01).In terms of the efficacy of the TCM symptoms,the healing rate of the treatment group was 77.78%and the total effective rate was 97.22%,while the healing rate of the control group was 16.67%and the total effective rate was 83.33%,the healing rate of the treatment group was significantly better than that of the control group(P<0.01).In terms of the TCM symptoms score,local signs score and VAS score,all scores decreased significantly in both groups after treatment,and there was a significant difference between the two groups before and after treatment(P<0.01),and the scores in the treatment group were significantly lower than those in the control group when compared with the two groups after treatment(P<0.01).In terms of safety,there were no significant adverse reactions or discomfort during the treatment period in both groups.Conclusion:Network pharmacology studies have shown that Xiaoyao Shukun Decoction treats SPID through multiple targets and multiple pathways.It is not only closely related to important targets such as IL1 B,PTGS2,CASP3,IL6,CCL2,MAPK3,EGF,TP53,PPARG,CXCL8,mainly reflected in the regulation of IL-17,TNF and other signaling pathways,but also closely related to biological processes and molecular functions such as oxidative stress,antioxidant response,endoplasmic reticulum cavity,chemokine activity.It reflects the characteristics of Xiaoyao Shukun Decoction as a compound multi-component,multi-target and multi-channel,and provides a theoretical basis for its application in clinical and subsequent experimental research.Clinical studies have shown that Xiaoyao Shukun Decoction can significantly improve the clinical symptoms and signs of SPID patients with qi stagnation and blood stasis.It is an effective prescription for clinical treatment of SPID,and has no obvious adverse events.It can be applied to the treatment of SPID patients with qi stagnation and blood stasis.