Clinical Observation And Experimental Study Of Modified Shenqi Dihuang Decoction In The Treatment Of (Deficiency Of Qi And Yin) In Henoch-schonlein Purpura Nephritis In Children

Objective:1.The purpose of this study is to conduct a bibliometric analysis of Henoch-Schonlein purpura nephritis(HSPN)in children from 2000 to 2022,to explore the research status and frontier trend of HSPN in children,and to sort out the scientific and technological trends and directions.2.To collect the clinical data of children with HSPN with deficiency of qi and yin,and statistically analyze the improvement of laboratory indexes and traditional Chinese medicine syndromes before and after treatment with Modified Shenqi Dihuang Decoction,so as to evaluate the clinical curative effect of Modified Shenqi Dihuang Decoction and the improvement of adrenal cortex function.3.Network pharmacology analysis combined with animal experimental study to explore the mechanism of Modified Shenqi Dihuang Decoction in the treatment of HSPN.Methods:1.Screening the literature in the field of HSPN in children in the Web of Science Core Collection(Wo SCC)from 2000 to 2022.Visual analysis of their annual publications,countries,institutions,authors,journals,keywords,and references were using Cite Space5.8.R3 and VOSviewer1.6.18.2.The children with HSPN of deficiency of both qi and yin who signed the informed consent form were randomly divided into treatment group(Modified Shenqi Dihuang Decoction)and control group(Shenyan Kangfu Tablets).The changes of 24-hour urine protein,urine red blood cell count,cortisol and TCM syndrome score were observed before and after treatment in the two groups.3.The active components and effective targets of Modified Shenqi Dihuang Decoction were obtained by using TCMSP and BATMAN-TCM.The related targets of HSPN were obtained based on Gene Cards,Drug Bank,OMIM,TTD and Dis Ge NET database,and Cytoscape 3.7.2 was used to construct the “traditional Chinese medicine-active ingredient-disease common target” network.Gene Ontology(GO)function enrichment analysis and Kyoto Encyclopedia of genes and genomes(KEGG)pathway enrichment analysis was carried out through Metascape platform,and animal experiments was used to verify some targets.Result:1.Current research focuses are “pathogenesis” and “treatment”.Currently,the recognized pathogenesis is the “four-hit” theory,Gd-Ig A1 is the core link,KDIGO and European consensus suggest that HSPN should be graded according to its severity,and the updated Oxford Classification(MEST-C)is helpful to evaluate the renal prognosis of HSPN.2.A total of 64 eligible children were included in this study.During the treatment process,5 cases were excluded,4 cases were lost to follow-up and dropped out,and 27 cases were finally treated in the treatment group and 28 cases in the control group.The total effective rate was 81.5% in the treatment group and 67.9% in the control group,with significant difference between the two groups(P<0.05).The TCM symptoms(hematuria,shortness of breath,low voice,poor appetite,dry mouth and throat,lassitude,feverish palms and soles)of the treatment group and the control group were improved compared with those before treatment(P<0.05),and there was no significant difference in urinary foam between the two groups(P>0.05).The symptoms of hematuria,shortness of breath,low voice,dry mouth and throat in the treatment group were significantly improved compared with those in the control group(P<0.05),but there was no significant difference in the symptoms of anorexia,lassitude and feverish palms and soles(P>0.05).The urine red blood cell count and 24-hour urine protein in the treatment group and the control group were decreased compared with those before treatment(P<0.01),and the difference between the two groups was statistically significant(P<0.01).The cortisol of the treatment group and the control group was higher than that before treatment(P<0.01),and the difference between the two groups was statistically significant(P<0.01).3.The network pharmacology analysis showed that 93 active components were obtained,228 predicted targets were identified,and 67 targets were shared with HSPN.The core targets included VEGFA,TGF-β1,etc.GO function enrichment analysis involves apoptosis signaling pathway,oxidative stress response,angiogenesis and other processes;KEGG pathway enrichment analysis involves VEGF signaling pathway,TGF-β signaling pathway,etc.Modified Shenqi Dihuang Decoction can reduce the expression of serum TGF-β1 and VEGFA in HSPN rats,inhibit renal fibrosis,inflammatory reaction and immune response,alleviate renal pathological damage and relieve HSPN.Conclusion:1.Although the number of literatures in this field is limited,the number of publications has increased significantly in recent years,showing an overall upward trend,indicating that more and more scholars pay attention to HSPN in children.The “four-hit” theory and treatment scheme are still the current research hotspots in this field.The mechanism of action of Gd-Ig A1 and the updated Oxford Classification may be the focus of future research.2.Modified Shenqi Dihuang Decoction can relieve the symptoms of deficiency of both qi and yin,clear away residual evil,promote the rise of cortisol and improve the function of adrenal cortex.3.Modified Shenqi Dihuang Decoction can significantly reduce the expression of serum TGF-β1 and VEGFA in rats with HSPN,and alleviate the renal pathological damage caused by HSPN.Modified Shenqi Dihuang Decoction is the result of multi-component,multi-target and multi-pathway interaction in treating HSPN.