| Objective:The aim of this study is to evaluate the therapeutic efficacy and safety of Guoshi capsule in the prevention and treatment of early steroid-induced avascular necrosis of the femoral head(SANFH)through clinical observation,while providing a foundation for clinical treatment.Furthermore,this study seeks to explore the mechanism of Guoshi capsule in preventing and treating early SANFH using network pharmacology approaches.Methods:1.According to the inclusion and exclusion criteria,we selected 60 patients with SANFH who visited our hospital’s orthopedic clinic from February 2022 to August 2022.The patients were randomly divided into a treatment group(30 patients)and a control group(30 patients).The treatment group received Bone Erosion Capsules,while the control group received Xianling Gubao Capsules,with a treatment period of 180 days.After treatment,we analyzed the changes in pain scores(VAS),hip joint function scores(Harris),and serum TLR-4 and NF-κB levels before and after treatment in both groups.2.The network diagram of active ingredients and target actions of traditional Chinese medicine was constructed using the TCMSP database and Cytospace3.7.1.Disease targets related to SANFH were retrieved from the OMIM,Gene Cards,and Drug Bank databases using " steroid-induced avascular necrosis of femoral head " as a keyword.Venn diagrams were drawn using the intersection of drug-disease targets.Protein-protein interaction(PPI)analysis was conducted using the STRING11.5 database.Potential Gene Ontology(GO)biological process and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses were performed using R4.1.2 software and R packages(cluster Profiler,pathview),and the data results were visualized using a biological platform.Results:1.Before treatment,statistical analysis of the two groups of patients showed no significant difference in age and gender(P>0.05).Similarly,there was no significant difference in the observed indicators such as VAS scores,Harris scores,and serum TLR-4and NF-κB levels before treatment(P>0.05).After 180 days of treatment,the observed indicators were statistically analyzed and compared between the two groups.After treatment,the symptoms of both groups improved.The post-treatment VAS scores,Harris scores,and changes in serum TLR-4 and NF-κB levels were significantly different compared to before treatment(P<0.05).After treatment,the treatment group exhibited significant improvements in VAS scores,Harris scores,and serum TLR-4 and NF-κB levels compared to the control group,with statistically significant differences(P<0.05).2.Network pharmacology analysis revealed that Bone Erosion Capsules have a total of 358 effective active ingredients for the human body,with 418 related targets.For SANFH,we identified 609 potential targets.There were 53 common targets in the intersection of the two.Based on the PPI network analysis,we selected 10 core nodes,i.e.,key targets.Through GO enrichment study,we found that Bone Erosion Capsules can effectively regulate the expression of cytokines,promote the absorption of lipopolysaccharides,and effectively inhibit the activity of bacterial-derived molecules,thus effectively treating SANFH.Moreover,KEGG enrichment analysis revealed that Bone Erosion Capsules treat SANFH through multiple signaling pathways,such as the interleukin IL-17 pathway and hypoxia-inducible factor-1.Conclusion:Bone Erosion Capsules have a significant therapeutic effect in the treatment of early-stage SANFH,and are superior to the use of Xianling Gubao Capsules alone.This may be related to the regulation of TLR-4 and NF-κB expression by Bone Erosion Capsules.Active ingredients in Bone Erosion Capsules,such as quercetin,p-coumaric acid,and luteolin,regulate targets such as ALB,IL6,TNF,IL1 B,and CXCL8,acting on major signaling pathways such as IL-17 and HIF-1,to exert their therapeutic effects on SANFH.This demonstrates the multi-component,multi-pathway,and multi-target characteristics of traditional Chinese medicine network pharmacology... |
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