Clinical Study And Mechanism Analysis Of Chinese Herbal Fumigation In The Treatment Of Evaporative Dry Eye Based On Network Pharmacology

Objective:This project combined with network pharmacology to explore the mechanism of Chinese medicine fumigation formula for the treatment of evaporative dry eye.And it evaluated the efficacy and provided a basis for clinical treatment of evaporative dry eye by observing the changes in IOP,BUT,SIT,FL,OSDI scale scores and TCM symptom scores in the treatment of evaporative dry eye with Chinese herbal fumigation combined with Sodium Hyaluronate Eye Drops.Methods:The target information of each drug in the herbal fumigation formula was retrieved from the TCMSP database,and the target information of evaporative hyperintense dry eye was retrieved from the OMIM,Drugbank and Gene Cards databases.Cytoscape 3.8.0 was used to visualise the "herbal-active-component-target".The results were imported into STRING 11.5 to obtain PPI and then enriched by Metascape for GO and KEGG analysis.108 patients who attended the ophthalmology department of Kunming Hospital of Traditional Chinese Medicine and were diagnosed with evaporative over-intensity dry eyes were collected and divided into 3 groups A,B and C according to the principle of randomized control,with 36 cases in each group.All groups were treated with 0.1% sodium glassate eye drops,group A was treated with Chinese medicine fumigation on top of the next,group B was treated with pure water fumigation on top of this,and group C was treated with 0.1% sodium glassate eye drops only.One drop was used 4 times a day,and each course of fumigation was performed 3 times for 7days,for a total of 3 courses of treatment.The information of patients’ IOP,BUT,SIT,FL,OSDI scale scores and TCM symptom scores were collected before and after treatment,and the efficacy of the herbal fumigation formula combined with sodium vitrate eye drops in the treatment of evaporative hyperintense dry eye was evaluated by statistical analysis.Information on patients’ IOP,BUT,SIT,FL,OSDI scale scores and TCM symptom scores between pre and post therapy was collected and statistically analysed to evaluate the efficacy of the Chinese herbal fumigation formula combined with Sodium Hyaluronate Eye Drops in the treatment of evaporative dry eye.Results:1.A total of 31 herbal active ingredients,265 targets,503 disease targets and 43 intersecting targets were obtained.Among them,TNF,AKT1,EGFR,VEGFA,HSP90AA1,PTGS2 and ESR1 targets were highly correlated and might be the key targets of the herbal fumigation formula for the treatment of evaporative dry eye.GO analysis revealed that the active ingredients and targets may be involved in biological processes such as inflammatory response,regulation of small molecule metabolic processes,protein homogenization activity,signaling receptor regulatory activity,signaling receptor activator activity,oxidoreductase activity,etc.The KEGG enrichment pathway was mainly associated with TNF,IL-17 and MAPK signaling pathway.2.A total of 108(216 eyes)patients were included in this study,11(22 eyes)of which were detached and 97(194 eyes)of which were actually included.3.Pre-treatment comparison: patients’ gender,age,IOP,BUT,SIT,FL,OSDI scale scores and TCM symptom scores were all not statistically significant(p > 0.05).4.Post-treatment comparisons:(1)IOP was not statistically significant(P>0.05).(2)Intra-group comparison of main indicators BUT,SIT and FL: they were all statistically significant in all three groups between pre and post therapy(P < 0.05).Between-group comparison: BUT scores: Group A vs Group C(P=0.000<0.05),Group B vs Group C(P=0.042<0.05),Group A vs Group B(P=0.044< 0.05).SIT scores: Group A vs Group C(P=0.000<0.05),Group A vs Group B(P=0.000<0.05),Group B vs Group C(P=0.002<0.05).FL scores: Group A vs Group C(P=0.000 <0.05),Group B vs Group C(P=0.044 < 0.05),Group A vs Group B(P=0.001 < 0.05),the differences were all statistically significant.(3)Intra-group comparison of secondary indicators OSDI scale scores and TCM symptom scores: all three groups were statistically significant(P < 0.05)between pre and post therapy.Comparison between groups: OSDI scale scores Group A vs Group C(P=0.000<0.05),Group B vs Group C(P=0.019<0.05),Group A vs Group B(P=0.000<0.05).Chinese medicine symptom scores were statistically significant between Group A and Group C(P=0.000<0.05),Group B and Group C(P=0.016<0.05),and Group A and Group B(P=0.023<0.05).5.Total effective rate: 88.20% in group A,77.40% in group B and 68.80% in group C.Group A was better than groups B and C and P=0.012<0.05,the difference was statistically significant.Conclusion:1.The Chinese herbal fumigation formula may have a therapeutic effect on EDE through multiple components,multiple targets and multiple pathways,and the specific mechanism should be verified through animal experiments.2.Chinese herbal fumigation treatment combined with Sodium Hyaluronate Eye Drops,pure water fumigation treatment combined with Sodium Hyaluronate Eye Drops and Sodium Hyaluronate Eye Drops were all effective in the treatment of EDE.3.Chinese herbal fumigation combined with Sodium Hyaluronate Eye Drops were effective in increasing SIT and BUT,reducing FL,improving OSDI scale scores and TCM symptom scores compared to the other two treatment modalities.