| Objective:A Bayesian network Meta-analysis was used to analyze the efficacy and safety of Chinese patent medicines in combination with conventional Western medicine for the treatment of irritable bowel syndrome with diarrhea(IBS-D),in order to provide evidence-based medical evidence for clinical drug selection.The mechanism of the most efficacious TCM for the treatment of IBS-D was also predicted by using network pharmacology methods.Methods:The databases of China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,China Biology Medicine Disc(CBM),PubMed,Embase,Web of Science and Cochrane Library were conducted to retrieve information about oral proprietary Chinese medicine combined with conventional Western medicine for the treatment of IBS-D.The search time was from the establishment of the database to November 15,2022.The Cochrance risk of bias assessment tool was used to evaluate the risk of bias in the included studies,and the data were analyzed using Stata 14.0 and GeMTC 0.14.3 software.The best efficacy in improving the total effective rate of IBS-D was obtained by network Meta-analysis of Buzhongyiqi pills/granules.The active ingredients of Buzhongyiqi Formula and their action targets were searched in the Chinese Medicine systems Pharmacology Database and Analysis Platform.The Gene Cards database,OMIM database,DRUGBANK database,and TTD database were searched to obtain information on disease targets related to IBS-D.The targets of the action of Buzhongyiqi Formula were intersected with the targets of IBS-D.Based on the STRING database and Cytoscape 3.9.1 software,the "drug-active ingredient-target" network diagram and protein-protein interaction(PPI)network diagram were constructed,and topological analysis was performed using Cytoscape software.The main active ingredient information and key target information were obtained.GO enrichment analysis and KEGG analysis were performed by Metascape platform.Results:1.A total of 51 studies were included,with 4468 patients,involving 13 oral Chinese patent medicines.The results of the network Meta-analysis showed that,in terms of improving the total effective rate,the top three therapeutic regimens were Shenling Baizhu Granules/Powders/Pills combined with conventional western medicine treatments>Wumei Pills combined with conventional western medicine treatments>Wuling Capsule combined with conventional western medicine treatments;in terms of improving the abdominal pain scores,the top three therapeutic regimens were Wuling Capsule combined with conventional western medicine treatments>Tongxiening Granules combined with conventional western medicine treatments>Bupi Yichang Pills combined with conventional western medicine treatments=Fengliao Changweikang Capsule/Granules/Pills combined with conventional western medicine treatments;in terms of improving diarrhea scores,the top three therapeutic regimens were Wuling Capsule combined with conventional western medicine treatments>Bupi Yichang Pills combined with conventional western medicine treatments>Tongxiening Granules combined with conventional western medicine treatments;in terms of improving abdominal distension scores,the top two therapeutic regimens were are Qizhi Weitong Granules combined with conventional western medicine treatments>Wuling Capsule combined with conventional western medicine treatment;in terms of reducing the incidence of adverse reactions,the top three therapeutic regimens were Bupi Yichang Pills combined with conventional western medicine treatments>Shenling Baizhu Granules/Powders/Pills combined with conventional western medicine treatments>Shenbei Guchang Capsule combined with conventional western medicine treatments.2.A total of 136 active ingredients,244 corresponding targets,1905 IBS-D-related targets and 120 drug-disease common targets were obtained from the network pharmacology study.The "drug-active ingredient-target" network was constructed,b and the main active ingredients were quercetin,kaempferol,dousterol,isorhamnetin,naringenin,etc.based on the degree.A total of 12 key targets were identified as IL6,JUN,AKT1,VEGFA,STAT3,CASP3,PTGS2,IL1B,MAPK3,EGF,CCL2,and the main signaling pathways including TNF signaling pathway,IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,and MAPK signaling pathway.Conclusions:1.Compared with conventional western medicine treatment,the combination of oral Chinese patent medicine can improve the total effective rate of the treatment of diarrhea-predominant irritable bowel syndrome,improve the symptoms of abdominal pain,diarrhea and abdominal distension,and will not increase the incidence of adverse reactions.Buzhongyiqi pill/granule is the best treatment to improve the total effective rate.Wuling capsule is the most effective treatment for abdominal pain and diarrhea.Qizhi Weitong granule is the best treatment to improve the symptoms of abdominal distension.Bupi-yicang pill was the treatment with the lowest incidence of adverse reactions.2.The main active ingredients of Buzhongyiqi decoction include quercetin,kaempferol,dousterol,isorhamnetin and naringenin,which act on IL6,JUN,AKT1,VEGFA,STAT3,CASP3,PTGS2,IL1B,MAPK3 and other targets,and participate in TNF signaling pathway,IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,MAPK signaling pathway,regulate inflammatory response,immune response,cell proliferation and apoptosis,smooth muscle contraction and other biological processes,thereby reducing intestinal inflammation,regulating gastrointestinal dynamics,repairing intestinal epithelial mucosal barrier,regulating visceral hypersensitivity,and playing a role in the treatment of IBS-D. |
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