A Systematic Review Of Traditional Chinese Medicine In The Treatment Of Diabetic Nephropathy And A Study On Its Medication Rule

Purpose: By observing the therapeutic effect of TGFβ1-Smad signaling pathway mediated by Chinese medicine monomer in the treatment of diabetic nephropathy animal model,the therapeutic effect of TGFβ1-smad on diabetic nephropathy was systematically evaluated,providing reliable evidence-based medical basis for the prevention and treatment of diabetic nephropathy by Chinese medicine through improving renal fibrosis.The data mining technology was used to study the syndrome and treatment rules of TCM compound in treating diabetic nephropathy with turbid poison and stasis syndrome,and to provide reference for the prescription and medication selection of TCM in the treatment of diabetic nephropathy.Meterial and method: Randomized controlled studies on the treatment of diabetic nephropathy rats with TCM monomeric based on TGFβ1-Smad signaling pathway were comprehensively searched from the establishment of the database to October 6,2021.Bayes Markov chain-Monte Carlo method was used to analyze and compare the efficacy differences of TCM monomer,western medicine,TGFβ1expression,blood glucose,blood urea nitrogen,blood creatinine,24-hour urinary protein and kidney index in blank control group,and the efficacy and types of included drugs were analyzed.According to the categories of traditional Chinese medicine involved in the above research,combined with the syndrome of diabetic nephropathy combined with the diagnosis and treatment guidelines,the literature related to the syndrome of turbidity poison stasis of diabetic nephropathy treated by Chinese herbal compounds was collected from the establishment of the database to October 31,2022,and the Excel data set and SPSS data mining model were established.Frequency analysis,compatibility relationship,association rules,visualization analysis and cluster analysis were conducted for the prescription combinations included in the study,so as to obtain the high-frequency drugs,drug combinations,classification and potential new prescriptions for the treatment of this disease.Results:1.Systematic evaluation and mesh meta-analysis:(1)33 studies were included in this study,including 30 TCM monomers,including:The main chemical components of rhubarb,coptis chinensis,Radix astragalus,panax notoginseng,hawthorn and other traditional Chinese medicine,6 kinds of western medicine,a total of 811 diabetic nephropathy rat models,compared with placebo control group,the traditional Chinese medicine monomeric reduced the expression of TGFβ1 by 0.72[0.39,1.07],blood urea nitrogen by 5.03[3.01,7.10],fasting blood glucose decreased by 8.94[6.29,11.60],24-hour urinary protein decreased by18.40[11.51,25.47],serum creatinine decreased by 34.91[15.75,54.07] and renal index decreased by 1.62[0.65,2.62],all of which were statistically significant(P<0.05).(2)Category analysis of traditional Chinese medicine: Through the analysis of the research drugs included in the above systematic evaluation,it was found that these traditional Chinese medicine monomers were from the categories of traditional Chinese medicine such as clearing heat and detoxifying,promoting blood circulation and tonifying deficiency.2.Data mining:(1)Literature collection: There were 154 clinical studies on the treatment of turbidities,poisons and stasis syndrome with Chinese herbal compounds conforming to the nanpo standard,and 146 effective prescriptions were obtained,involving 193 TCM.(2)Frequency and frequency analysis: the top 10 Chinese herbs in use frequency were:Astragalus membranaceus,rhubarb,salvia miltiorrhiza,poria cocos,yam,Cornus officinalis,atractyloides atractyloides,Rehmannia rehmannia,alisma alisma;Drug meridian for liver,lung,spleen,kidney;The four qi are mainly cold,warm and flat.Five commonly used sweet,bitter,Xin;The main types of drugs were tonifying deficiency,clearing heat,promoting blood circulation and removing blood stasis,and enhancing water and dampness.(3)Correlation analysis: The drug combinations with strong correlation were astragalus-Rhubarb,Astragalus-Salviorrhiza and Astragalus-Poria;Astragalus-Salvia miltiorrhiza-Rhubarb,Astragalus-Poria-Rhubarb,Astragalus-Poria-Yam.(4)Cluster analysis: five new prescriptions were obtained.The first one was yam,dogwood,Rehmannia,Moutan bark,poria cocos,alisma alisma;The second: Gorgon euryale,golden cherry,Atractylodes,codonopsis;The third: Angelica sinensis,Coptis chinensis,rhubarb,Astragalus,Tangerine peel,Ligusticum Chuanxiong;The fourth:Salvia miltiorrhiza,Rehmannia,motherwort,wolfberry,poria cocos;The fifth: Leech,Pueraria,Centella.Conclusion:1.TCM monomer can inhibit TGFβ1-smad signaling pathway,reduce the expression of TGFβ1,delay renal fibrosis,protect the kidney,and treat diabetic nephropathy.2.The treatment of turbidius-toxic-stasis syndrome of diabetic nephropathy mainly includes tonifying deficiency,activating blood circulation,detoxifying and expelling turbidity.The treatment method emphasizes "clearing heat and detoxifying,activating blood circulation and removing stasis,enhancing water and expelling turbidity,and tonifying deficiency and loss".3.The pathogenesis of nephritis with turbidity,poison and stasis may be related to renal fibrosis.