Based On Clinical-state-medicine Theory To Study The Clinical Efficacy Of Naosuikang In The Treatment Of Post-stroke Cognitive Impairment No Dementia

Part Ⅰ:Bibliometric analysis and literature review of the diagnosis and treatment of post-stroke cognitive impairment no dementia with TCMObjectiveTo reveal the current situation,analysis potential research direction of post-stroke cognitive impainnent no dementia(PSCIND)in the field of Traditional Chinese Medicine(TCM),and state a hypothesis of TCM in the field of PSCIND clinical prospects.Methods"Post-stroke cognitive impairment no dementia" as the core term,the databases of medical papers were searched separately.According to the inclusion and ranking standards,the documents were sorted,summarized.The retrieved information is sorted out and built into a database,analyzed and visualized by bibliometrics,and presents the current status of Chinese and Western medicine of PSCIND.Results(1)A total of 548(461 Chinese and 87 English)literatures were retrieved,and 31 duplicates were excluded.After reading of titles and abstracts,a total of 359 articles unrelated to TCM or PSCIND topics were excluded.After reviewing the full text of remain articles,a total of 17 PSCIND studies related to TCM were obtained according to this study inclusion and exclusion.All of them are human subjects.(2)There are 9 papers with clinical efficacy as the research target,3 on traditional Chinese medicine treatment.1on acupuncture and moxibustion combined with Chinese medicine,2 on acupuncture and moxibustion combined with rehabilitation therapy,2 on integrated model including traditional Chinese medicine and acupuncture.There are 8 researches related to TCM syndrome types.The key words of the literature are made into matrix data files for network topology analysis and visualized processing." TCM syndrome types(elements)","ischemic stroke",and "(vascular)cognitive impairment" are hot-spot frequency words,but not the" post-stroke cognitive impairment no dementia/PSCIND".Compared with PSCIND literature in the field of TCM,the total number of non-TCM papers has doubled(non-TCM vs.TCM=35/17).Clinical efficacy,disease characteristics(cognitive/psychological characteristics,biomarkers).disease risk/risk prediction(risk factors)are the top 3 focus of those research papers.Furthermore,the non-TCM’s clinical publications in this field are better than TCM’s,74.3%vs.52.9%.ConclusionThere are few researches of PSCIND in the field of TCM,and the content is relatively limited.It has the feasibility of deeply exploration or related research.Part Ⅱ:Research on the clinical efficacy of Naosuikang in the treatment of PSCIND based on clinical-state-medicine theoryObjectiveTo study the clinical efficacy of PSCIND with Naosuikang as the core treatment based on clinical-state-medicine theory.MethodsA randomized parallel controlled study method was used to enroll 46 PSCIND cases that met the research criteria.They were divided into the treatment group and the control group according to random method.After collecting relevant information and neuropsychological scales,they entered the observation period.The treatment group was treated with cerebrovascular disease basic drug treatment combined with Naosuikang plus TCM clinical-state psychological treatment.The control group was treated with cerebrovascular disease basic drug treatment combined with nimodipine.Observed for 6 months,with MoCA effect index as the main outcome index.SDSVD and FIM integral index are used as secondary outcome indicators to evaluate the clinical curative effect.After the observation,the follow-up without treatment can be continued for 3 months.ResultsThere was no significant difference between the two groups of clinical information at the baseline stage.Because the matching was reasonable,it had a reliable feasibility of this controlled study.After the 6-month observation period,the main clinical outcome indicator—MoCA score index showed that the total effective rate of the treatment group was 82.61%,and the control group was 69.57%.There was no statistically significant difference between the two groups.Both the secondary outcome indicator TCM symptom score index and the FIM score index indicated that the difference between the two groups is not statistically significant,and the overall effective rate is about 40%.The MoCA subdomain scales and FIM subgroups cognitive score further analysis showed that the clinical-state-medicine treatment plan with Naosuikang can improve the attention,language ability,delayed recall and FIM cognitive score.The difference between the before and after treatment is statistically significant.ConclusionIncluding Naosuikang’s treatment plan has a positive effect on PSCIND based on clinical-state-medicine theory,and it is not inferior to western medicine.It has good effects in cognitive subfields such as attention,language ability,and delayed recall.Part Ⅲ:The Exploring Research of Naosuikang Prescription in The Treatment of Post-stroke Cognitive Impairment No Dementia Based on Network Pharmacology ObjectiveTo explore the potential targets and pathways of Naosuikang prescription in the treatment of PSCIND based on network pharmacology.Methods12 herbs of Naosuikang were incorporated into the drug component-target gene network platform one by one.Based on the JunchenZuozhu prescription principle and the screening to s criteria,a Naosuikang compound-target gene data file is created after selecting,merging,and deduplicating.At the same time,a pathogenic genes file of PSCIND is download form online Genecards database.After taking the intersection with the above two files,an association data file of PSCIND and Naosuikang is formed.Network databases and offline software are both used to visualize the association data files as network diagrams and perform topological analysis.And then this analysis results are systematically compared and analyzed with previous research of Nasosuikang prescription to find out the differences and new research directions.Results(1)201 compounds and relevant association 2236 targets genes in 12 herbs of Naosuikang prescription are found.The above data was further clustered and de-duplicated by using the TCM principle of formulating.Finally,290 Naosuikang prescriptions relevant association target genes were identified.The data was overlapped and matched with the PSCIND pathogenic genes retrieved from the Genecards websites database.10 intersection genes were determined,namely ALB,ALOX5,CRP,EDN1,IL1B,MMP9,NOS3,SLC6A4,TNF,and VDR.(2)Further protein-protein interaction network topology analysis showed that,except for NOS3,other hot-spot genes did not appear in the above 10 intersection target genes.However,the interesting thing is that the NOS3 gene was not the most hot-spot link in the Naosuikang compounds-targets gene network.There are 41 biological processes,2 types of molecular functions,2 types of cellular components and five KEGG pathways in the effect of Naosuikang on PSCIND,which were predicted by online network pharmacology platform database.(3)The comparison found that the co-operating gene of Naosuikang capsule and Naosuikang prescription only has NOS3.The content and direction of past basic research on Naosuikang and the findings of this network pharmacology research have not yet reached an intersection.Conclusions(1)Naosuikang has the pharmacological feasibility for the treatment of PSCIND,but it may not be the best choice;(2)It is necessary to explore the prospects,target genes and pathways of Naosuikang’s treatment in the future,meanwhile,it can reversely explore more effective composition of TCM prescription compounds in the field of PSCIND.