| Objective:(1)To study the clinical efficacy of modified Pinxia Hopu Decoction combined with mediprogesterone in the treatment of patients with spittoon gas obstruction syndrome of lung squamous cell carcinoma,so as to provide reference for clinical and scientific research.(2)Using network pharmacology tools to explore the mechanism of modified Pinxia Houpu Decoction in the treatment of tumor cachexia.Methods:(1)Patients with malignant liquid sputum and gas obstruction syndrome of lung squamous cell carcinoma in the Department of Oncology,Affiliated Hospital of Tianjin Institute of Traditional Chinese Medicine from June 2020 to December 2021 were collected and randomly divided into control group and experimental group.Both groups were given megestrol acetate 160mg/ day,and the experimental group was given combined treatment of pinxia Honpo Decoction for 21 days.After treatment,the TCM symptom score,appetite state,weight change,c-reactive protein,hemoglobin,serum albumin fluctuation were assessed.IBM SPSS Statistics 25 statistical software was used to analyze the obtained data.(2)Gene cards database,human Mendelian genetic online database(OMIM)and drugbank database were used to determine tumor cachexia gene.The protein interaction relationships of potential intersection targets were obtained by STRING database,the core protein network was screened by Cytohubba plug-in MCC algorithm,and the Metascape tool was used for enrichment analysis.Finally,Cytoscape software is used for graphical rendering.Results:(1)The study finally included 73 qualified cases,36 cases in the control group and 37 cases in the experimental group.Baseline comparison: there was no significant difference between the two groups(p>0.05),suggesting that the two groups were comparable.TCM syndrome score: in the control group,the effective rate was 5%(2/36 cases),the stable rate was 39%(14/36 cases),the ineffective rate was 56%(20/36 cases),and the overall effective rate was 44%(16/36 cases);After treatment,the effective rate of the experimental group was27%(10/37 cases),the stable rate was 54%(20/37 cases),the ineffective rate was 19%(7/37cases),and the overall effective rate was 72%(27/37 cases).The difference between the two groups was statistically significant(p<0.001).Appetite score: the appetite score of the two groups increased after treatment(p<0.001),and there was significant difference between the two groups(p<0.05).Weight change: the body weight of the two groups increased after treatment(p<0.001),and there was no significant difference between the two groups(p>0.05).Serum albumin level: the serum albumin level of the two groups increased after treatment(p<0.001),and there was significant difference between the two groups(p<0.05).Hemoglobin level: the hemoglobin level of the two groups increased after treatment(p<0.001),and there was no significant difference between the two groups(p>0.05).Serum CRP level: the serum CRP level of the two groups decreased after treatment(p<0.001),and there was significant difference between the two groups(p<0.05).Adverse reactions: there were 3 cases of slight abnormality of transaminase in the experimental group and 4 cases of slight abnormality of transaminase in the control group,which recovered after symptomatic treatment.Another person stopped taking megestrol due to abnormal blood coagulation.(2)The modified Banxia Houpu Decoction with 36 active components and 230 potential targets were obtained by network pharmacology tool;The interaction between each component and the target was determined according to the degree value.The top 10 traditional Chinese medicine components with multi-target binding ability were quercetin,luteolin,β Sitosterol,baicalein,stigmasterol,2-methoxy-3-methyl-9,10-anthraquinone,2-met hoxy-9,10-dihydrophenanthrene-4,5-diol,cavidine,eucalyptol,coniferin.73 intersecting targets were obtained,and 66 targets with high interaction possibility were obtained after string analysis(confidence space 0.9).The data were further analyzed by cytohubba plug-in MCC to obtain the core targets of TOP10,which are IL-6,TNF,IL-4,Jun and IL-1respectively β、IL-8、IL-1α、The topological relationship of IL-10,myc and TP53 shows that the first 8 bits are more closely related to each other.Enrichment analysis showed that 66 core targets were involved in cancer signaling pathway(hsa05200),PI3 K Akt signaling pathway(hsa04151),MAPK signaling pathway(hsa04010),small cell lung cancer signaling pathway(hsa05222),hypoxia inducible factor-1 signaling pathway(hsa04066),cancer transcriptional deregulation signaling pathway(hsa05202)and NF-κB signal pathway(hsa05202),mitochondrial autophagy signal pathway(hsa04137),PPAR signal pathway(hsa03320),chemokine signal pathway(hsa04062),cell cycle pathway(hsa04110),p53 signal pathway(hsa04115),bladder cancer signal pathway(hsa05219),etc.go enrichment analysis indicates that Jiawei Banxia Houpu decoction can interfere with cell migration,cell differentiation,proliferation,apoptosis and other processes,involving the regulation of transcriptional co regulators Cytokine receptor,ubiquitin like protein ligase,phosphatase and other key components related to cell signal transduction.Conclusion:(1)Modified Banxia Houpu decoction combined with megestrol can significantly reduce the syndrome of phlegm Qi obstruction in patients with malignant fluid of lung squamous cell carcinoma,improve the weight and nutritional level of patients,and reduce the systemic inflammatory response.When combined with megestrol,it can further significantly improve the patient’s appetite and serum albumin level,reduce the systemic inflammatory response,but can not further improve the hemoglobin content.(2)Network pharmacology suggests that flavonoids in the form of quercetin and luteolin may affect IL-1β、IL-6,TNF and other signal molecule transduction pathways can reduce the symptoms of tumor cachexia. |
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