不稳定型心绞痛围术期应用调脾护心法治疗的效果及其作用机制  

Clinical Efficacy and Mechanism of Regulating Spleen and Protecting Heart for the Treatment of Unstable Angina Pectoris during Perioperative Period

作　　者：方才敬 刘攀 郭言午 戴小华[3,4] FANG Caijing;LIU Pan;GUO Yanwu;DAI Xiaohua(The First Clinical Medical College,Anhui University of Chinese Medicine,Hefei 230031,Anhui,China)

机构地区：[1]安徽中医药大学第一临床医学院,合肥230031 [2]上海中医药大学附属曙光医院安徽医院 [3]安徽中医药大学第一附属医院,合肥230031 [4]安徽中医药大学心血管病研究所,合肥230031

出　　处：《中西医结合心脑血管病杂志》2024年第15期2720-2728,共9页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：安徽省中医药领军人才资助项目,编号:中医药发展秘2018-23。

摘　　要：目的:通过回顾性研究观察不稳定型心绞痛围术期应用调脾护心法治疗的临床疗效,运用数据挖掘、网络药理学分析用药规律及作用机制。方法:选取2020年9月—2022年9月安徽中医药大学第一附属医院收治的不稳定型心绞痛围术期病人400例,分为中药组(372例)和非中药组(28例),非中药组采用西医常规治疗,中药组在非中药组基础上加用调脾护心法中药汤剂治疗,手术前后均每天服用2次,每次200 mL。比较两组中医证候积分和心绞痛症状改善情况;运用数据挖掘总结中药组处方用药规律,网络药理学分析核心处方作用靶点。结果:治疗后,中药组中医证候积分低于非中药组(P<0.05),心绞痛症状疗效优于非中药组(P<0.05)。数据挖掘共筛选出调脾护心法医案372例,核心药物83味,药性以温热为主,温性药物最多,药味酸、苦、甘为主,共占73.40%;聚类分析发现以“白术、陈皮、茯苓、广木香、蒲公英、酸枣仁、炙甘草、炙远志”为核心处方;网络药理学分析:生物利用度(OB)≥30%、类药性(DL)≥0.18核心中药成分185个;对19个交集基因进行基因本体(GO)分析,发现在细胞组分方面主要与胞质部分、细胞外围、质膜、内膜系统等相关;在分子功能方面与酶结合、信号受体结合等密切联系;在生物学过程方面主要与细胞对化学刺激的反应、定位调控等有关;京都基因与基因组百科全书(KEGG)发现其与晚期糖基化终产物及其受体(AGE-RAGE)、丝裂原活化蛋白激酶(MAPK)、白细胞介素-17(IL-17)信号通路、肿瘤坏死因子(TNF)信号通路等密切相关。结论:在常规治疗基础上,运用调脾护心法干预不稳定型心绞痛围术期病人可以提高临床疗效,处方核心药物是白术、陈皮、茯苓、广木香、蒲公英、酸枣仁、炙甘草、炙远志,其作用机制可能与AGE-RAGE、MAPK、IL-17、TNF信号通路相关。Objective:To observe the clinical efficacy of regulating spleen and protecting heart for the treatment of unstable angina pectoris in perioperative period by retrospective study,and to analyze the rule of medication and mechanism of action by data mining and network pharmacology.Methods:Four hundred perioperative patients with unstable angina pectoris were divided into the traditional Chinese medicine group(372 cases)and the non-traditional Chinese medicine group(28 cases).The patients of non-traditional Chinese medicine group were treated with conventional Western medicine,and the patients of traditional Chinese medicine group were treated with traditional Chinese medicine of regulating spleen and preserving heart on the basis of the non-traditional Chinese medicine group,they were treated with 200 mL twice a day before and after surgery.The traditional Chinese medicine syndrome scores and angina pectoris symptoms were compared between the two groups.Data mining was used to summarize the prescription rules of traditional Chinese medicine group,and network pharmacology was used to analyze the core prescription action targets.Results:After treatment,the traditional Chinese medicine syndrome score in the traditional Chinese medicine group was less than that in the non-traditional Chinese medicine group(P<0.05).The clinical efficacy of angina pectoris symptoms in the traditional Chinese medicine group was better than that in the non-traditional Chinese medicine group(P<0.05).A total of 372 cases of regulating spleen and protecting heart were selected by data mining,with 83 core drugs,mainly warm and hot drugs,warm drugs were the most,sour,bitter and sweet drugs,accounting for 73.40%.Cluster analysis found that the core prescriptions were"white rhizoma,Pericarpium Citri Reticulatae,Poria,Radix Aucklandiae,Herba Taraxaci,Semen Ziziphi Spinosae,prepared licorice root,Radix Polygalae".The results of network pharmacological analysis showed that oral bioavailability(OB)≥30%,drug-like(DL)≥0.18 core Chinese medicine com

关 键 词：不稳定型心绞痛 围术期 调脾护心法 中医证候积分 数据挖掘 网络药理学 

分 类 号：R259[医药卫生—中西医结合]