伤科接骨片治疗骨折临床效果的Meta分析及其“病-症-方”关联功效机制  

Meta-analysis of Clinical Efficacy and“Disease-Symptom-Formula”Associated Mechanism Investigation of Shangke Jiegu Tablet Against Fractures

作　　者：刘雪婷 陈凛 张苏雅 奚灏瀛 张宁 林娜[1] 张彦琼 LIU Xueting;CHEN Lin;ZHANG Suya;XI Haoying;ZHANG Ning;LIN Na;ZHANG Yanqiong(Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences,Beijing 100700,China;Dalian Meiluo Traditional Chinese Medicine Factory Co.,LTD,Dalian 116036,China)

机构地区：[1]中国中医科学院中药研究所,北京100070 [2]大连美罗中药厂有限公司,大连116036

出　　处：《医药导报》2024年第12期1919-1929,共11页Herald of Medicine

基　　金：技术服务类项目(H2023067);中国中医科学院科技创新工程项目(C12021A03808)。

摘　　要：目的系统评价伤科接骨片干预骨折的临床疗效,并从“病-症-方”关联角度,探索该中成药品种的作用机制及其各功效组的配伍特点。方法首先检索中文数据库(中国知网、万方数据库、维普数据库)和英文数据库(PubMed、Cochrane Library、EMbase)自建库至2024年1月伤科接骨片干预骨折的临床研究文献,应用风险评价工具对文献研究内容进行质量评价,提取数据并采用Stata 16.0版软件进行分析。利用中医药整合药理学研究平台(TCMIP v2.0)获得骨折临床症状表型相关基因集,再利用GEO数据库获得临床骨折相关的差异表达基因集。同时,从TCMIP v2.0收集伤科接骨片所含化学成分及其候选靶标谱。构建“骨折相关基因-伤科接骨片候选靶标”互作网络,通过计算网络拓扑特征值,筛选核心网络靶标,并通过功能富集分析,解析该中成药品种各功效组的作用机制。结果Meta分析共纳入14篇文献,样本量共计1293例,提示伤科接骨片对骨折的总有效率(RR=1.24,95%CI:1.18~1.31,P<0.001);“病-症-方”关联网络分析结果显示,伤科接骨片候选靶标所参与的通路主要分布于骨损伤的愈合、神经、血液系统调节和“免疫-炎症”调节等功能模块,且方药中不同功效组的作用特点各有侧重。结论伤科接骨片具有良好的促进骨折愈合疗效,并可通过调节血液循环系统和神经系统、矫正“免疫-炎症”失衡、维持骨和能量代谢稳态而发挥其活血化瘀、消肿止痛、续筋接骨、清热解毒的综合功效。相关研究结果为明确伤科接骨片的优势疗效环节和临床定位奠定基础。Objective This study systematically evaluated the clinical efficacy of Shangke Jiegu tablet in the treatment of fracture,and explored the mechanism of action of Shangke Jiegu tablet and the compatibility of each efficacy group from the“Disease-Symptom-Formula”perspective.Methods Clinical research literatures on the use of Shangke Jiegu tablet for fracture intervention were retrieved from Chinese databases(CNKI,Wanfang Database,VIP database)and English databases(PubMed,Cochrane Library,EMbase),covering the period from the inception of the databases to January 2024.Risk assessment tools were used to evaluate the literature’s quality,and the data were extracted and analyzed using Stata 16.0 software.Gene sets associated with fracture symptoms were identified through the TCMIP platform(version 2.0).Differential gene expression related to fractures was obtained from the GEO database.Chemical composition and candidate target profiles of the 12 herbs in Shangke Jiegu tablets were collected from TCMIP v 2.0.An interaction network between fracture-related genes and drug candidate targets was established,and core network targets were screened based on topological features,with functional enrichment analysis performed.Results A total of 14 articles were incorporated into the Meta-analysis,encompassing a total sample size of 1293 cases,indicating an overall response rate of Shangke Jiegu tablets in fracture therapy(RR=1.24,95%CI:1.18-1.31,P<0.001).The"Disease-Symptom-Formula"association network analysis indicated that the pathways related to the putative targets of Shangke Jiegu tablet were primarily involved in bone healing,nerve and blood system regulation,and immune-inflammation regulation.Different efficacy groups within the prescriptions showed varying emphases on these roles.Conclusions Shangke Jiegu tablet may facilitate fracture healing by regulating blood and nervous systems,correcting immune-inflammatory imbalances,and maintaining bone and energy metabolism.The comprehensive effects include the dissipation of

关 键 词：伤科接骨片 骨折 META分析 网络药理学 临床疗效 “病-症-方”关联 

分 类 号：R285[医药卫生—中药学] R274.1[医药卫生—中医学]