基于多中心真实世界数据研究中西医结合治疗类风湿关节炎的用药规律及忍冬藤-伸筋草药对的分子作用机制  

Study on the rule of combination of traditional Chinese and Western medicine in the treatment of rheumatoid arthritis and the molecular mechanism of Lonicerae Japonicae Caulis-Lycopodh Herba based on multicenter real-world data

作　　者：姜平 时一鸣 杜星辰 李晖 章渊源 姜婷 汪荣盛 沈杰 郑新春 丁琴 秦盈盈 刘佳 郭梦如 古英 胡春蓉[5] 苏晓[6] 薛鸾[7] 方勇飞 苏励[9] 高明利 薛愉[2] 彭江云 朱琦 何东仪 沈逸 JIANG Ping;SHI Yiming;DU Xingchen;LI Hui;ZHANG Yuanyuan;JIANG Ting;WANG Rongsheng;SHEN Jie;ZHENG Xinchun;DING Qin;QIN Yingying;LIU Jia;GUO Mengru;GU Ying;HU Chunrong;SU Xiao;XUE Luan;FANG Yongfei;SU Li;GAO Mingli;XUE Yu;PENG Jiangyun;ZHU Qi;HE Dongyi;SHEN Yi(Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Shanghai Changning District Health Committee,Shanghai 200050,China;Mianyang Hospital of TCM,Mianyang 621000,China;Chongqing Ninth People’s Hospital,Chongqing 400700,China;Traditional Chinese Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;The First Affiliated Hospital of the Army Military Medical University,Chongqing 400038,China;Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Liaoning Hospital of Traditional Chinese Medicine,Shenyang 110033,China;Yunnan Hospital of Traditional Chinese Medicine,Kunming 650021,China)

机构地区：[1]上海中医药大学附属光华医院,上海200052 [2]复旦大学附属华山医院,上海200040 [3]上海市长宁区卫生健康委员会,上海200050 [4]绵阳市中医院,绵阳621000 [5]重庆市第九人民医院,重庆400700 [6]上海中医药大学附属市中医医院,上海200071 [7]上海中医药大学附属岳阳中西医结合医院,上海200437 [8]陆军军医大学第一附属医院,重庆400038 [9]上海中医药大学附属龙华医院,上海200032 [10]辽宁省中医院,沈阳110033 [11]云南省中医院,昆明650021

出　　处：《中华中医药杂志》2024年第12期6671-6677,共7页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.82074234);国家中医药管理局区域中医(专科)诊疗中心建设项目-风湿病科(No.2018-2022);上海市卫生健康委员会华东片区中西医结合关节病专科联盟项目[No.ZY(2021-2023)-0302];上海市何东仪名中医工作室建设项目(No.SHGZS-202220)。

摘　　要：目的:基于类风湿关节炎(RA)多中心真实世界数据,分析中西医结合治疗RA的用药规律及高频中药药对的分子作用机制。方法:分析3310例RA患者的临床数据,进行相应数据挖掘和网络药理学分析。结果:最终纳入189例RA患者,结果显示忍冬藤-伸筋草为高频率使用的中药药对,并与甲氨蝶呤片联合应用治疗RA。忍冬藤-伸筋草药对通过木犀草素、β-谷甾醇和豆甾醇等关键成分作用于PTGS2、TNF、CASP8、BCL2、CASP3、MMP3和MMP9等基因并调控细胞凋亡、IL-17信号通路、TNF信号通路及VEGF信号通路等多条途径发挥治疗RA的作用。结论:本研究系统挖掘了中西医结合治疗RA的用药规律和药物组合,并在分子水平上进一步阐释了中药药对治疗RA的具体作用机制,为中西医结合治疗RA提供一定的临床指导。Objective:Based on the multicenter real-world data of rheumatoid arthritis(RA),to analyze the medication rule of integrated traditional Chinese and Western medicine in the treatment of RA and the molecular mechanism of high frequency traditional Chinese medicine(TCM)pairs.Methods:The clinical data of 3310 patients with RA were analyzed.Data mining and network pharmacology analysis were carried out.Results:A total of 189 patients with RA were enrolled.The results showed that Lonicerae Japonicae Caulis-Lycopodh Herba(LJC-LH)was a frequently used pair of TCM,and it was combined with methotrexate(MTX)tablets to treat RA.LJC-LH play a role in the treatment of RA by acting on PTGS2,TNF,CASP8,BCL2,CASP3,MMP3 and MMP9 genes and regulating apoptosis,IL-17 signaling pathway,TNF signaling pathway and VEGF signaling pathway through key components such as luteolin,β-sitosterol and stigmasterol.Conclusion:This study systematically excavates the medication rule and drug combination of integrated traditional Chinese and Western medicine in the treatment of RA,and further explains the specific mechanism of TCM in the treatment of RA at the molecular level,so as to provide some clinical guidance for the treatment of RA with integrated traditional Chinese and Western medicine.

关 键 词：真实世界 数据挖掘 网络药理 类风湿关节炎 忍冬藤 伸筋草 药对 机制 

分 类 号：R28[医药卫生—中药学]