中医真实世界慢性胃炎患者胃胀症状改善的核心方挖掘和机制分析OA

Objective To mine the effective core TCM prescriptions for improving gastric distension in chronic gastritis based on real-world clinical medical record data;To explore their syndrome patterns,medication characteristics and potential mechanisms.Methods Outpatient medical records of patients with chronic gastritis accompanied by gastric distension in the Spleen-Stomach Department of Guang'anmen Hospital,China Academy of Chinese Medical Sciences,from March 2009 to September 2023 were screened.Inclusion and exclusion criteria for gastric distension symptom improvement were formulated combining clinical practice and expert opinions.Longitudinal analysis of consecutive medical records of the same patient was performed to determine"effective visits",and finally effective prescription data for the treatment of gastric distension in chronic gastritis were screened.The Link-LDA topic model was used to mine"symptom-herb"correlation topics.Complex network analysis was adopted to construct a symptom-TCM network and reveal the core prescription structure.Combined with network pharmacology,databases including BATMAN-TCM 2.0,HIT 2.0,HERB 2.0 and SwissTargetPrediction were integrated to predict the targets of core prescriptions.Gastric distension-related targets were retrieved from the SymMap database for intersection analysis,followed by construction of a PPI network.KEGG pathway enrichment analysis was carried out to analyze the target and pathway mechanisms of core prescriptions.Results A total of 2 887 effective prescriptions related to gastric distension in chronic gastritis were included.Two core syndrome-prescription correlation topics were identified:Topic 1 corresponded to spleen-stomach yang deficiency and liver-stomach stagnant heat(mixed cold and heat)syndrome,with core herbs including Bupleuri Radix,Paeoniae Radix Alba,Inulae Flos and Haematitum Preparatum;Topic 2 corresponded to spleen-stomach qi deficiency and liver-stomach qi stagnation syndrome,with core herbs including Codonopsis Radix,fried Atractylodis Macrocephalae Rhizoma with wheat bran,Coptidis Rhizoma and Zingiberis Rhizoma.Complex network analysis showed that both types of prescriptions focused on invigorating the spleen and harmonizing the stomach,regulating qi and resolving distention,with qi-regulating herbs such as Citri Reticulatae Pericarpium frequently used,but with significant differences in therapeutic emphasis:Topic 1 focused on warming the middle and descending rebellion,and harmoniously regulating cold and heat,while Topic 2 focused on invigorating the spleen and replenishing qi,and acrid-opening and bitter-descending.Network pharmacology analysis suggested that Topic 1 prescriptions may exert therapeutic effects on gastric distension by regulating tight junction and focal adhesion pathways,while Topic 2 prescriptions may alleviate gastric distension by regulating gastric acid secretion.Conclusion Using a data-driven approach,this study identifies two core effective syndrome-prescription combinations for gastric distension in chronic gastritis.Their syndrome classification,medication law and potential mechanisms are highly consistent with TCM theories,fully embodying the TCM thought of"treating the same disease with different methods"based on syndrome differentiation and treatment.It provides real-world data support and methodological reference for symptom-oriented precise TCM treatment of chronic gastritis.