Efficacy evaluation and potential pharmacological mechanism of tanreqing injection in the treatment of COPD combined with respiratory failure based on meta-analysis and network pharmacology

BACKGROUND: Tanreqing injection (TRQI) is a Chinese patent medicine. It is commonly used in the treatment of acute exacerbation of COPD in China. It substantially improves the partial pressure of oxygen (PaO(2)), partial pressure of carbon dioxide (PaCO2), and lung function in patients with COPD combined with respiratory failure (RF) and improves the total clinical effective rate. MATERIALS AND METHODS: Relevant randomized controlled trials (RCTs) on the treatment of COPD combined with RF with TRQI were collected through search of PubMed, Web of Science, Embase, Cochrane Library, CBM, VIP, Wanfang, and CNKI up to October 2, 022. Two investigators in this study independently evaluated the quality of the literature and utilized RevMan 5.4 software for analysis. In network pharmacology, TCMSP database, PubChem database, DisGeNet, Genecards, and other databases were searched to screen the chemical components and targets of TRQI and mapped with COPD-RF targets to obtain potential action targets, which were then analyzed using bioinformatics techniques to initially explore their effects. RESULT: A total of 18 RCTs containing 1485 patients, showed that TRQI combined with conventional treatment improved the total clinical efficiency of patients with COPD combined with RF compared with that of the conventional treatment group ([RR = 1.33, 95% CI (1.25, 1.41), P < 0.01]), PaCO2 [SMD = −1.29, 95% CI (−1.41, −1.17), P < 0.00001], PaO2 [SMD = 1.19, 95% CI (1.06, 1.31), P < 0.00001], pulmonary function [SMD = 1.00, 95% CI (0.79, 1.21), P < 0.00001]. Through network pharmacology analysis, 284 potential TRQI and 19 common targets were identified. TNF, TP53, SIRT1, SRC, CCND1, IL-10, NF-κB, MAPK14, STAT3, SMAD3 are core targets proteins. In addition, 56 related pathways of TRQI were identified, such as the TNF, MAPK, IL-17, NF-κB signaling pathways. CONCLUSION: In conclusion, the efficacy of TRQI combined with conventional treatment for COPD combined with RF was higher than that of conventional treatment alone. These findings suggest that TRQI acts on COPD-RF through a multi-target, multi-component, and multi-pathway mechanism. Future studies may explore the active components of TRQI.