清肾颗粒通过调控miR-23b及Nrf2通路改善慢性肾脏病湿热证患者的肾功能：基于网络药理学和临床试验

doi:10.12122/j.issn.1673-4254.2025.09.07

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (9): 1867-1879.doi: 10.12122/j.issn.1673-4254.2025.09.07

• • 上一篇

清肾颗粒通过调控miR-23b及Nrf2通路改善慢性肾脏病湿热证患者的肾功能：基于网络药理学和临床试验

呼琴¹(), 金华²^,³()

^1.安徽中医药大学第一临床医学院，安徽合肥 230000
^2.合肥综合性国家科学中心大健康研究院//新安医学与中医药现代化研究所，安徽合肥 230031
^3.安徽中医药大学第一附属医院肾内科，安徽合肥 230031

收稿日期:2025-03-27 出版日期:2025-09-20 发布日期:2025-09-28
通讯作者: 金华 E-mail:qinhu992024@163.com;ya790312@sina.com
作者简介:呼琴，在读博士研究生，E-mail: qinhu992024@163.com
基金资助:
国家自然科学基金(82274307);合肥综合性国家科学中心大健康研究院新安医学与中医药现代化研究所专项资金(2023CXMMTCM018)

Qingshen Granules improves renal function of patients with chronic kidney disease damp-heat syndrome by activating the miR-23b and Nrf2 pathway

Qin HU¹(), Hua JIN²^,³()

^1.First Clinical Medical College of Anhui University of Chinese Medicine, Hefei 230000, China
^2.Institute of Xin'an Medicine and Modernization of Traditional Chinese Medicine, Institute of Health, Hefei Comprehensive National Science Center, Hefei 230031, China
^3.Department of Nephrology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China

Received:2025-03-27 Online:2025-09-20 Published:2025-09-28
Contact: Hua JIN E-mail:qinhu992024@163.com;ya790312@sina.com
Supported by:
National Natural Science Foundation of China(82274307)

摘要/Abstract

摘要：

目的探讨清肾颗粒对慢性肾脏病（CKD）湿热证患者miR-23b及Nrf2通路及氧化应激干预作用。方法通过TCMSP、UniProt检索并映射清肾颗粒调控靶点，利用Small RNA测序技术筛选慢性肾衰竭湿热证的疾病基因，构建“活性成分-交集靶点-疾病”网络。利用KEGG通路富集分析及分子对接，明确清肾颗粒通过Nrf2通路影响CKD的靶点。临床试验：纳入60例CKD3~5期且表现为湿热证的非透析患者，设观察组和对照组，30例/组，另设20例正常组。对照组接受西医常规治疗，观察组在此基础上加用清肾颗粒，疗程8周。检测指标包括PBMC中miR-23b-5p、Nrf2和HO-1蛋白的表达水平，肾功能指标（Scr、eGFR），以及血清中ROS、AOPP、 PON-1的含量。结果清肾颗粒经筛选得到6种主要活性成分，10个关键靶点（ACTB、JUN、PTEN、ESR1、GSK3B、PPARG、PIK3CA、APP、PIK3R1、BECN1）。通过Small RNA测序，发现miR-23b-5p基因表达上调。KEGG通路分析显示Nrf2通路发挥重要作用。分子对接揭示核心靶点与活性成分结合活性良好，NFE2L2与木犀草素结合活性最好。清肾颗粒能降低患者血清Scr及ROS和AOPP水平，升高eGFR及血清PON-1水平（P<0.05）；升高PBMC中的 Nrf2和HO-1蛋白水平（P<0.05）；升高miR-23b-5p的表达水平（P<0.05）。结论 miR-23b表达及Nrf2通路异常可能是CKD湿热证患者的关键干预靶点。清肾颗粒能通过多种活性成分作用于多靶点改善CKD湿热证患者肾功能，其治疗效果可能与 miR-23b 表达的上调、Nrf2 抗氧化通路活性的增强以及机体氧化应激水平的降低密切相关。

关键词: 清肾颗粒, 慢性肾脏病, microRNA, Nrf2通路, 网络药理学

Abstract:

Objective To investigate the therapeutic mechanism of Qingshen Granules (QSG) in patients with chronic kidney disease (CKD) damp-heat syndrome. Methods The regulatory targets of QSG were retrieved and mapped using TCMSP and UniProt. Small RNA sequencing technology was used to screen the target genes of chronic renal failure damp-heat syndrome to construct the "active ingredients-intersection targets-diseases" network, followed by KEGG pathway enrichment analysis and molecular docking of the core targets. Sixty patients with CKD (stage 3-5) presenting with damp-heat syndrome and not undergoing dialysis were randomized equally into two groups for conventional Western medicine treatment (control group) and additional treatment with QSG (observation group) for 8 weeks, with 20 healthy individuals as the normal control group. The expression levels of miR-23b-5p, Nrf2 and HO-1 protein in peripheral blood mononuclear cells (PBMC), renal function indicators (Scr and eGFR), and serum ROS, AOPP and PON-1 levels were compared among the 3 groups after the treatments. Results Six main active ingredients of QSG were identified, and their key targets included ACTB, JUN, PTEN, ESR1, GSK3B, PPARG, PIK3CA, APP, PIK3R1, and BECN1. MiR-23b-5p expression was significantly up-regulated in CKD damp-heat syndrome, in which the Nrf2 pathway abnormality played an important pathogenic role. Molecular docking results suggested good binding activity of the core targets with the active ingredients of QSG, and NFE2L2 had the strongest binding with luteolin. In patients with CKD damp-heat syndrome, QSG treatment significantly decreased serum Scr, ROS and AOPP levels, obviously improved eGFR, and increased serum PON-1 levels, expression levels of Nrf2 and HO-1 proteins in PBMCs, and the expression level of miR-23b-5p. Conclusion QSG can improve the renal function in patients with CKD damp-heat syndrome possibly by up-regulating miR-23b expression, activating the Nrf2 antioxidant pathway, and reducing oxidative stress levels.

Key words: Qingshen Granules, chronic kidney disease, microRNA, Nrf2 pathway, network pharmacology

呼琴, 金华. 清肾颗粒通过调控miR-23b及Nrf2通路改善慢性肾脏病湿热证患者的肾功能：基于网络药理学和临床试验[J]. 南方医科大学学报, 2025, 45(9): 1867-1879.

Qin HU, Hua JIN. Qingshen Granules improves renal function of patients with chronic kidney disease damp-heat syndrome by activating the miR-23b and Nrf2 pathway[J]. Journal of Southern Medical University, 2025, 45(9): 1867-1879.

图/表 18

表1 研究对象的一般资料比较

Tab.1 Comparison of general data of the participants

Group	Age (year)	Course	Gender		CKD staging			Underlying medical conditions
Group	Age (year)	Course	Male	Female	3	4	5	Chronic nephritis	Hypertension	Diabetes	Polycystic kidney disease
Normal (n=20)	51.55±8.17	-	11	9	-	-	-	-		-	-	-
Control (n=30)	48.73±9.13	3.74±1.92	17	13	1	17	12	12		7	7	4
Observation (n=30)	50.03±9.64	3.91±2.04	16	14	5	11	14	10		8	8	4

图1 "复方-活性成分-靶点"网络关系图

Fig.1 Diagram of TCM compound prescription-active ingredients-targets network.

表2 两组差异miRNA的表达

Tab.2 Expression of differential miRNAs between the two groups

miRNA_id	log2 Fold Change	qValue	Regulation
hsa-let-7b-3p	8.206372	1.35×10^-5	Up
hsa-let-7f-2-3p	9.086326	0.0016	Up
……	……	……	……
hsa-miR-20a-5p	10.3875	1.37×10^-5	Up
hsa-miR-21-5p	5.334294	0.000371	Up
hsa-miR-23b-5p	-4.50953	0.003782	Down
hsa-miR-26b-5p	4.938481	0.003172	Up
hsa-miR-27a-3p	4.084065	0.005144	Up
hsa-miR-30d-3p	-2.49269	0.049808	Down

图2 miRNA靶基因预测韦恩图

Fig.2 Venn diagram of miRNA target gene prediction. 1: Elements exist only in a single list (one of miRDB, TargetScan, funrich, miranda) and are not shared with other lists. 2: Elements exist in two lists simultaneously. 3: Elements exist in three lists simultaneously. 4: Elements exist in four lists simultaneously.

图3 "活性成分-交集靶点-疾病"网络图

Fig. 3 Diagram of the Active Ingredients-Intersection Targets-Diseases network.

图4 PPI网络分析

Fig.4 PPI network analysis. A: PPI network. B: Network diagram of the core genes. C: Network diagram of core gene screening.

图5 GO富集分析条形图

Fig.5 Bar chart of GO enrichment analysis.

图6 KEGG通路富集分析桑基图

Fig.6 Sankey diagram of KEGG pathway enrichment analysis.

图7 "活性成分-关键靶点-信号通路"网络图

Fig.7 Network diagram of the Active Ingredients-Key Targets-Signaling Pathways.

表3 活性成分与核心靶点的结合能

Tab.3 Binding energy of the active ingredients to the core targets

Key ingredients	Target	Affinity (kcal/mol)
	ACTB	-2.88
	PTEN	-2.55
Quercetin	PPARG	-5.31
	PIK3CA	-4.9
Kaempferol Apigenin Luteolin	NFE2L2 ACTB PTEN PPARG PIK3CA NFE2L2 ACTB PTEN PPARG PIK3CA NFE2L2 ACTB PTEN PPARG PIK3CA NFE2L2	-4.8 -3.61 -3.5 -4.1 -2.63 -4.96 -3.21 -2.34 -4.13 -4.05 -6.0 -4.34 -3.58 -4.26 -4.19 -5.38

图8 分子对接及结合位点图

Fig.8 Molecular docking and the binding sites. A: Quercetin-PPARG. B: luteolin-ACTB. C: Apigenin-PIK3CA. D: Kaempferol-PTEN. E: Quercetin-PTEN.

表4 中医症候积分比较

Tab.4 Comparison of TCM syndrome scores (n=30, Mean±SD)

Group	TCM syndrome scores
Group	Pre-treatment	Post-treatment
Control	11.98±1.69	10.87±2.14
Observation	12.60±1.11	8.53±2.19*^▲

表5 两组患者Scr、eGFR比较

Tab.5 Comparison of Scr and eGFR between the two groups of patients (n=30, Mean±SD)

Group	Scr (μmol/L)			eGFR(mL/min)
Group	Pre-treatment	Post-treatment	△Scr	Pre-treatment	Post-treatment	△eGFR
Control	328.51±109.32	322.25±110.45	6.26±20.57	19.33±9.20	19.78±9.19	0.45±1.51
Observation	317.81±114.33	298.47±108.61*	19.34±23.86^▲	20.02±9.31	21.68±10.15*	1.65±2.15^▲

表6 PBMC中Nrf2、HO-1比较

Tab.6 Comparison of Nrf2 and HO-1 in PBMCs among the 3 groups (Mean±SD)

Group	n	Nrf2/β-actin		HO-1/β-actin
Group	n	Pre-treatment	Post-treatment	Pre-treatment	Post-treatment
Normal	20	1.04±0.06	-	1.10±0.09	-
Control	30	0.42±0.07^△	0.48±0.09*	0.32±0.06	0.36±0.11*
Observation	30	0.45±0.07^△	0.55±0.12*^▲	0.33±0.06	0.42±0.10*^▲

图9 各组PBMC中Nrf2、HO-1比较

Fig.9 Nrf2 and HO-1 in the PBMCs in each group. A:Normal group. B: Control group(Pre-treatment).C: Control group (Post-treatment). D:Observation group(Pre-treatment). E: Observation group(Post-treatment).

表7 血清ROS、PON-1、AOPP水平比较

Tab.7 Comparison of serum ROS, PON-1 and AOPP levels among the 3 groups before and after treatment (Mean±SD)

Group	n	ROS (U/mL)		PON-1 (U/L)		AOPP (μmol/L)
Group	n	Pre-treatment	Post-treatment	Pre-treatment	Post-treatment	Pre-treatment	Post-treatment
Normal	20	21707.25±844.70	-	79.40±5.25	-	2045.52±156.85	-
Control	30	36181.78±2904.00^△	35090.40±3001.58*	47.94±9.58	50.84±12.18*	3596.73±236.77	3493.55±236.38*
Observation	30	36019.23±2370.14^△	30176.07±2850.72*^▲	51.28±9.24	60.50±13.29*^▲	3527.61±347.18	2825.24±311.16*^▲

表8 PBMC中miR-23b-5p比较

Tab.8 Comparison of miR-23b-5p in PBMCs among the 3 groups (Mean±SD)

Group	n	miR-23b-5p
Group	n	Pre-treatment	Post-treatment
Normal	20	1.05±0.19	-
Control	30	0.35±0.09^△	0.39±0.14
Observation	30	0.38±0.11^△	0.53±0.19*^▲

图10 miR-23b-5p表达量的相关性分析

Fig10 Correlation analysis of miR-23b-5p expression. A: miR-23b-5p and Scr (negative correlation). B: miR-23b-5p and eGFR (positive correlation). C: miR-23b-5p and Nrf2 (positive correlation). D: miR-23b-5p and ROS (negative correlation). E: miR-23b-5p and AOPP (negative correlation). F: miR-23b-5p and HO-1 (positive correlation). G: miR-23b-5p and PON1 (positive correlation).

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清肾颗粒通过调控miR-23b及Nrf2通路改善慢性肾脏病湿热证患者的肾功能：基于网络药理学和临床试验

Qingshen Granules improves renal function of patients with chronic kidney disease damp-heat syndrome by activating the miR-23b and Nrf2 pathway

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