目的 挖掘中医药治疗腹膜透析相关性腹膜炎（peritoneal dialysis-associated peritonitis，PDAP）的组方规律，并探讨核心药物组合的作用机制。方法 以2013年1月至2024年12月于天津中医药大学第一附属医院肾病科住院患者的病历为资料来源，建立PDAP证型及处方信息数据库，运用WPS表格（20305）和R语言对纳入患者的证型和中药进行频次统计，并对中药进行关联规则分析和聚类分析，筛选出核心药物组合；通过中药系统药理学数据库（Traditional Chinese Medicine Systems Pharmacology Database，TCMSP）、HERB、ETCM、BATMAN-TCM数据库获取核心药物组合的活性成分，并结合Swiss Target Prediction预测药物作用靶点；运用Digsee、DrugBank、GeneCard、OMIM、NCBI Gene数据库预测疾病相关靶点；运用微生信平台得到疾病与药物的交集靶点；运用Cytoscape建立“活性成分-交集靶点”网络，筛选出关键成分；以STRING平台数据为基础，利用Cytoscape软件构建蛋白质-蛋白质相互作用（protein-protein interaction，PPI）网络，筛选核心靶点；通过DAVID数据库对交集靶点进行基因本体论（gene ontology，GO）和京都基因与基因组百科全书（Kyoto encyclopedia of genes and genomes，KEGG）富集分析；采用AutoDockVina对关键成分与核心靶点进行分子对接。结果 共纳入109例患者，提取处方109首，涉及2种单一证型、22种复合证型，210味药物，药性以温、平、寒、微寒为主，药味以甘、苦、辛为主，归经以脾、胃、肝、肺经居多，系统聚类分析可归为7大类；筛选出“半夏-陈皮-砂仁-枳壳”核心药物组合，涉及94个活性成分、1 494个作用靶点，与PDAP有561个交集靶点；槲皮素（quercetin）、柚皮素（naringenin）、5,7,8,3',4'-五甲氧基黄酮（5,7,8,3',4'-pentamethoxyflavone）、胡萝卜素（carotene）、那可汀（norcotine）、黄芩黄酮I（skullcapflavone I）等为核心成分，白细胞介素-6（interleukin-6，IL6）、肿瘤坏死因子（tumor necrosis factor，TNF）、甘油醛-3-磷酸脱氢酶（glyceraldehyde-3-phosphate dehydrogenase，GAPDH）、白蛋白（albumin，ALB）、丝氨酸/苏氨酸激酶1（serine/threonine kinase 1，AKT1）、白细胞介素-1β（interleukin-1 beta，IL1B）等为关键靶点；KEGG分析显示主要涉及糖尿病并发症中晚期糖基化终产物及其受体（advanced glycation end products-receptor for advanced glycation end products，AGE-RAGE）信号通路、磷脂酰肌醇-3-羟激酶（phosphatidylinositol-3-hydroxykinase，PI3K）-蛋白激酶B（protein kinase B，Akt）信号通路、缺氧诱导因子-1（hypoxia-inducible factor-1，HIF-1）、黏着斑（focal adhesion）等信号通路；分子对接结果显示关键靶点与核心成分具有良好亲和力。结论 PDAP的中医治法主要以固护脾肾、祛湿解毒、理气通腑为主，兼以活血化瘀，其核心药物组合“半夏-陈皮-砂仁-枳壳”治疗PDAP的潜在靶点主要涉及IL6、TNF、GAPDH、ALB、AKT1、IL1B等，其作用机制主要涉及炎症反应、细胞凋亡过程的调控以及细胞群体增殖的调控等生物学过程，为中医药治疗PDAP提供理论依据，为进一步探究其作用机制提供方向。

Objective To investigate the formulation patterns of traditional Chinese medicine (TCM) in treating peritoneal dialysis-associated peritonitis (PDAP) and explore the mechanism of action of core drug combinations. Methods Clinical records from PDAP patients hospitalized in the Nephrology Department of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (January 2013—December 2024) were collected to establish a syndrome-pattern and prescription database. Active components were retrieved from Traditional Chinese Medicine Systems Pharmacology Database (TCMSP), HERB, ETCM, and BATMAN-TCM databases, with target prediction via Swiss Target Prediction. Disease-related targets were identified through Digsee, DrugBank, GeneCard, OMIM and NCBI Gene databases. Intersection targets were obtained using the Weishengxin Bioinformatics Platform. Cytoscape was used to construct “active component-intersection target” networks and protein-protein interaction (PPI) networks, with subsequent screening of key components and core targets. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analyses were performed through DAVID database. Molecular docking was conducted using AutoDock Vina. Results The study included 109 patients with 109 prescriptions, involving two single syndrome patterns and 22 compound patterns, comprising 210 herbs. Herbs predominantly exhibited warm, neutral, cold, and slightly cold properties; sweet, bitter, and pungent flavors; and tropism towards spleen, stomach, liver, and lung meridians. Seven clusters were identified through systematic clustering analysis. The core combination “Banxia (Pinelliae Rhizoma)-Chenpi (Citri Reticulatae Pericarpium)-Sharen (Amomi Fructus)-Zhike (Aurantii Fructus)” contained 94 active components and 1 494 targets, with 561 PDAP-related intersection targets. Key components included quercetin, naringenin, 5,7,8,3',4'-pentamethoxyflavone, carotene, norcotine and skullcapflavone I. Core targets included interleukin-6 (IL6), tumor necrosis factor (TNF), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), albumin(ALB), serine/threonine kinase 1 (AKT1), and interleukin-1 beta (IL1B). KEGG analysis revealed that the main pathways involved were advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE), phosphatidylinositol-3-hydroxykinase (PI3K)-protein kinase B (Akt), hypoxia-inducible factor-1(HIF-1), focal adhesion, and other signaling pathways. Molecular docking demonstrated strong binding affinity between key targets and core components. Conclusion TCM treatment of PDAP primarily focuses on tonifying and protecting the spleen and kidney, resolving dampness, detoxification, regulating qi, and promoting bowel movement, complemented by blood activation and stasis removal.The potential therapeutic targets of the core herbs combination “Pinelliae Rhizoma-Citri Reticulatae Pericarpium-Amomi Fructus-Aurantii Fructus” in the treatment of PDAP primarily involve IL6, TNF, GAPDH, ALB, AKT1, IL1B, etc. Its mechanism of action primarily involves biological processes such as inflammatory responses, negative regulation of apoptotic process and positive regulation of cell population proliferation,which may provide the theoretical basis for TCM in the treatment of PDAP, and the direction for further study of the potential mechanism.

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国家自然科学基金资助项目（82274472）；天津市科委多元投入基金项目重点项目（21JCZDJC01160）