Clinical efficacy of Salvia miltiorrhiza in pathological scar treatment:A systematic review and meta-analysis

To systematically assess the clinical efficacy of Salvia miltiorrhiza(SM)in treating pathological scars and provide a reference basis for scar pharmacotherapy,we conducted a comprehensive literature search in both English and Chinese databases from database inception to December 2022.Key search terms included Salvia miltiorhiza,cryptotanshinone,tanshinone IIA,sodium-tanshinol,compound Salvia miltiorrhiza dripping pills,cicatrix,cicatrices,and scar.The inclusion criteria encompassed all clinical randomized controlled studies on the treatment of pathological scars with SM,without regard to blinding or allocation concealment,as well as irrespective of patient nationality,race,or age.Data from the selected literature were subjected to analysis using Rev Man 5.4 software,employing the standard mean difference or weighted mean difference for numerical variables and odds ratios(ORs)for dichotomous variables.Statistical significance was set at P<0.05.Six eligible studies involving a total of 778 patients met the inclusion criteria.The analysis revealed a significant therapeutic efficacy with an OR of 3.83(95%CI:2.65–5.54),indicating a substantially higher therapeutic efficacy rate in SM group compared to the control group.Furthermore,the total effective rate of treatment exhibited an OR of 6.94(95%CI:2.53–19.06),signifying a significantly superior treatment outcome in SM group.Regarding scar scores,no significant improvement was observed in SM group compared to the control group after 3 months of treatment(mean difference[MD]=–0.96,95%CI:–2.29–0.36).However,after 6 months of treatment,the scar score demonstrated a noteworthy improvement in SM group(MD=–1.37,95%CI:–2.44 to–0.30)compared to the control group.In summary,this study affirmed that SM treatment markedly enhanced the therapeutic efficacy and overall treatment efficiency for clinical scar patients,underscoring its positive clinical therapeutic impact on scar patients.

Discussion on the mechanism of Salvia miltiorrhiza in treating pathological scars based on network pharmacology

In the present study, we aimed to explore the mechanism of Salvia miltiorrhiza in the treatment of pathological scars(PS) by network pharmacology. The active ingredients and drug targets of Salvia miltiorrhiza were screened out through TCMSP database, the disease targets of PS in Gene Cards database were obtained, and Venn diagram analysis on drug targets and disease targets was performed, and the intersection was used as the target of Salvia miltiorrhiza for the treatment of PS. Cytoscape software was used to construct a drug-ingredient-target-disease network diagram. A protein-protein interaction network was constructed through String website, its key protein modules and hub genes were screened with Cytoscape software, and GO and KEGG enrichment analyses were performed in DAVID database. Fifty-nine active ingredients, 138 drug targets, and 90 targets of Salvia miltiorrhiza for the treatment of PS were screened out. Core ingredients, such as luteolin and tanshinone IIA, were obtained. The hub genes, such as VEGFA, TP53, JUN, STAT3, AKT1, MAPK1, and PTGS2, and signaling pathways, such as HIF-1, TNF, MAPK, PI3 K-Akt, and Jak-STAT, were screened out. Salvia miltiorrhiza might improve PS hypoxia, inflammation, and balance of proliferation and apoptosis of fibroblasts by regulating HIF-1, TNF, MAPK, PI3 K-Akt, and Jak-STAT signaling pathways. Moreover, it had the characteristics of multiple centers, multiple targets, and multiple pathways.