参芪扶正注射液对胸部肿瘤放疗患者血浆细胞因子网络调控作用

Study on the Controlling Effect of Shenqi Fuzheng Injection on Plasma Cytokine Network in Patients with Thoracic Tumor Undergoing Radiotherapy

目的评价参芪扶正注射液(简称参芪液)对胸部肿瘤放疗患者放疗前、照射40～50Gy(放疗中)及放疗结束时血浆肿瘤坏死因子(TNF-α)、白细胞介素-10(IL-10)及转化生长因子-β(TGF-β)含量变化的影响及在放射性肺炎防治中的作用。方法58例入选患者随机分为2组,对照组按治疗常规给予放疗;治疗组在此基础上加用参芪扶正注射液250 mL静脉滴注,每天1次,放疗前3天开始,至放疗结束后1周。于放疗前、放疗中及放疗结束时分别采血冻存,采用酶联免疫吸附法统一检测血浆中TNF-α、IL-10及TGF-β水平。并按RTOG急性放射性肺炎标准观察放射性肺炎发生情况。结果放疗前两组TGF-β、TNF-α、IL- 10水平及IL-10/TNF-α比值比较,差异无统计学意义(P>0.05)。放疗中两组血浆TGF-β水平均较放疗前升高,血浆IL-10水平逐渐下降,但差异无统计学意义(P>0.05);血浆TNF-α水平均较放疗前亦升高,对照组升高达高峰,差异有统计学意义(P<0.01),与治疗组同期比较,差异亦有统计学意义(P<0.05,P<0.01)。放疗结束时对照组血浆TGF-β水平达高峰,差异有统计学意义(P-0.01),而治疗组差异无统计学意义(P>0.05);血浆IL-10水平明显降低,与放疗前比较,差异有统计学意义(P<0.05,P<0.01)。放疗中、后,两组IL-10/TNF-α比值逐渐下降,对照组与放疗前比较,差异有统计学意义(P<0.05),而治疗组IL-10/TNF-α比值明显高于对照组,两组比较差异有显著统计学意义(P<0.05)。对照组急性放射性肺炎发生率明显高于治疗组,差异有统计学意义(x^2=8.7133,P<0.01)。结论血浆TNF-α及IL-10/TNF-α比值有望作为检测急性放射性肺炎易感性的指标。参芪扶正注射液可调控细胞因子网络,有效防治放射性肺炎。

Objective To investigate the effect of Shenqi Fuzheng Injection （SFI） in radiation pneumonitis and its influence on the levels of plasma transforming growth factor beta （TGF-β）, tumor necrosis factor-α（TNF-α） and interleukin-10 （IL-10） at various stages （pre-, mid- and post-radiation） of radiotherapy （RT）. Methods Fifty-eight patients enrolled in this study were randomized into two groups, all received conventional radio therapy, but the treatment group was intravenously dripped with SFI additionally, once daily, starting 3 days before radiotherapy to 1 week after the end of it. Levels of TGF-β, TNF-α and IL-10 in blood samples collected and frozen at different time point of RT, before radiotherapy （Pre-RT）, after received 40-50 Gy radiation （Mid-RT） and in time of terminating RT （Post-RT）, were measured with enzyme linked immunosorbent assay （ELISA）. And the occurrence of radiation pneumonitis was analyzed according to RTOG acute radiation pneumonitis criteria. Results Level of TGF-13 increased in both groups after RT, either Mid- or Post-RT, but in comparing with that at Pre-RT, statistical significant （P 〈 0.05） only showed in the control group at Post-RT time when it raised to peak, while in inter-group comparing insignificance was shown. Level of TNF-α also increased in both groups, but statistical significance only showed in the control groups as compared with that of Pre-RT, accordingly, it was lower in the treatment group than that in the control group at corresponding time points （P〈0.05）. Level of IL-10 decreased gradually in the process of RT, as compared with that at Pre-RT, significant difference was shown in both groups at Post-RT but not at Mid-RT, as compared between groups, no significance （P〈0.05） was shown, though the treatment group showed a high tendency. As for the ratio of IL-10/TNF-α, significant difference of lowering in the control group after RT was shown as compared with that at Pre-RT （P 〈 0.05）, and also as compared with that in the treatment group at corresponding time point （P 〈 0.05）. The occurrence of radiation pneumonia ≥ grade 2 in the treatment group was significantly lower than that in the control group （χ^2 = 8.7133, P 〈 0.01）. Conclusion Plasma level of TNF-α and ratio of IL-10/ TNF-α could be the practicable indexes for estimating the susceptibility of acute radiation pneumonia; SFI can regulate the network of cytokine, and thus be effective in preventing and treating radiation pneumonitis.