中肺合剂对血浆TGF-β和IL-6影响及防治放射性肺炎的临床观察

Clinical study of ZhongFei Decoction Influence on Changes of TGF-β和IL-6 and the Preventive Effects of on Radiation-induced Pneumonia

目的:观察中肺合剂对肺癌患者放疗中血浆转化生长因子-β(TGF-β)和白介素-6(IL-6)含量的影响及防治放射性肺炎的临床疗效。方法:将2009年12月-2011年6月入组的83例肺癌患者随机分为两组,观察组42例给予三维适形或调强放射治疗同时口服中肺合剂,对照组41例三维适形或调强放射治疗。放疗前及放疗40～50Gy时分别采血冻存,采用酶联免疫吸附法检测血浆中TGF-β和IL-6含量。根据RTOG放射性肺损伤标准进行评价,观察两组放射性肺炎出现时间、发生率及纤维化情况。结果:观察组放射性肺炎发生率21.42%(9/42),对照组26.82%(11/41),出现放射性肺炎中位时间分别为80天和51天;其中观察组3、4级肺炎发生率为4.76%(2/42),对照组21.95%(9/41)(P<0.05),两组放射性肺炎发生率比较无显著性差异(P>0.05)。但观察组的3、4级放射性肺炎的发生率低于对照组,出现肺炎的中位时间明显延长,统计学均有显著性差异(P<0.05);观察组放射性肺纤维化发生率为7.14%(3/42),对照组为24.39%(10/41),两组统计学有显著性差异(P<0.05)。观察组放疗前后TGF-β和IL-6分别为(5266.56±895.34)pg/mL和(4622.07±1275.90)pg/mL,(68.32±19.35)pg/mL和(57.44±25.03)pg/mL;对照组(5071.46±716.98)pg/mL和(5659.52±769.11)pg/mL,(64.89±11.76)pg/mL和(77.43±18.86)pg/mL。放疗后两组差异均有统计学意义(P<0.05)。结论:中肺合剂能下调血浆中TGF-β和IL-6表达,降低3、4级放射性肺炎的发生率、减轻放射性肺炎的严重度,可有效防治放射性肺损伤。

Objective：To observe the the relationship between Zhong Fei Decoction and the changes of plasma transform growth factor-beta（TGF-beta） and interleukin-6 and to evaluate the therapeutic eff icacy of Zhong Fei Decoction in prevention of radiation-induced pulmonary injure.Methods：From December 2009 to June 2011,Eighty-three cases of lung cancers were randomized into two groups： 42cases in the observation group were treated with Zhong Fei Decoction combined with 3DCRTor IMRT radiotherapy.Other 41 cases of the control group were only treated with 3DCRTor IMRT radiotherapy.Blood specimens were taken from veins before radiation and after 40～50Gy,for determination of the levels of TGF-βand IL-6 in plasma by ELISA.The extent of pneumonia and the time of occurrence were Observed,the degree of radiation-induced pneumonia was evaluated according to the protocol proposed by RTOG.Results：The incidence rate of acute radiation pneumonitis was 21.42 %（9/42） in the observation group and 26.82%（11/41） in the control group,its incidence was no significant difference（P〈0.05）.Grades 3 and 4 acute radiation pneumonitis was occurred in 4.76 %（2/42） of the patients in the observation group and 21.95%（9/41） in the control group,the rates of acute radiation pneumonia at grade 3 or 4 in the observation group was significantly lower than that in the control group（P〈0.05）,and the average occur time of radiation pneumonia in observation group was 80 days and the control group was 51days,The observation group was significantly later than that in the control group and the difference was significant（P〈0.05）.The incidence rate of radiation fibrosis was 7.14 %（3/42） in the observation group and 24.39 %（10/41）） in the control group（P〈0.05）,TGF-βand IL-6 levels of the observation group in pre and post-radiation 40～50Gy were（5266.56±895.34）pg/mL and（4622.07±1275.90） pg/mL,（68.32±19.35） pg/mL and（57.44±25.03）pg/mL;while in the control group（5071.46±716.98）pg/mL and（5659.52±769.11）pg/mL,（64.89±11.76）pg/mL and（77.43±18.86）pg/mL;there were statistically significant differences in the post-radiation between the two groups（P〈0.05）.Conclusion：Zhong Fei Decoction can down-regulate TGF-βand IL-6 expression.It is effective in postponeing the development of acute radiation pneumonitis and preventing the occurrence of Grade s 3～4 acute radiation pneumonitis.