中肺合剂对肺癌放疗所致细胞因子的影响及防治放射性肺炎的初步观察

Zhongfei Decoction improves lung function and delays occurrence of radiation-induced pneumonia in lung cancer patients undergoing radiotherapy

目的观察中肺合剂对肺癌患者放疗前及40Gy时血浆肿瘤坏死因子-a（tumornecrosisfactora，TNF—a）和血管紧张素转换酶（angiotensinconvertingenzyme，ACE）含量的影响和防治放射性肺炎的疗效，并探讨其作用机制。方法将83例患者随机分为两组，观察组42例三维适形或调强放射治疗同时口服中肺合剂，对照组41例仅三维适形或调强放射治疗。放疗前及放疗40Gy时分别采血冻存，采用酶联免疫吸附法检测血浆中TNF—a及ACE含量和检查肺功能，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及肺功能变化情况。结果观察组和对照组出现肺炎中位时间分别为80d和51d，放疗40Gy时两组肺的通气功能较放疗前有不同程度的改善，但观察组改善明显，差异有统计学意义（P〈005）；观察组放疗前及40Gy时TNF-oc和ACE分别为（127．56±38．48）pg／ml和（110．58±41．90）pg／ml，（28．43土730）pg／ml和（30．43±9．90）pg／ml：对照组为（124．93±27．24）pg／ml和（144．22±3428）pg／ml，（26．12±8．85）pg／ml和（19．63±7．53）pg／ml。放疗40Gy时两组比较差异均有统计学意义（P〈0．05）。结论中肺合剂能下调血浆中TNF—OC的表达，提高血浆中ACE值，有效推迟放射性肺炎的发生并改善患者的肺功能。

Objective To investigate the effects of Zhongfei Decoction in prevention of radiation-induced pulmonary injure in lung cancer patients undergoing radiotherapy. Methods Eighty-three patients with lung cancers were randomly assigned into two groups： 42 cases in the Zhongfei group were treated with three-dimensional conformal radiotherapy （3DCRT） or Intensi- ty-modulated radiotherapy （IMRT） and Zhongfei Decoction; 41 cases in control group were treated with 3DCRTor IMRT alone. The plasma TNF- a and angiotensin converting enzyme （ACE） levels were measured by ELISA and the pulmonary functions were examined before and after radiotherapy with dose of 40 - 50Gy. According to the protocol proposed by Radiation Therapy On- cology Group （RTOG） the extent of radiation-induced pneumonia and the time of occurrence were evaluated. Results The average occurrence time of radiation pneumonia in Zhongfei group was 80 d and that in control group was 51d （P〈0.05）. The plasma TNF- a and ACE levels in Zhongfei group before and after radiation of 40 - 50Gy were （127.56 ＋ 38.48）pg/ml and （110.58 ±41.90） pg/ml, （28.43 ±7.30） pg/ml and（30.43 ±9.90） pg/ml, respectively; while those in control group were （124.93 ±27.24） pg/ml and （144.22 ± 34.28）pg/ml, （26.12 ± 8.85）pg/ml and （19.63± 7.53）pg/ml, respectively; there were statistically significant differences in plasma TNF-a and ACE levels after radiation between two groups （P〈0.05）. Conclusion Zhongfei Decoction is effective in delaying the development of acute radiation pneumonia and improving pulmonary function of lung cancer patients receiving radiotherapy, which is associated with the down-regulation of TNF- a and up-regulation of ACE in plasma.