三种不同功效中药注射制剂治疗放射性肺炎的实验研究

Experimental Study on Treating Radiation Pneumonitis by Three Kinds of Different Herbal Injections

目的:比较痰热清注射液、丹参注射液及生脉注射液治疗放射性肺炎的疗效,并探讨其机制,同时以方测证,为临床制定规范化的辨证分型及治法方药提供依据。方法:选取益气养阴治法代表中药制剂生脉注射液、活血化瘀治法代表中药制剂丹参注射液以及清热化痰治法代表中药制剂痰热清注射液;同时从50只健康雌性SD大鼠随机抽取10只作为正常组,其余大鼠用6MV-X线直线加速器对大鼠双肺进行单次照射25Gy造模后再随机分为痰热清组、丹参组、生脉组及模型组,每组10只。观察各组大鼠外观、体质量、肺系数、肺纤维化评分及肺组织病理变化,同时观察各组大鼠血清IL-6、TNF-α、TGF-β1的水平变化情况。结果:治疗组(痰热清注射液、丹参及生脉组)大鼠外观体质量无明显差异;生脉组肺系数明显低于丹参液组及痰热清组(P<0.01),痰热清组低于丹参组(P<0.01),同时各治疗组明显低于模型组;肺组织病理染色呈炎性及纤维化改变,与模型组相比,各治疗组较轻(P<0.01),同时生脉组明显优于丹参组及痰热清组,差异具有统计学意义(P<0.01)。ELISA结果显示各造模大鼠血清IL-6、TNF-α、TGF-β1较空白组明显升高(P<0.01),但各治疗组明显优于模型组。在各治疗组中,生脉组IL-6及TGF-β1表达最低,差异具有统计学意义(P<0.01),丹参组中TNF-α表达最低(P<0.01)。结论:3种中药制剂均能有效缓解放射性肺炎,其机制可能与抑制炎症因子的表达有关;同时益气养阴生津法治疗放射性肺炎疗效较显著,以方测证,提示气阴两虚可能是放射性肺炎的主要证型。

Objective： To provide evidence for the establishment of standardized syndrome differentiation and patterns, principles, the prescriptions and the herbs in clinic by comparing clinical effects of TanReQing injection, DanShen injection and ShengMai injection in treating radiation pneumonitis, exploring the mechanism and testing the patterns with the prescriptions. Methods： TanReQing injection, DanShen injection and ShengMai injection were cho- sen as the represents; meanwhile ten rats were picked as the normal group, other rats were radiated by 6MV-X linear accelerator to establish the models, randomized into TanReQing group, DanShen group, ShengMai group and the model group, ten rats each group. The changes of IL-6, TNF-α and TGF-β1 in the serum were observed, pathological changes of lung tissue, the appearance, body weight, lung indexes and the scales of pulmonary fibrosis were ex- plored. Results： There was insignificant difference in the appearance and body weight of the rats among the treat- ment groups （TanReQing group, DanShen group and ShengMai group）; pulmonary index of ShengMai group was lower than that of DanShen group and TanReQing group（P〈0.01）, TanReQing group was lower than DanShen group （P〈0.01）, meanwhile all the treatment groups were lower than model group obviously; pathological staining of the lung showed inflammatory and fibrotic changes, compared with the model group, the symptoms of the treatment groups were relieved （P〈0.01）, at the same time, ShengMai group was superior to DanShen group and TanReQing group, the difference had statistical meaning （P〈0.01）. ELISA results showed that the levels of IL-6, TNF-α and TGF-β1 in the serum were higher than those of blank group （P〈0.01）, but the treatment groups were superior to the model group significantly. Among all the treatment groups, the levels of IL-6 and TGF-β in ShengMai group were lower, the difference had statistical meaning （P〈0.01）, the level of TNF-α was the lowest in DanShen group （P〈0.01）. Conclusion： All three kinds of herbal preparations could effectively relieve radiation pneumonitis, the mechanism might be related to inhibiting the expressions of inflammatory factors; at the same time, Qi-invigorating Yin-nourish- ing liquid-engendering method is effective in treating radiation pneumonitis, which demonstrates that dual deficiency of Qi and Yin might be the main pattern of radiation pneumonitis by testing the patterns with the prescriptions.