清肺八味汤防治放射性肺炎及对血清TGF-β1、TNF-α影响的观察

Qingfei Bawei Decoction Preventing Radiation Pneumonitis and Its Influence on TGF-β1 and TNF-α

目的：观察清肺八味汤对胸部肿瘤患者放疗前、放疗至45～50 Gy时血清中转化生长因子-β1（TGF-β1）、肿瘤坏死因子-α（TNF-α）水平的影响及其对预防放射性肺炎发生的效果,并探讨其作用机制。方法：收集2013年3月—2014年5月在医院行首程放射治疗的胸部恶性肿瘤患者62例,随机分为治疗组和对照组,每组各31例。治疗组放疗开始至放疗结束1个月服用清肺八味汤。放疗前、放疗至45～50 Gy时分别采用ELISA法检测血清中TGF-β1,TNF-α含量;根据患者临床症状及影像学检查结果,于放疗期间及放疗后3个月内评估并记录患者发生放射性肺炎的情况。采用RTOG急性放射性肺损伤分级标准对放射性肺炎进行分级评价,评价终点为≥2级放射性肺炎。结果：61例患者完成治疗,治疗组30例,对照组31例,基线资料比较无明显差异。治疗组和对照组放射性肺炎的总发生率分别为43.3%、48.3%,差异无统计学意义（P〉0.05）;但3级肺炎发生率治疗组（3/30）较对照组低（10/31）,两组比较有统计学差异（χ^2=4.219,P〈0.05）。治疗组放疗前TGF-β1、TNF-α的值分别为（164.20±16.93）pg/m L、（139.72±30.95）pg/m L,放疗至45～50 Gy时分别为（188.14±13.46）pg/m L、（153.86±27.33）pg/m L;对照组放疗前分别为（168.36±14.53）pg/m L、（146.17±25.48）g/m L,放疗至45～50 Gy时分别为（231.63±16.11）pg/m L、（164.74±31.50）pg/m L,。放疗至45～50 Gy时两组TGF-β1含量比较差异有统计学意义（t=-11.419,P〈0.01）,TNF-α含量比较差异无统计学意义（P〉0.05）。结论：清肺八味汤可下调胸部肿瘤放疗患者血清细胞因子TGF-β1的升高水平,能有效降低3级以上重度放射性肺炎的发生。

Objective： To observe the influence of Qingfei Bawei Decoction on changes of serum transforming growth factor-β1（ TGF-β1） and tumor necrosis factor-α（ TNF-α） before radiotherapy and radiotherapy of 45 ～ 50 Gy and evaluate the efficacy of Qingfei Bawei Decoction in prevention of radiation pneumonitis（ RP） and explore its mechanism in thoracic cancer patients. Methods： From March 2013 to May 2013,sixty-two thoracic cancer patients treated with radiotherapy for the first time were randomly assigned into two groups： 31 cases in the treatment group were treated with radiotherapy and Qingfei Bawei Decoction and 31 cases in control group treated with radiotherapy and placebo. The serum TGF-β1 and TNF-α levels were measured by ELISA（ enzyme linked immune sorbent assay） before or after radiotherapy of 45 ～ 50 Gy. According to clinical symptoms and imaging results,regular evaluation and records of clinical symptoms in patients with radiation pneumonitis were performed during the period of radiotherapy and within 3 months after radiotherapy. According to RTOG acute radiation-induced lung injury grading standards,the extent of RP was evaluated. The endpoint of the study was the development grade≥2 RP. Results： The two groups had no significant differences in baseline data（ P〉0. 05）. The total incidences of RP of the treatment group and the control group were 43. 3% and 48. 3% re-spectively. The differences were not statistically significant（ P〉0. 05）. The rates of acute radiation pneumonia at grade3 in the observation group（ 3 /30） was significantly lower than that in the control group（ 10 /31）（ χ^2= 4. 219,P〈0. 05）.Before radiotherapy,the serum levels of TGF-β1 and TNF-α in the treatment group were respectively（ 164. 20 ±16. 93） pg / m L and（ 139. 72 ± 30. 95） pg / m L and after radiation of 45 ～ 50 Gy those were respectively（ 188. 14 ± 13. 46）pg / m L and（ 153. 86 ± 27. 33） pg / m L while those in the control group were（ 168. 36 ± 14. 53） pg / m L and（ 146. 17 ±25. 48） g / m L before radiotherapy and after radiation of 45 ～ 50 Gy were respectively（ 231. 63 ± 16. 11） pg / m L and（ 164. 74 ± 31. 50） pg/m L. The serum TGF-β1 was statistically significant between the two groups after radiation of 45～ 50 Gy（ P〈0. 01）. Conclusion： With the use of Qingfei Bawei Decoction,the serum levels of TGF-β1 could be down-regulated,meanwhile,the incidence of radiation pneumonitis at grade 3 could be reduced effectively in thoracic cancer patients undergoing radiotherapy.