养阴清热化瘀汤联合胸部肿瘤放疗对急性放射性肺炎的临床疗效

Clinical Effect of Yangyin Qingre Huayu Decoction Combined with Thoracic Radiotherapy on Acute Radiation Pneumonia

目的：观察养阴清热化瘀汤联合胸部肿瘤放疗对急性放射性肺炎的临床疗效及炎症细胞因子水平影响,并探讨其作用机制。方法：2013年7月—2015年7月间放化疗住院的胸部放疗患者132例,采用随机数字表法分为养阴清热化瘀汤治疗组（65例）和对照组（67例）,治疗组在放疗或同步放化疗基础上给予养阴清热化瘀汤,每日1剂,从放疗开始,连用3月。对照组采用单纯放疗或同步放化疗。于放疗开始前及放疗40~50 Gy后取空腹静脉血3 m L,测定血浆中白细胞介素-6（IL-6）,肿瘤坏死因子-α（TNF-α）,转化生长因子-β（TGF-β）含量,采用美国肿瘤放射治疗协作组织（RTOG）急性放射性肺损伤（RP）标准评价急性放射性肺炎发生率及发生时间,采用SF-36量表及中医临床症状评分表评价患者生活质量及临床症状。结果：治疗组急性RP发生率为15.38%,对照组为29.85%,治疗组和对照组RP出现中位时间分别为81 d和57 d,治疗组出现RP的时间明显晚于对照组（P〈0.05）。IL-6,TNF-α,TGF-β含量治疗组放疗后不同程度下降（P〈0.05）。放疗后治疗组躯体角色、心理健康、机体疼痛量表评分明显提高,中医临床症状评分明显降低,治疗组评分变化明显优于对照组（P〈0.05）。结论：养阴清热化瘀汤可降低放射性肺炎的发生率,推迟放射性肺炎的发生时间,提高患者的生活质量,提高患者对放疗的依从性。

Objective： To study the clinical curative effect of Yangyin Qingre Huayu decoction combined with thoracic radiotherapy on acute radioactive pneumonia（RP）, and its effect on the levels of inflammatory cytokines. Method： The 132 cases of hospitalized patients treated with chemotherapy and radiotherapy from July 2013 to July 2015 were randomly divided into Yangyin Qingre Huayu decoction treatment group（65 cases） and control group（67 cases）. Treatment group was given Yangyin Qingre Huayu decoction in addition to concurrent radiotherapy and chemotherapy,one dose a daily,for three months since the start of radiotherapy. Control group was provided with pure chemotherapy or concurrent radiotherapy. Before the beginning of radiotherapy and after 40-50 Gy for radiotherapy,3 m L fasting venous blood was collected to determined plasma interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α） and transforming growth factor-β（TGF-β）. The Radiation Therapy Oncology Group（RTOG） ＇s acute RP evaluation criteria was adopted to evaluate the acute radiationinduced pneumonia incidence and time of occurrence. And the SF-36 scale and traditional Chinese medicine（TCM） clinical symptom score table（self-prepared） were applied in evaluation of the quality of life of the patients and their clinical symptoms. Result： The incidence of acute RP in treatment group was 15. 38%,and control group was 29. 85%. The median times for RP appearance in treatment group and control group were the 57 thday and the 81 stday,respectively,indicating that treatment group showed a much later median time for RP appearance than control group（P〈 0. 05）. Before the treatment,treatment group and control group showed no statistical difference in IL-6,TNF-α,TGF-β content. After the radiotherapy,in treatment group showed decreases in content to varying degrees,which was significantly superior to control group（P 〈0. 05）. After the radiotherapy,the treatment group showed significant increases in physical role,mental health,body pain,and decrease in TCM clinical symptom score,which was much superior to control group（P〈 0. 05）. Conclusion： Yangyin Qingre Huayu decoction can reduce the incidence of radiation pneumonitis,delay the time of occurrence of radiation pneumonitis,and improve patients＇ quality of life and their compliance to radiotherapy.