西黄胶囊防治急性放射性口腔黏膜炎的疗效及相关机制

The protection of Xihuang Capsules against acute radiation-induced oral mucositis and its mechanisms

目的探讨西黄胶囊(人工牛黄、人工麝香、乳香、没药)对急性放射性口腔黏膜炎的防治作用及相关机制。方法将80例接受根治性放疗的鼻咽癌患者随机分为2组,给药组(照射+西黄胶囊)和对照组(单纯照射)。依据急性放射性黏膜损伤分级标准比较2组开始出现黏膜炎的时间和耐受剂量。并用ELISA法检测唾液炎性因子TNF-α和IL-6水平。结果与单纯照射组比较,给药组出现黏膜炎时间明显偏晚,放疗耐受剂量显著偏高(t=2.180、12.930,P<0.05);DT=40、70 Gy时,给药组Ⅲ、Ⅳ度口腔黏膜炎发生率均低于单纯照射组(Z=3.661、4.270,P<0.01);放疗前(DT=0 Gy),2组炎性因子TNF-α和IL-6质量浓度无差别(t=1.010、1.469,P>0.05);炎性因子水平随着放疗剂量的增加而升高,DT=40 Gy时达峰值,但给药组TNF-α和IL-6质量浓度均显著低于单纯照射组(t=8.305、6.069,P<0.05);DT=70 Gy时,炎性因子均降至低于治疗前水平且给药组明显低于单纯照射组(t=3.835、2.488,P<0.05)。结论西黄胶囊能够延缓并减轻急性放射性口腔黏膜炎,提高放疗耐受剂量,可能与抑制炎性介质TNF-α和IL-6的释放有关。

AIM To explore the radioprotective function of Xihuang Capsules（Bovis Calculus artifactus,Moschus,Olibanum,Myrrha） in patients with acute radiation-induced oral mucositis and its mechanisms.METHODS Eighty patients with nasopharyngeal carcinoma undergone radiotherapy were randomized into two groups：treatment group（radiation plus Xihuang Capsules） and control group（radiation alone）.The comparison of two groups in the onset and the tolerated dose of mucositis was made according to the acute radiation injury classification standard.The levels of TNF-α and IL-6 in saliva were detected by ELISA.RESULTS After the treatment with Xihuang Capsules,the onset of oral mucositis delayed significantly and the tolerated dose elevated markedly comparing with the control group（t=2.180,12.930,P〈0.05）.The morbidity rate of Ⅲ-Ⅳ-degree of oral mucositis in the treatment group was lower than that of the control group at the dosage of 40 Gy and 70 Gy,respectively（Z=3.661,4.270,P〈0.01）.Furthermore,there was no difference in the levels of TNF-α and IL-6 in the pre-treatment in the two groups（t=1.010,1.469,P〉0.05）.With the increase in radiant dose,the levels of TNF-α and IL-6 in the two groups both elevated dramatically,and peaked at the dose of 40 Gy,but both levels in the treatment group were lower than those of the control group（t=8.305,6.069,P〈0.05）.When DT=70 Gy,the levels of TNF-α and IL-6 were lower than pre-radiation,and the levels of TNF-α and IL-6 in the treatment group were lower than those in the radiation alone group（t=3.835,2.488,P〈0.05）.CONCLUSION Xihuang Capsules can delay and reduce acute radiation-induced oral mucositis and improve radiation tolerated dose,so it may involve the release of TNF-α and IL-6 in saliva.