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目的探讨矽肺患者是否通过肺泡巨噬细胞(alveolar macrophage,AM)表面共刺激分子CD40途径参与矽肺纤维化的发生、发展,以及益气活血汤对矽肺患者纤维化的干预作用。方法采用随机数字表法将46例门诊及住院的矽肺患者分为西药常规治疗组及中药治疗组,每组23例。西药常规治疗组予抗炎、化痰及解痉平喘等常规对症支持治疗,中药治疗组在此基础上加用益气活血汤治疗,每天1剂,疗程为14天。另选18名经纤维支气管镜检及临床诊断肺部均无明显病变的慢性咳嗽、喉部异物感者作为正常对照组,给予对症支持治疗。疗程结束后收集3组肺泡灌洗液,分离并培养AM细胞,采用RT-PCR法检测各组AM表面CD40 mRNA表达水平,免疫印迹法检测其表面CD40蛋白表达水平。结果与正常对照组比较,西药常规治疗组肺泡灌洗液AM表面CD40 mRNA及CD40蛋白表达水平升高(P<0.01);与西药常规治疗组比较,中药治疗组肺泡灌洗液AM表面CD40 mRNA及CD40蛋白表达水平降低(P<0.01)。结论矽肺患者可能通过AM表面共刺激分子CD40的高表达,参与矽性肺纤维化的形成。益气活血汤可阻断其作用,抑制纤维化的进展,从而发挥对矽肺患者的干预治疗作用。
Objective To investigate whether silicosis patients participate in the occurrence and development of silicotic fibrosis through co-stimulatory molecule CD40 pathway of alveolar macrophage (AM), and the intervention of Yiqi Huoxue Decoction on fibrosis in patients with silicosis. Methods 46 cases of outpatients and inpatients with silicosis were randomly divided into routine western medicine group and traditional Chinese medicine group, with 23 cases in each group. Western medicine routine treatment group to anti-inflammatory, phlegm and antispasmodic asthma and other conventional symptomatic and supportive treatment, Chinese medicine treatment group on the basis of the use of Yiqi Huoxue Tang treatment, one day, the course of 14 days. Eighteen patients who had bronchial microscopy and clinically diagnosed chronic cough without significant pathological changes in the lungs were treated with symptomatic and symptomatic treatment of throat foreign body as a normal control group. After the course of treatment, three groups of alveolar lavage fluid were collected, AM cells were isolated and cultured. The expression of CD40 mRNA on AM surface was detected by RT-PCR and the expression of CD40 on the surface was detected by immunoblotting. Results Compared with the normal control group, the expressions of CD40 mRNA and CD40 protein on the surface of alveolar lavage fluid in AMI group were significantly increased (P <0.01). Compared with the conventional western medicine group, the expression of CD40 mRNA And CD40 protein expression decreased (P <0.01). Conclusion The silicosis patients may participate in the formation of silicotic pulmonary fibrosis through the high expression of co-stimulatory molecule CD40 on AM surface. Yiqi Huoxue Decoction can block its function and inhibit the progress of fibrosis, so as to exert the therapeutic effect on patients with silicosis.