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目的观察清燥救肺汤加黄芪对局部中晚期胸部肿瘤放射治疗的肺保护作用及对肿瘤坏死因子-α(TNF-α)、内皮素(ET)表达水平的影响。方法将局部中晚期胸部肿瘤放射治疗者随机分为治疗组和对照组。治疗组在放射治疗开始起服用清燥救肺汤200 ml,黄芪口服液10 ml,2次/d,连续6个月。放射治疗前后测定血浆TNF-α和ET,放射治疗开始15 d起观测临床症状、高分辨率CT和肺弥散功能。结果治疗组放射治疗前血浆TNF-α为(1.92±0.49)ng/ml,放射治疗后为(2.51±0.73)ng/ml;对照组放射治疗前为(1.90±0.51)ng/ml,放射治疗后为(5.12±1.01)ng/ml,较治疗组明显升高(P<0.001)。治疗组放射治疗前血浆ET为(56.73±18.35)pg/ml,放射治疗后为(68.97±21.76)pg/ml;对照组放射治疗前为(58.93±16.98)pg/ml,放射治疗后为(97.87±37.83)pg/ml,明显升高(P<0.001)。放射治疗开始后5个月和10个月治疗组CO弥散量下降情况较对照组差异有统计学意义(P<0.05)。治疗组和对照组急性放射性肺炎和肺纤维化的发生率比较差异有统计学意义(P<0.05)。结论清燥救肺汤加黄芪能抑制放射治疗后血浆TNF-α、ET的过度表达,降低放射治疗后弥散功能的恶化,可以用于放射性肺损伤的治疗和预防。
Objective To observe the protective effects of Qingpi Yifu Tonga and Radix Astragali on the radiotherapy of locally advanced thoracic tumors and its effect on the expression of tumor necrosis factor-α (TNF-α) and endothelin (ET). Methods Radiotherapy of locally advanced thoracic tumors were randomly divided into treatment group and control group. The treatment group took 200ml of Qingrejianfei Decoction and 10ml of Astragalus Oral Liquid at the beginning of radiotherapy for 2 times a day for 6 months. Plasma TNF-α and ET were measured before and after radiotherapy. Clinical symptoms, high-resolution CT and pulmonary diffuse function were observed 15 days after the start of radiotherapy. Results The plasma levels of TNF-α in the treatment group before radiotherapy were (1.92 ± 0.49) ng / ml and (2.51 ± 0.73) ng / ml after radiotherapy, while those in the control group before radiotherapy were (1.90 ± 0.51) ng / (5.12 ± 1.01) ng / ml, which was significantly higher than that of the treatment group (P <0.001). The ET before treatment in the treatment group was (56.73 ± 18.35) pg / ml and (68.97 ± 21.76) pg / ml after radiotherapy; the control group was (58.93 ± 16.98) pg / ml before radiotherapy and 97.87 ± 37.83) pg / ml, significantly higher (P <0.001). Compared with the control group, the decrease of CO diffusion in the treatment group at 5 and 10 months after the start of radiotherapy was statistically significant (P <0.05). The incidence of acute radiation pneumonitis and pulmonary fibrosis in the treatment group and the control group was significantly different (P <0.05). Conclusion Qingzaojian Tongji Astragalus can inhibit the over-expression of plasma TNF-α and ET after radiotherapy and reduce the deterioration of diffusing function after radiotherapy, which can be used in the treatment and prevention of radiation-induced lung injury.