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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(χ2=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 effect of Qingfei Bawei Decoction on the levels of TGF-β1 and TNF-α in serum of patients with chest tumor before radiotherapy and 45 ~ 50 Gy of radiotherapy To prevent the occurrence of radiation pneumonitis, and to explore its mechanism of action. Methods: Sixty-two patients with thoracic malignant tumor who underwent first-line radiotherapy in our hospital from March 2013 to May 2014 were randomly divided into treatment group and control group, with 31 cases in each group. Treatment group began radiotherapy to the end of 1 month of radiotherapy Qingfei Bawei Tang. Serum levels of TGF-β1 and TNF-α were measured by ELISA before radiotherapy and at 45-50 Gy. Patients were assessed and recorded during radiotherapy and within 3 months after radiotherapy based on clinical symptoms and imaging findings The case of radiation pneumonitis. Radiological pneumonitis was graded using RTOG classification criteria of acute radiation lung injury, and the end point was ≥2 grade of radiation pneumonitis. Results: 61 patients completed treatment, 30 cases in the treatment group and 31 cases in the control group. There was no significant difference in baseline data. The total incidence of radiation pneumonitis in the treatment group and control group were 43.3% and 48.3% respectively, with no significant difference (P> 0.05). However, the incidence of grade 3 pneumonia in the treatment group (3/30) 31). There was a significant difference between the two groups (χ2 = 4.219, P <0.05). The values of TGF-β1 and TNF-α before treatment in the treatment group were (164.20 ± 16.93) pg / m L and (139.72 ± 30.95) pg / m L respectively, and were 188.14 ± 13.46 pg / (153.86 ± 27.33) pg / m L, respectively. The control group before treatment was (168.36 ± 14.53) pg / m L and 146.17 ± 25.48 g / m L 231.63 ± 16.11) pg / m L, (164.74 ± 31.50) pg / m L, respectively. There was significant difference of TGF-β1 content between the two groups when radiotherapy was performed at 45-50 Gy (t = -11.419, P <0.01). There was no significant difference in TNF-α content between the two groups (P> 0.05). Conclusion: Qingfei Bawei Decoction can downregulate the level of serum TGF-β1 in patients with thoracic tumor radiotherapy and can effectively reduce the incidence of severe radiation pneumonitis above grade 3.