| Objective:This paper from zhongjing theory, the first part is theoretical research from zhongjing theory, the theory of traditional Chinese medicine combined with ancient historical documents to find out syndrome type radiation-induced lung injury in line; the second part of observation and clear stasis BNI complex the efficacy of radiation-induced lung injury prevention therapies; third part of radiation dose volume histograms DVH parameters V20 explore Chinese medicine with radiotherapy radioactive lung injury correlated to provide a basis for optimizing radiation-induced lung injury in clinical treatment programs; and finally the animals experiments to observe the effects of the treatment method of factor TGF-β Smad pathway expression in lung tissue radioactivity associated lung injury in rat cells and/signals, initially revealed the mechanisms of radiation-induced lung injury interventions for the treatment of pulmonary fibrosis TCM intervention next working science foundation.Methods:Shuyang Hospital of 2013-2015 were collected in the first line of chest tumor dimensional conformal radiotherapy hospitalization or outpatient. According to clinical trials, sample size calculation formula to calculate the total of 40 patients required treatment prevention and signed informed consent law by BNI Jieduhuayu medicine. According to a random number table using randomized into the treatment group and the control group of the 20 patients in the control group were given glucocorticoid dexamethasone tablets, treatment group BNI Jieduhuayu law for the law, giving the water decoction decoction. Two in the beginning to the end of radiotherapy radiotherapy administered, were observed in six weeks time period. During the observation of cases given the appropriate symptomatic treatment of patients depending on the situation, taking drugs during treatment duration consistent. General information combined with patient, the duration of hematology, molecular biology, pulmonary function tests, observation and other indicators of quality of life scores were observed in patients with radiation-induced lung injury occurs group number of cases, grading severity, using statistical analysis, results Related efficacy conclusions. While collecting 40 cases in 2014-2015 Shuyang Hospital of chest tumor line three-dimensional conformal radiotherapy, radiation dose and lung patients V20 again. Without preventive interventions, again through a combination of clinical factors, biological factors and dose factors, the outcome can be predicted radiation-induced lung injury. Determination daughter Weijing decoction combined radiation-induced lung injury in animal experiments by observing Zhigancao soup lung tissue expression of cytokines and lung coefficient pathological change and to explore whether by TGF-β/Smad signal transduction mechanisms work.Results:A total of 38 patients with clinical observation, the occurrence of more than one of 11 cases of lung injury (incidence rate 28.9%), including three cases of the treatment group (15.7%) in the control group 8 cases (42.1%), the statistical analysis of Qi After detoxification treatment of blood stasis group observation period overall incidence of radiation pneumonitis was significantly lower than the dexamethasone group (P<0.05).Qi and blood stasis method Treatment group before treatment and after treatment of cases of lung and pulmonary diffusion total self-control all P<0.05, there is a significant difference; the control group of patients before treatment and after treatment, total lung capacity and lung diffusing capacity of self-control were P> 0.05, no significant difference; total two lung function and diffusion contrast, the treatment group and the total amount of lung diffusion capacity increase compared with the control group, but P> 0.05, no significant difference.Qi and blood stasis method stasis Treatment group observation period and stable situation in the end improve the quality of life post-dexamethasone is superior to the control group, decreased quality of life scores than the control group, the statistical test, Qi Yang Blood Therapy Group Jieduhuayu integral aspects of quality of life have higher efficiency dexamethasone group, the difference was significant (P<0.05).TGF-β1 levels of the treatment group and the control group compared to three weeks and six weeks of radiotherapy after thoracic radiotherapy in patients treated TGF-β1 levels were significantly lower than the control group(P<0.01).Pathological type and V20 may be relevant factors radiation-induced lung injury, especially lung cancer radiotherapy and V20≥20% higher than when patients are more prone to a radiation-induced lung injury.The impact of radiation treatment group index pulmonary fibrosis and lung tissue morphology: ①General:rat fur color normal control group, agile, responsive, appetite normal; model rats fur dark, sparse, Part shed serious, slow, unresponsive, decreased appetite, slow weight gain. In the first 14 days of the death of rats began to experiment ended when the first 28 days a total of four deaths. Chinese medicine, Western medicine rats after radiation reaction, ability to act gradually recover, slowly increasing food intake, body weight along with growth, including treatment group at day 21 dead rats began to day 28 were killed 2; western medicine In the first 16 days of the beginning of the group have died rats were killed 28 days to three. ②lung coefficient: Compared with the control group, model group on 14d,28d lung coefficient increased significantly (P<0.01); compared with the model group, BNI Jieduhuayu law and prednisone group of rats 14d,28d lung index were significantly lower in varying degrees (P<0.01); prednisone compared with the control group, treatment group on 14d,28d lung coefficient decreased significantly compared (P<0.05). ③pathological:Compared with the other groups, model group and HE and MASSON staining were observed in rats administered medicine destroy lung tissue alveolar structure with varying degrees and with varying degrees of inflammatory cell infiltration and collagen fibers; With the extended delivery period, compared with the model group, western medicine treatment group alveolar inflammation and pulmonary fibrosis in varying degrees of ease; (P<0.05) in which the BNI Jieduhuayu treatment group 14d, 28d degree of improvement in alveolar inflammation and fibrosis in the control group was significantly better than the same period of prednisone. (P<0.01) ④ TGF-β1 Smad study/ pathway:Compared with the control group, the lung tissue of rats in the model group TGF-β1mRNA, Smad3mRNA expression levels were significantly increased, and the difference was statistically significant (P<0.01); Smad7, Smad7mRNA decreased expression (P<0.01); Compared with the model group, chinese medicine and metacortandracin treatment group TGFβ1mRNA, Smad3mRNA there are different degrees of decline (P<0.05); Smad7, Smad7mRNA increased expression of P<0.05; compared with the comparison group, treatment group lung TGF-β1mRNA, expression Smad3mRNA decrease (P<0.01), Smad7mRNA increased (P<0.05).Conclusion: ①BNI stasis complex therapies for breast cancer patients with radiation-induced lung injury has a preventive effect. Its prevention and treatment of mainly the following aspects: the Medicines can reduce the incidence of breast cancer patients radiation pneumonitis; lower levels of TGF-β1; improve lung function; improving the quality of life. ②pathological type and V20 may be relevant factors in radiation-induced lung injury, especially lung cancer radiotherapy and V20> patients are more prone to a radiation-induced lung injury is higher than 20%. We should pay more attention to these patients, prevention work ahead. ③radioactive successfully prepared rat model of pulmonary fibrosis; Qi and blood stasis complex therapies can better control the growth of rats with lung index, inhibit early alveolitis and pulmonary fibrosis late. ④Qi and blood stasis complex therapies can effectively inhibit expression of TGF-β1 Smad signaling pathway of TGF-β1, Smad3 and other factors, while increasing the signaling pathway plays a role in the inhibition of radiation-induced lung injury of Smad7 mRNA expression, confirming the BNI Jieduhuayu therapies can play a better role in the anti-radiation-induced lung injury with TGF-β1/Smad signaling pathway are closely related. |
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