| Research Background:Radiotherapy is a common treatment for chest malignant tumors such as lungcancer,esophageal cancer,breast cancer and so on.Radiation pneumonia is acommon serious complication after radiotherapy,with an incidence of about 20%,which seriously affects the prognosis and quality of life of patientsThe pathogenesis of radiation pneumonia is not clear in western medicine.Atpresent,the accepted theories include target cell theory,cytokine theory,oxidativestress theory,immune response theory and so on.Alveoli are the main injury site of ionizing radiation.The initial basic lesions are pulmonary hyperemia,edema,pulmonary interstitial thickening and alveolar cavity collapse,which induce the highexpression of a variety of inflammatory factors such as IL-6,TGF-? and TNF-? inthe lung.In the later stage,lung injury was characterized by progressive fibrosis of alveolar septum,and alveolar atrophy gradually appeared and filled with connectivetissue.The most common treatment is corticosteroids,combined with antibiotics toprevent infection,and given oxygen inhalation,asthma,cough and other symptomatictreatment.Although it has achieved certain results,long-term use of hormone therapywill produce a series of adverse reactions,such as double infection,immunosuppression,endocrine disorders and so on.In recent years,many clinical RCT literatures about traditional Chinese medicinein the treatment of radiation pneumonia have shown that traditional Chinese medicinehas its unique advantages in the treatment of radiation pneumonia.The understandingof radiation in traditional Chinese medicine is mostly from the theory of fire,heat andtoxin,the lung leaves are delicate,do not tolerate the invasion of cold,heat,drynessand dampness,and the invasion of heat and toxin is the most likely to damage thefluid of the lung,resulting in the loss of lung yin.Yin deficiency is Yin Jin does notnourish blood,blood viscosity,resulting in blood flow is not smooth,blood stasis,block lung collaterals.Radiation pneumonia belongs to the syndrome of deficiencyand excess,deficiency and excess.Syndrome differentiation is mainly Feizaoyinxu,Xueyutanzu,Redujinkui.The main methods of treatment are Yangyin,Huoxue.Qingrejiedu.Shashenjiegeng decoction is an empirical prescription made by my tutor according to the experience of many years in the treatment of radiation pneumonia.with Yangyin as the main treatment,Huoxuehuayu and Xuanfeiqutan.In a small sample clinical randomized controlled study conducted under the guidance of mentors.radiation lung injury was treated with syndrome differentiation of traditional Chinese medicine.The effective rate of TCM treatment was 72%.There was no significant difference in symptom and image conversion rate between TCM group and hormone group(P<0.05),but the side effect of TCM group was significantly better than that of hormone group.Since then,the results of a small sample syndrome study showed that lung dryness and yin deficiency syndrome accounted for 63.6%of radiation pneumonia,which was the main syndrome type of radiation pneumonia.A small sample clinical trial carried out under the guidance of the tutor confirmed that the treatment of Shashenjiegeng decoction can significantly improve the clinical symptoms such as cough,dyspnea,fever,chest pain and so on,and has a clear effect on the patients with acute radiation lung injury.Previous rat experiments showed that Shashenjiegeng decoction could alleviate endothelial injury and reduce exudation and inflammatory cell infiltration.Early clinical and animal studies confirmed that Shashenjiegeng decoction was effective in the treatment of radiation pneumonia.However,there is a lack of research on the mechanism of its treatment of radiation pneumonia.Research purposes:1.Meta analysis:To analyze the existing randomized controlled studies on the treatment of radiation pneumonia with the method of Yangyin as the main treatment,and to evaluate the effective rate and safety of the method of nourishing yin in the treatment of radiation pneumonia.To evaluate the effect of this method on the quality of life of patients and related inflammatory factors in serum.2.Animal experiment:The rat RP model was successfully established to observe the expression of inflammatory factors in the injured lung tissue and serum of rats in each group.and to explore the mechanism of Shashenjiegeng decoction in the treatment of radiation pneumonia in rats.Compared with the model group and the western medicine control group,the advantages and disadvantages of traditional Chinese medicine treatment were discussed.By observing and comparing the therapeutic effects of the equivalent dose group,the middle dose group and the high dose group,the effects of different dose groups of Shashenjiegeng decoction on the expression of inflammatory factors were discussed.The purpose of this study is to provide preliminary data for further study on the signal pathway of Shashenjiegeng decoction in the treatment of radiation pneumonia.Research content and methods:1.Meta-analysis:For the literature search related to the treatment of radiation pneumonitis by nourishing yin method,the random analysis of the standard-compliant randomized controlled trials was performed using Revman 5.3 software.2.Animal experiment:108 male Sprague-Dawley rats were randomly divided into 6 groups:blank group(K group),model group(M group),western medicine control group(X group),Chinese medicine equivalent dose group(D group),Chinese medicine medium dose.Group(Z group),Chinese medicine high-dose group(G group),18 in each group.Except for the blank group,the other 5 groups underwent full chest irradiation under a linear accelerator with a single dose of 20 Gy.The rats were intragastrically administered from the first day after the irradiation.The high-dose,medium-dose,and equivalent-dose three groups of Chinese medicine were given by the Department of Preparation,Xiyuan Hospital.China Academy of Chinese Medical Sciences.An infusion paste having a high(4 times equivalent dose),medium(2 times equivalent dose),low(equivalent dose)concentration is prepared.The western medicine group used a suspension of dexamethasone acetate tablets dissolved,and 0.9%physiological saline was used in both the model group and the blank group.The rats were randomly divided into 14 days and 28 days.The rats in each group were randomly selected from each time point.The rats in each group were bled by the abdominal aorta and the right middle lobe was taken.The expressions of TNF-? and TGF-? cytokines in the lung tissues of rats in each group were observed,and the changes of cytokines such as TNF-?,TGF-?1 and IL-6 in serum were analyzed by SPSS 21 software.Result:1.Meta-analysisA total of 580 articles were searched,of which 9 were included,all of which were in Chinese,including 1 degree thesis,and the rest were domestic journal papers.A total of 714 patients were included,including the experimental group(n=360)and the control group(n=354.the medical records of 714 patients were analyzed by Revman5.3 software.The results showed that the method of nourishing yin could significantly improve the effective rate of radiation pneumonia,increase the KPS score of patients,reduce the expression level of inflammatory factors in serum,and did not mention the adverse reactions related to traditional Chinese medicine.2.Animal experiment2.1Expression of TNF-?,TGF-?1 and IL-6 in serum of rats.After irradiation,the values of TNF-?,TGF-?1 and IL-6 in serum of rats were significantly higher than those of unirradiated rats,and increased gradually from 14 days to 28 days.It is suggested that these three cytokines are related to the occurrence and development of radiation pneumonia.The expression of these three factors in the serum of the above two observation nodes,except for the traditional Chinese medicine group D of TGF-?1 for 14 days,there were statistical differences between the treatment group and the model group.The results showed that different dose groups of hormone and Shashenjiegeng decoction could inhibit the expression of the above three factors,and the traditional Chinese medicine group Z and traditional Chinese medicine G group were better than the traditional Chinese medicine group D.2.2 The expression of TNF-a in lung tissueThe cumulative optical density of TNF-a expression in the lung tissue of the model group was significantly higher than that of the blank group.The expression of TNF-? in lung tissue of rats in each treatment group was significantly lower than that in the model group,and there was no significant difference between each dose group and the western medicine group,but according to the trend of specific value,group Z and group G were better than group D.2.3 The expression of TGF-? in lung tissueThe cumulative optical density of TGF-? expression in the lung tissue of the model group was significantly higher than that of the blank group.The expression of TGF-(3 in lung tissue of rats in each treatment group was significantly lower than that in the model group,indicating that hormone and Shashenjiegeng decoction could reduce the expression of TGF-? in lung tissue,and there was no significant difference between each dose group of traditional Chinese medicine and the western medicine group.According to the trend of the measured IOD value,the traditional Chinese medicine group Z and traditional Chinese medicine group G were better than the traditional Chinese medicine group D.The expression of TGF-? increased with time.In conclusion:1.Meta-analysis:The Meta analysis of Yangyin method in the treatment of radiation pneumonia showed that the method of nourishing yin in the treatment of radiation pneumonia was effective and safe,and could effectively improve the quality of life of patients and reduce the level of inflammatory factors in serum.It is considered that the method of nourishing yin in the treatment of radiation pneumonia may be related to the reduction of the release of related factors in serum,but it still needs to be further verified.2.Animal experimental study:Animal experimental study shows that hormone and Shashenjiegeng decoction can reduce the level of inflammatory factors associated with radiation pneumonia.In reducing the expression of inflammatory factors,the middle dose and high dose of traditional Chinese medicine are better than the equivalent dose.The results showed that hormone and Shashenjiegeng decoction were effective,and the therapeutic effect of Shashenjiegeng decoction was better than the equivalent dose with the increase of concentration.Combined with the basis of previous research,it can be considered that the mechanism of Shashenjiegeng decoction in the treatment of radiation pneumonia is related to the reduction of the expression of inflammatory factors in serum and lung tissue. |
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