参芪扶正注射液对胸部肿瘤放疗患者血浆细胞因子网络调控作用

目的 评价参芪扶正注射液（简称参芪液）对胸部肿瘤放疗患者放疗前、照射40～50Gy（放疗中）及放疗结束时血浆肿瘤坏死因子（TNF-α）、白细胞介素-10（IL-10）及转化生长因子-β（TGF-β）含量变化的影响及在放射性肺炎防治中的作用。方法58例入选患者随机分为2组，对照组按治疗常规给予放疗；治疗组在此基础上加用参芪扶正注射液250mL静脉滴注，每天1次，放疗前3天开始，至放疗结束后1周。于放疗前、放疗中及放疗结束时分别采血冻存，采用酶联免疫吸附法统一检测血浆中TNF-α、IL-10及TGF-G水平。并按RToG急性放射性肺炎标准观察放射性肺炎发生情况。结果放疗前两组TGF-B、TNF-α、IL-10水平及IL-10／TNF-α比值比较，差异无统计学意义（P〉0．05）。放疗中两组血浆TGF-β水平均较放疗前升高，血浆IL-10水平逐渐下降，但差异无统计学意义（P〉0。05）；血浆TNF-α水平均较放疗前亦升高，对照组升高达高峰，差异有统计学意义（P〈0，01），与治疗组同期比较，差异亦有统计学意义（P〈0．05，P〈0．01）。放疗结束时对照组血浆TGF-β水平达高峰，差异有统计学意义（P〈0．01），而治疗组差异无统计学意义（P〉0，05）；血浆IL-10水平明显降低，与放疗前比较，差异有统计学意义（P〈0．05，P〈0。01）。放疗中、后，两组IL-10／TNF-α比值逐渐下降，对照组与放疗前比较，差异有统计学意义（P〈0．05），而治疗组IL-10／TNF-α比值明显高于对照组，两组比较差异有显著统计学意义（P〈0．05）。对照组急性放射性肺炎发生率明显高于治疗组，差异有统计学意义（Xz=8．7133，P〈0．01）。结论血浆TNF-α及IL-10／TNF-α比值有望作为检测急性放射性肺炎易感性的指标。参芪扶正注射液可调控细胞因子网络，有效防治放射性肺炎。

Study on the Controlling Effect of Shenqi Fuzheng Injection on Plasma Cytokine Network in Patients with Thoracic Tumor Undergoing Radiotherapy

OBJECTIVE: To investigate the effect of Shenqi Fuzheng Injection (SFI) in radiation pneumonitis and its influence on the levels of plasma transforming growth factor beta (TGF-beta), tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) at various stages (pre-, mid- and post-radiation) of radiotherapy (RT). METHODS: Fifty-eight patients enrolled in this study were randomized into two groups, all received conventional radio therapy, but the treatment group was intravenously dripped with SFI additionally, once daily, starting 3 days before radiotherapy to 1 week after the end of it. Levels of TGF-beta, TNF-alpha and IL-10 in blood samples collected and frozen at different time point of RT, before radiotherapy (Pre-RT), after received 40-50 Gy radiation (Mid-RT) and in time of terminating RT (Post-RT), were measured with enzyme linked immunosorbent assay (ELISA). And the occurrence of radiation pneumonitis was analyzed according to RTOG acute radiation pneumonitis criteria. RESULTS: Level of TGF-beta increased in both groups after RT, either Mid- or Post-RT, but in comparing with that at Pre-RT, statistical significant (P < 0.05) only showed in the control group at Post-RT time when it raised to peak, while in inter-group comparing insignificance was shown. Level of TNF-alpha also increased in both groups, but statistical significance only showed in the control groups as compared with that of Pre-RT, accordingly, it was lower in the treatment group than that in the control group at corresponding time points (P < 0.05). Level of IL-10 decreased gradually in the process of RT, as compared with that at Pre-RT, significant difference was shown in both groups at Post-RT but not at Mid-RT, as compared between groups, no significance (P < 0.05) was shown, though the treatment group showed a high tendency. As for the ratio of IL-10/TNF-alpha, significant difference of lowering in the control group after RT was shown as compared with that at Pre-RT (P < 0.05), and also as compared with that in the treatment group at corresponding time point (P < 0.05). The occurrence of radiation pneumonia > or = grade 2 in the treatment group was significantly lower than that in the control group (chi2 = 8.7133, P < 0.01). CONCLUSION: Plasma level of TNF-alpha and ratio of IL-10/ TNF-a could be the practicable indexes for estimating the susceptibility of acute radiation pneumonia; SFI can regulate the network of cytokine, and thus be effective in preventing and treating radiation pneumonitis.