| Part One:Overview On Idiopathic Pulmonary FibrosisIdiopathic Pulmonary Fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias.It is a progressive and lethal pulmonary fibrotic lung disease.The diagnostic histological changes are called usual interstitial pneumonia and are characterized by histological temporal heterogeneity,whereby normal lung tissue is interspersed with interstitial fibrosis, honeycomb cysts and fibroblast foci. Pulmonary functions show restricted gas eschange.High-resolution computed axial tomography demonstrates evidence of fibrosis and lung remodeling such as honeycomb cysts and traction bronchiectasis.Now there is unresponsive to treatment for IPF.In the past the term IPF included a number of idiopathic interstitial pneumonias that are now considered separate clin- icopathogical entities.Epidemiology investigate shows the incidence and prevalence of IPF have been difficult to determine because until recently the diagnostic criteria were uncertain and the terminology was poorly defined.The General Practice Research Database and the 4th Morbidity Survey in General Research from the United Kingdom suggest a prevalence of IPF of 3-6 per 10, 0000 person-years.IPF is more prevalent than other interstitial pneumonias and is diagnosed more frequently in men (male:female prevalence ratio 1.4:1.0). IPF is most commonly seen in patients between the ages of 40 and 70, and the majority of patients are over 60 years of age.The mean length of survival after diagnosis is 3.2-5 years.It is knows that Chinese medicine has long history in preventing and curing IPF.It is characterized by strengthening healthy qi,eliminating pathogens and distinguishing of symptoms and signs.Gradually Chinese medicine becomes one of the most important composition for treatment of IPF in our country. Based on the long-term clinical experience, advisor Wang Shuchen and Zhang Yanping use drugs for eliminating arthralgia spasm and promoting blood flow — Fei Bi Tong in treating IPF.And the effect is satisfacting.The purpose of this article is to help us evaluate the curative effect of this therapy through clinical experiment.At the same time we carry out the animal experiment to approach the conceivable mechanism of action about the above-mentioned therapy in resisting IPF.Part Two: Clinical Study on the effect of Fei Bi Tong for Idiopathic pulmonary fibrosisObjective: To ovserve the effect of Fei Bi Tong in treating IPF.Methods: 52 cases were randomly assigned to two groups:the treatment group (receive Fei Bi Tong)and the control group(receive predinsone) in the research of 3 months.Then we analyzed the total curativ effect,the changing of the symptoms and pulmonary function before and after the therapy.Results: The treatment group had not improved compared with the control group in the total curativ effect(p>0.05).And the treatment group provided greater improvement in the symptoms of dyspnea,dry cough,chest complaint(p<0.05).There was significant difference for the patients of the control group in relieving languor and debilitation after treating.For pulmonary function after the treatment there was no effective improved in the treatment group compared with pretherapy (p>0.05).The VC(%) significantly decreased in the control group after treating(p<0.05).And for the changing of the DLCO(%) between the two groups there was significant difference (p<0.05),the effect of the control group was better than that of the treatment group.Conclusion: Patients with IPF may benefit from the treatment with Fei Bi Tong, can delay the progression of diease and improve the quality of life.But the contribu-tiong to the long function needs more investigation.Part Three: Experimental Study on the effect of Fei Bi Tong for Idiopathicpulmonary fibrosisObjective: To discuss the effect of Fei Bi Tong on the change of IPF and expression of cell factor in pulmonary fibrosis mice.Methods: Sixty male SD rats,120±10g in weight,were divided randomly into 5 groupsjespectively 12 rats in normal control group,pulmonary fibrosis model group, corticosteroids group,Fei Bi Tong with low dose group and Fei Bi Tong with high dose group.Reproduce the mice model of pulmonary fibrosis by intratracheal injection bleomycin.After 28 days normal control group and model group were treated with distilled water by intragastric administration.The other groups were gived homologous treatment by intragastric administration daily.All the rats were killed 49 days later and sent to pathological examination.The immunohistochemical technique and image processing system to analyze the expression of type I and III collagen,matrix metalloproteinase-l(MMP-l) and tissue inhibitor of metalloproteinse(TIMP-l) then calculate MMP-l/TIMP-1 ratio in the lung tissue of rats.The level of laminin(LN) wasdetectded in the blood serum by radioimmunoassay,the transforming growth factor (TGF-Bi) and glutathione (GSH) by enzyme-linked immunosorbent assay.Result: There were more heavy pulmonary fibrosis and more type I and III collagen accumulation in fibrosis group, while the low grade in Fei Bi Tong with high dose group and corticosteroids group were observed. Similar with the normal control group,in Fei Bi Tong with high dose group MMP-l/TIMP-1 ratio tended to 1:1,and the concentration MMP-1 was stronger than TIMP-l.While in the model group TlMP-1 was more than MMP-l.The level of LN stepped up obviously in model group, and lower in Fei Bi Tong with high dose group and corticosteroids group(p<0.05).We also observed concentration of TGF-β i advanced in the model group and in all the therapy group, contrast to the normal group(p<0.05).While the level of GSH tended to descend in the pulmonary fibrosis group,but it was no statistical significance (p>0.05).conclusion: The therapy for Fei Bi Tong could decrease the overexpression of correlated cytokine in the lung tissue of fibrosis rats, accommodate the immune reaction of the patients with IPF,maintain the balance of metabolic.In the future it may be one of the marvelous therapy methods for IPF. |
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