| Part One: Overview On Idiopathic Pulmonary FibrosisIdiopathic pulmonary fibrosis (IPF) is a comparatively common representative disease of interstitial lung disease with unknown cause. Its characters are diffuse alveolitis and alveolar structure disorder, and those pathological changes could ultimately lead to pulmonary interstitial fibrosis. IPF clinical symptoms include ingravescent dyspnea, dry cough, shortness of breath and pain in chest. IPF is most commonly seen in patients between the ages of 50 to 70 and male is more than female. The incidence rate of IPF is about 5 to10 people among 100 000 people. Recently the incidence rate of IPF has trend of increasing. At present, the main treatment of IPF are glucocorticoid and immunosuppressants, but these drugs' results are dissatisfactory and side effects are obvious. So the urgent question is to seek effective medicine for IPF.Cytokine network plays an important role in IPF's occurrence and development. Some cytokines even play decisive role in regulation and maintenance of pulmonary fibrosis. The ratio of Th1 and Th2 cytokine of IPF patient presents severe disequilibrium. Th1-type cytokines (such as IFN-γ) are absolutely or relatively fewer when compared with Th2-type cytokines (such as IL-4) . It suggests that alterations in T cell subpopulations of Th1 and Th2 cells and their associated pattern of cytokine production may contribute to progression of IPF.In recent years, people pay more attention to Chinese medicine in treating IPF .It can improve the clinical symptoms rapidly and improve the quality of IPF patient's life with less side effects. The TCM doctors have their own ideas in treating IPF. Based on a long-term clinical experience, my mentor Professor Wang Shuchen and Zhang Yanping use the decoction of Xuanfuhua, plus the drugs of Ruanjian Sanjie, Tongbi Huoxue and Yiqi Yangyin to treat the patient of IPF. And its clinical effect is satisfactory.The purpose of this article is to help us approach the conceivable mechanism of action the above-mentioned therapy in resisting IPF through animal experiments. At the same time we carry out the clinical experiment to evaluate the curative effect of this therapy.Part Two: Clinical Study on the Effect of Feixiantong for Idiopathic Pulmonary FibrosisObjective: To evaluate the clinical effect of Feixiantong in treating IPF objectively.Methods: 58 cases selected were randomly divided into two groups: the treatment group (receive Feixiantong) and the control group (receive predinsone) in the research of 3 months. Then analyzed the integrated effect scores, symptoms changes, lung function, chest CT changes and quality of life before and after the treatment.Results: There was no significant difference in the integrated effects between the treatment group and the control group (P>0．05) , but the treatment group provivided greater improvement in cough and chest pain. There is no effective improvement both the treatment group ans the control group(P<0．05) . In chest CT, there is also no significant difference between the two groups (P> 0．05) . The treatment group play better than the control group in improving the quality of the IPF patients' life(P<0．05) .Conclusion: The patients with IPF may benefit from the treatment of the decoction of Feixiantong. It can improve the quality of life and delay the progression of disease. We should do further research with increasing samples.Part Three: Experimental Study on the effect of Feixiantong for Idiopathic Pulmonary FibrosisObjective: To study the ingredients of Feixiantong decoction and observe its effect in correcting the Th1/Th2 imbalance of pulmonary fibrosis.Methods: 100 male SD rats, weighing 120±10g, were randomly divided into 10 groups, respectively 10 rats in nomal control group, pulmonary fibrosis model group, corticosteroid group, Feixiantong group, Yiqi group, Huoxue group, Ruanjian group, Yiqi plus Huoxue group, Ruanjian plus Yiqi group and Ruanjian plus Huoxue group. The rat model with pulmonary fibrosis was established with bleomycin. Feixiantong decoction was divided into seven subgroups with the method of orthogonal design. To semi-quantitative analysis the histopathologic changes of lung tissue and detect the levels of IFN-γ, IL-4, TNF-a in blood serum. The immunohistochemical technique and image processing system to analyze the expression of typeⅠandⅢcollagen.Results: Pulmonary fibrosis model was successfully established. All the Feixiantong decoction and its ingredients possessed the actions on regulating the Th1/Th2 imbalance. Compared with the BLM group, the treating group showed a decreased tendency towards of IL-4 content and the increased tendency towards of IFN-γcontent. Ruanjian group displayed the more obvious efficacy than the other two groups. Huoxue herbs were used solely showed no obvious effects, but if it was used with Huoxue group together, it showed better efficacy. Among ingredients groups, Feixiantong decoction displayed the best efficacy. TNF-a levels in the treatment group were increased lighter than in the model group, except for Huoxue group and Yiqi group, other treatment groups have significant differences (P <0．05) .Conclusions: Feixiantong decoction could shift the Th1/Th2 imbalance in pulmonary fibrosis possibly and reduce the expression of typeⅠandⅢcollagen. The experiment provides a new idea for clinical treatment, but it took a short time. So we need a long-term abservation for further research in treating IPF. |
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