Clinical And Experimental Study Of "Qingre Jiedu Huoxue Decoction" Intervention For Radiation Pneumonitis

1 BackgroundRadiation therapy is one of the common means of tumor therapy.Radiation therapy can cause radiation-induced lung injury,which can be divided into two phases:radiation pneumonitis and radiation pulmonary fibrosis.At present,there are many theories about its pathogenesis,but it is still not clear,including target cell damage theory,cell cascade factor theory,oxidative stress theory,immune imbalance theory,etc.The influencing factors of radiation pneumonitis include the characteristics of the patients,the diseases,the radiation therapy and other treatment factors.Clinical manifestations of radiation pneumonia consist of cough,shortness of breath,chest pain,or fever,expectoration,fatigue,etc.The treatment of radiation pneumonitis includes corticosteroids,ACEIs,antioxidants,ulinastatin,ambroxol hydrochloride and so on.Radiation is considered as heat toxin in Traditional Chinese medicine theory.The key pathogenesis of this disease is heat toxin,yin deficiency,blood stasis,qi deficiency,phlegm,jin deficiency,which is often combined with the others.In the whole process of radiation pneumonitis,"heat toxin and blood stasis"are of great importan.My tutor habour an idea that the pathogenesis are heat and toxin in the lung,heat damaging Yin,Yin loss in the early stage and that the treatment principle are clearing heat and nourishing Yin.Qingre Jiedu Huoxue formula created by my tutor are often used and have good effects on radiation pneumonitis.In this article,the clinical observation and animal experiment used by Qingre Jiedu Huoxue formula in order to be explored the effects and mechanisms.2 Objectives2.1 Clinical observation:to observe the clinical effect of Qingre Jiedu Huoxue Formula in the treatment of radiation pneumonitis.2.2 Animal experiment:to observe the relationship between Th17/Treg in peripheral blood of rats with radiation pneumonitis,and to explore its mechanism.3 Materials and Methods3.1 Clinical trial:the patients were randomly divided into the control group and the experimental group,each group containing 30 cases(n=60).The control group received oral prednisone tablets 40mg/d,tapering,treatment for 3 weeks,and if infected,were added antibiotic therapy;experimental group on the basis of the control group,take Qingre Jiedu Huoxue Formula for 3 weeks.The therapeutic effects were classified as radiation injury,chest X-ray,CT performance,KPS score and symptom score.3.2 Animal experiment:male and female SD rats were randomly divided into blank group(K),model control group(M),hormone group(J),Chinese medicine group(Z),Chinese medicine plus hormone group(X),each group containing 10 rats.Except the blank group,the other groups were irradiated by 16Gy.Each group was administrated one time a day after irradiation.The Chinese medicine group:9.7g/kg/d crude drug;The hormone group:1-2 weeks with 1.25mg/kg/d prednisone solution,the 3th week with 0.625mg/kg/d prednisone solution,the 4th week with distilled water;Traditional Chinese medicine and hormone group:1-2 weeks with traditional Chinese medicine and hormone medicine(9.7g crude drug+1.25mg/kg/d prednisone),1ml/100g,one time a day to rats by gavage,the 3th week with traditional Chinese medicine and hormone medicine(9.7g crude drug +0.625mg/kg/d prednisone),the 4th week with Chinese medicine(9.7g/kg/d)drug liquid;blank group and model group were given distilled water.Lung and peripheral blood were collected.Flow cytometry was used to test Th17 and Treg and ELISA was used to test IL-17A,TGF-beta 1,IL-6.4 Results and Conclusions4.1 Clinical trial:Qingre Jiedu Huoxue formula combined with glucocorticoid could alleviate radiation pneumonitis and improve symptoms such as cough,chest pain,shortness of breath,which is similar to using glucocorticoid only.Qingre Jiedu Huoxue formula could improve the symptoms such as dry mouth,fatigue,which is superior to using corticosteroid.Qingre Jiedu Huoxue formula combined with glucocorticoid had more advantages in the treatment of radiation pneumonitis than glucocorticoid only.4.2 Animal experiment:in the peripheral blood of SD rats of radiation pneumonitis,Treg transferred to Th17 and TGF-beta 1,IL-6,IL-17A increased.Qingre Jiedu Huoxue formula,glucocorticoid and Qingre Jiedu Huoxue formula combined with glucocorticoid could make Th17 to transfer to Treg,reduce TGF-beta 1,IL-6,IL-17A level and improve the local inflammation of lung tissue.Qingre Jiedu Huoxue formula combined with glucocorticoid have advantages over Qingre Jiedu Huoxue formula or glucocorticoid.