特发性肺纤维化患者血清TGF-β、IFN-γ水平及中药治疗效果观察
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摘要
目的探究特发性肺纤维化(IPF)血清转化生长因子-β(TGF-β)和干扰素-γ(IFN-γ)水平及中药治疗效果。方法选取2017年3月—2018年5月住院治疗的60例IPF患者作为观察组,选取同期于医院体检的健康正常者30例作为对照组。观察IPF患者治疗前与对照组血清TGF-β、IFN-γ水平变化。观察组根据治疗方法分为A、B组,A组行益气养阴祛瘀方治疗,B组行乙酰半胱氨酸治疗。应用圣乔治呼吸问卷(SGRQ)评价患者治疗后生活质量,观察临床疗效。结果观察组治疗前血清TGF-β水平高于对照组,血清IFN-γ水平低于对照组(P <0. 01)。A组治疗后SGRQ评分低于B组(P <0. 05)。A组总有效率高于B组(P <0. 05)。结论益气养阴祛瘀方可有效治疗IPF,提高生活质量水平。IPF患者TGF-β水平较高,IFN-γ水平较低,临床可通过使用TGF-β拮抗剂及外源性给予IFN-γ从而延缓IPF疾病进程。
Objective To investigate levels of serum transforming growth factor-beta( TGF-β) and interferongamma( IFN-γ) in patients with idiopathic pulmonary fibrosis( IPF) and effect by traditional Chinese medicine therapy.Methods A total of 60 patients with IPF admitted during March 2017 and May 2018 were selected as observation group,and other 30 healthy persons taking physical examination at the same period were selected as control group. Changes of serum TGF-β and IFN-γ levels between IPF patients before treatment and in control group were observed. The observation group was divided into subgroup A and B according to therapeutic methods,and subgroup A was treated with supplementing Qi and nourishing Yin removing blood stasis,while subgroup B was treated with Acetylcysteine. St. George respiration questionnaire( SGRQ) was used to evaluate life quality of patients after treatment,and then clinical effects were observed. Results Before treatment,in observation group,serum TGF-β level was significantly higher,while serum IFN-γ level was significantly lower than those in control group( P < 0. 01). After treatment,SGRQ score in subgroup A was significantly lower than that in subgroup B( P < 0. 05). The total effective rate in subgroup A was significantly higher than that in subgroup B( P < 0. 05). Conclusion Supplementing Qi and nourishing Yin removing blood stasis may effectively treat IPF patients,improve quality of life. Patients with IPF have higher TGF-β levels and lower IFN-γ levels,which can be delayed by use of TGF-β antagonists and exogenous administration of IFN-γ.
Objective To investigate levels of serum transforming growth factor-beta( TGF-β) and interferongamma( IFN-γ) in patients with idiopathic pulmonary fibrosis( IPF) and effect by traditional Chinese medicine therapy.Methods A total of 60 patients with IPF admitted during March 2017 and May 2018 were selected as observation group,and other 30 healthy persons taking physical examination at the same period were selected as control group. Changes of serum TGF-β and IFN-γ levels between IPF patients before treatment and in control group were observed. The observation group was divided into subgroup A and B according to therapeutic methods,and subgroup A was treated with supplementing Qi and nourishing Yin removing blood stasis,while subgroup B was treated with Acetylcysteine. St. George respiration questionnaire( SGRQ) was used to evaluate life quality of patients after treatment,and then clinical effects were observed. Results Before treatment,in observation group,serum TGF-β level was significantly higher,while serum IFN-γ level was significantly lower than those in control group( P < 0. 01). After treatment,SGRQ score in subgroup A was significantly lower than that in subgroup B( P < 0. 05). The total effective rate in subgroup A was significantly higher than that in subgroup B( P < 0. 05). Conclusion Supplementing Qi and nourishing Yin removing blood stasis may effectively treat IPF patients,improve quality of life. Patients with IPF have higher TGF-β levels and lower IFN-γ levels,which can be delayed by use of TGF-β antagonists and exogenous administration of IFN-γ.
引文
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[12]徐中菊,张悦.补益类中药抗肾纤维化作用及机制研究概况[J].辽宁中医杂志,2013,40(1):183-185.
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[14] Swigris J J,Stewart A L,Gould M K,et al. Patients'perspectives on how idiopathic pulmonary fibrosis affects the quality of their lives[J]. Health Qual Life Outcomes,2005,3:61.
[15] De Vries J,Kessels B L,Drent M. Quality of life of idiopathic pulmonary fibrosis patients[J]. Eur Respir J,2001,17(5):954-961.
[16] Proell V,Carmona-Cuenca I,Murillo M M,et al. TGFbeta dependent regulation of oxygen radicals during transdifferentiation of activated hepatic stellate cells to myofibroblastoid cells[J]. Comp Hepatol,2007,6(1):1.
[17]王欣燕,吴晓梅,陈克辉.特发性肺纤维化患者支气管肺泡灌洗液中细胞因子研究[J].哈尔滨医科大学学报,2003,37(6):491-493.
[18] Yong S J,Adlakha A,Limper A H. Circulating transforming growth factor-beta(1):a potential marker of disease activity during idiopathic pulmonary fibrosis[J]. Chest,2001,120,(1Suppl):68S-70S.
[19] Wallace W A,Ramage E A,Lamb D,et al. A type 2(Th2-like)pattern of immune response predominates in the pulmonary interstitium of patients with cryptogenic fibrosing alveolitis(CFA)[J]. Clin Exp Immunol,1995,101(3):436-441.
[20] Ziesche R,Hofbauer E,Wittmann K,et al. A preliminary study of long-term treatment with interferon gamma-1b and low-dose prednisolone in patients with idiopathic pulmonary fibrosis[J]. N Engl J Med,1999,341(17):1264-1269.
[2]孟泳,崔应麟,王艳梅,等.益气养阴法对气阴两虚型特发性肺纤维化缓解期的辅助治疗效果[J].山东医药,2016,56(29):86-88.
[3]任玉娇,朱雪,张伟.益气温阳活血化瘀法论治特发性肺纤维化合并肺动脉高压[J].中医杂志,2017,58(14):1186-1188,1195.
[4]辛大永,冯京帅.益气软坚消癥法提高气虚血瘀型特发性肺纤维化患者生活质量的临床研究[J].世界中医药,2016,11(12):2714-2716,2721.
[5] Durcan N,Murphy C,Cryan S A. Inhalable siRNA:potential as a therapeutic agent in the lungs[J]. Mol Pharm,2008,5(4):559-566.
[6] John A E,Luckett J C,Tatler A L,et al. Preclinical SPECT/CT imaging of alphavbeta6 integrins for molecular stratification of idiopathic pulmonary fibrosis[J]. J Nucl Med,2013,54(12):2146-2152.
[7] Raghu G,Collard H R,Egan J J,et al. An official ats/ers/jrs/alat statement:idiopathic pulmonary fibrosis:evidence-based guidelines for diagnosis and management[J]. Am J Respir Crit Care Med,2011,183(6):788-824.
[8] Furukawa T,Taniguchi H,Ando M,et al. The St.George's Respiratory Questionnaire as a prognostic factor in IPF[J]. Respir Res,2017,18(1):18.
[9] Navaratnam V,Fleming K M,West J,et al. The rising incidence of idiopathic pulmonary fibrosis in the U. K[J]. Thorax,2011,66(6):462-467.
[10] Song J W,Hong S B,Lim C M,et al. Acute exacerbation of idiopathic pulmonary fibrosis:incidence,risk factors and outcome[J]. Eur Respir J,2011,37(2):356-363.
[11]李辉,代媛媛,李国勤.重温肺痿肺痹文献,探讨特发性肺间质纤维化治疗[J].北京中医药,2010,29(11):839-842.
[12]徐中菊,张悦.补益类中药抗肾纤维化作用及机制研究概况[J].辽宁中医杂志,2013,40(1):183-185.
[13]陈晶,张博华.黄芪、大黄的抗肾纤维化作用研究进展[J].中医药学,2011,39(6):101-104.
[14] Swigris J J,Stewart A L,Gould M K,et al. Patients'perspectives on how idiopathic pulmonary fibrosis affects the quality of their lives[J]. Health Qual Life Outcomes,2005,3:61.
[15] De Vries J,Kessels B L,Drent M. Quality of life of idiopathic pulmonary fibrosis patients[J]. Eur Respir J,2001,17(5):954-961.
[16] Proell V,Carmona-Cuenca I,Murillo M M,et al. TGFbeta dependent regulation of oxygen radicals during transdifferentiation of activated hepatic stellate cells to myofibroblastoid cells[J]. Comp Hepatol,2007,6(1):1.
[17]王欣燕,吴晓梅,陈克辉.特发性肺纤维化患者支气管肺泡灌洗液中细胞因子研究[J].哈尔滨医科大学学报,2003,37(6):491-493.
[18] Yong S J,Adlakha A,Limper A H. Circulating transforming growth factor-beta(1):a potential marker of disease activity during idiopathic pulmonary fibrosis[J]. Chest,2001,120,(1Suppl):68S-70S.
[19] Wallace W A,Ramage E A,Lamb D,et al. A type 2(Th2-like)pattern of immune response predominates in the pulmonary interstitium of patients with cryptogenic fibrosing alveolitis(CFA)[J]. Clin Exp Immunol,1995,101(3):436-441.
[20] Ziesche R,Hofbauer E,Wittmann K,et al. A preliminary study of long-term treatment with interferon gamma-1b and low-dose prednisolone in patients with idiopathic pulmonary fibrosis[J]. N Engl J Med,1999,341(17):1264-1269.