培土生金化瘀中药对肺间质纤维化大鼠干预作用的实验研究
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摘要
肺间质纤维化是一组以肺间质弥漫性渗出、浸润和纤维化为主要病变的疾病,它是许多肺间质疾病的共同结局,病程一般呈进行性发展。其病理特点为慢性炎症反应导致肺泡上皮持续损伤、成纤维细胞过度增殖和细胞外基质过度沉积。由于其发病机制目前尚未完全明确,因此临床尚缺乏特异的治疗药物[1]。传统治疗以糖皮质激素和免疫抑制剂为主,主要是通过减轻炎症反应来延缓肺纤维化的进程[2],但临床诊断的肺纤维化患者,绝大多数纤维化已经形成,并不断进展[3],加之激素疗效尚不理想,长期使用会产生明显不良反应[2],因此开发疗效好、安全性高的药物已成为当务之急。
     中医理论多将肺纤维化归为“咳嗽”“喘证”、“肺痹”等范畴,认为肺纤维化的病位在肺,而与多脏器有关,病机多为正虚邪实。本实验结合古今文献的研究,根据五行相生等的中医基础理论及长期的临床观察,认为该病病位虽然在肺,但与脾密切相关,病机以虚、瘀为关键,提出了肺纤维化“脾虚血瘀”的中医病机假说,由此针对肺纤维化主要病理变化,采用培土生金,活血化瘀的基本治法,拟定培土生金化瘀中药复方加减变化治疗该病,在临床实践中取得了较为满意的效果。为了进一步探讨该复方治疗肺纤维化的作用机理,我们采用该药复方治疗肺间质纤维化大鼠,选择相关分子生物学指标,通过现代先进的实验技术,从不同层面、不同水平动态观察中药复方对实验性肺纤维化的影响,进而探讨其治疗肺纤维化的机理,为肺纤维化的临床治疗提供理论依据。
     本实验采用博莱霉素复制大鼠肺纤维化模型,分别在7天、14天、28天三个时间点,研究培土生金化瘀中药复方对肺纤维化大鼠的干预作用,从分子生物学、免疫学、病理学等不同层面来探讨该中药复方的作用机制。实验研究共分为四部分:
     1培土生金化瘀中药对博莱霉素所致大鼠肺纤维化的肺组织形态及肺系数的影响
     通过对模型动物一般状况的观察(如体重、活动、饮食、及呼吸等)及对肺重、肺系数、病理形态学的研究(HE染色、MASSON染色),通过进行数据统计来比较培土生金化瘀中药的作用效果,以观察培土生金化瘀中药复方对肺间质纤维化大鼠的影响,。
     结果显示:除了正常组外,其余各组大鼠均有不同程度的活动减少、体重下降、饮食减少以及肺系数的增加;肺组织HE染色和MASSON染色均可见程度不同的肺泡炎和细胞外基质沉积。经培土生金化瘀中药复方治疗后大鼠一般状态有所好转;肺系数有所减少;病理形态学显示肺泡炎及肺纤维化均有不同程度的改善。
     结论:(1)博莱霉素诱导大鼠肺纤维化模型成功。
     (2)培土生金化瘀中药复方能在一定程度上改善肺间质纤维化大鼠的肺泡炎及肺纤维化。
     2培土生金化瘀中药对博莱霉素所致大鼠肺纤维化羟脯氨酸含量影响的机制研究
     通过对肺纤维化模型大鼠羟脯氨酸含量影响的实验研究,探讨在肺间质纤维化形成过程中羟脯氨酸含量的变化情况。羟脯氨酸是机体胶原蛋白的主要成分之一,在弹性蛋白中含量极少,而在其它蛋白则不存在[4]。因此,羟脯氨酸为胶原纤维所特有,以此作为肺纤维化的指标,可以判断肺纤维化的程度。
     结果显示:除正常组外其余各组大鼠肺组织胶原沉积明显,数据显示羟脯氨酸含量有不同程度的增加,且纤维化程度随时间的推移而持续加重。经培土生金化瘀中药复方治疗后羟脯氨酸含量有所下降,从而间接地降低肺组织中胶原的含量,起到了减轻肺纤维化的作用。
     结论:培土生金化瘀中药复方可减少肺间质纤维化大鼠的羟脯氨酸含量,从而使纤维化大鼠的纤维化程度有所改善。
     3培土生金化瘀中药对肺间质纤维化大鼠肺组织中TGF-β1及MCP-1蛋白表达影响的机制研究
     通过免疫组织化学染色的方法,结合图像半定量分析技术,研究TGF-β1及MCP-1不同时期的蛋白表达,从免疫组化方面进一步探讨了培土生金化瘀中药对肺纤维化的作用机制。
     结果显示:在肺纤维化发展的各个时间点,TGF-β1及MCP-1蛋白在肺组织中的表达均较正常组明显升高。经培土生金化瘀中药复方治疗后,TGF-β1及MCP-1蛋白表达有不同程度的降低,提示培土生金化瘀中药复方可能通过抑制TGF-β1及MCP-1在肺组织中的异常高表达,从而使肺纤维化程度有所减轻。
     结论:培土生金化瘀中药复方可调节TGF-β1及MCP-1蛋白的表达,从免疫组化方面使肺纤维化的程度有所减轻。
     4培土生金化瘀中药对肺间质纤维化肺组织TGF-β1mRNA基因表达影响的机制研究
     本实验采用RT-PCR的方法,结合图像分析技术,比较各组肺组织在不同时间点上TGF-β1mRNA的基因表达,从分子生物学方面进一步探讨了培土生金化瘀中药的作用机制。
     结果显示:在肺纤维化发展的各个时间点,TGF-β1mRNA在肺组织中均有表达,且强度与正常组比较有显著性差异。经培土生金化瘀中药复方治疗后,TGF-β1mRNA在肺组织中的表达有不同程度的下调,提示培土生金化瘀中药复方可抑制纤维化大鼠的TGF-β1mRNA基因表达,从而改善纤维化,达到预防与治疗的目的。
     结论:培土生金化瘀中药复方可下调TGF-β1mRNA在肺组织中的基因表达,从而表明该中药复方可在分子生物学水平减轻肺纤维化的程度。
     综上所述,本课题采用博莱霉素复制肺纤维化动物模型,应用培土生金化瘀中药复方对肺纤维化大鼠进行干预治疗,从不同层面、不同水平研究培土生金化瘀中药复方对肺纤维化大鼠的作用机制。结果表明,该中药复方能有效的改善肺纤维化的病理状态、降低羟脯氨酸含量、抑制了TGF-β1mRNA、TGF-β1及MCP-1蛋白在肺内的高表达,从而减轻了肺纤维化大鼠的肺泡炎及肺纤维化程度,阻断了纤维化的病理进程,为今后肺纤维化的临床治疗提供了更为坚实的理论依据。
Pulmonary interstitial fibrosis (PF) is a kind of disease characterized by diffusion, infiltration and fibrosis as a common outcome of many interstitial lung diseases. Constantly, the course of PF progressively develops. Its pathological features are the chronic inflammation leading to persistent injury of alveolar cell, over reproduction of lung fibroblast (FB) and excess deposition of extracellular matrix (ECM). It′s well known, the injury of tissues is usually accompanied by inflammation and repairing course. If the scope of injury is small, tissues can recover to normal structure and function, such as the infection reducing by most of bacteria and virus. Otherwise when the range is relatively big or recurrence, the frequent repairing will lead to fibrosis or scar formation, which will influence flexibility and respiratory function and induce the patient died of heart and lung failure as well as hypoxemia. As result of its pathogenesis is not thoroughly clear so far, there is no specific medicine in clinic. The traditional medicine is mainly glucocorticoid and immunosuppressant, delaying the course of PF through relieving inflammation. But to the patient diagnosed as PF in clinic, not only fibrosis has been developing and the disease condition had been developing continuously, but also the curative effect is still dissatisfactory and obvious adverse reactions were induced after long application. Therefore at present, the urgent question is to develop the better effect and high security medicine for PF.
     PF is mostly divided into the category of“Consumptive Lung Disease”“Bi syndrome of the lung”in TCM, believed that the location of PF is in lung, also relating to multiple viscera, and its pathogenesis due mostly to deficient vitality and excessive evil. Through combining with the study on the ancient and modern literature and the long clinical observation, we considered that this disease is belonged to the category of“Consumptive Lung Disease”, and the ill location lies in lung, but closely connective with spleen, and the key of pathogenesis is deficiency and stasis, so we put forward the hypothesis of deficiency of spleen and blood stasis. Furthermore combining with the theory of TCM, we also believes that invigorating spleen and lung, promoting blood and stasis-resolving is the basically big method, and applies the modification of the herbal compound of strengthening earth to support metal and stasis-resolving in treating PF, and has achieved the satisfactory effects in clinic. In order to further explore the effect of the herbal compound on PF, we apply the compound to treat PF rats, choose relative molecular biological markers, and use advanced experimental technique, observing the effect of the herbal compound on PF rats from different levels and angels, which provide theory basis for treating PF in clinic.
     In this experiment, we apply BLM to induce the PF model on rats, studying the effect of“strengthening earth to support metal and stasis-resolving compound”on PF rats, at the time of 7d,14d and 28d, exploring the mechanism of the herb from the different levels and angels such as molecular biology, immunity and pathology etc,so as to find the more effect medicines for the clinic. The experimental research consists of four parts as following:
     1 The effects of“strengthening earth to support metal and stasis-resolving compound”on pathomorphology and lung index in PF rats.
     Through observing general status of PF rats (such as weight, movement and respiration etc),
     Lung index and the changes in pathomorphology (HE and MASSON stain), studying the effects of”strengthening earth to support metal and stasis-resolving compound”on PF rats, and then comparing the effects of the herbal compound according to statistic data.
     The results showed as following: Exclude the normal group, other groups in PF rats had the phenomena of weight reducing, movement decreasing, less eating and lung index increasing. Under the microscope, alveolitis and collagen deposition were observed in different degrees among lung interstitial by HE and MASSON stain. After the herbal compound treatment, the general status of PF rats were improved, lung index reduced, and alveolitis and fibrosis relieved on pathomorphology.
     The results:⑴The PF rat model induced by BLM was successfully duplicated.⑵The herb compound of“strengthening earth to support metal and stasis-removing”can improve the degree of the alveolitis and fibrosis in PF rats.
     2 The study on the effects of”strengthening earth to support metal and stasis-resolving compound”on contents of HYP in PF rats.
     Though the research on the effects of”strengthening earth to support metal and stasis-resolving compound”on the contents of HYP in PF rats, discussing the change about contents of HYP in the process of PF. HYP is one of the main components in the collagen of body, and very few in the elastin, whereas no in the other protein. Therefore, HYP is the endemic components of collagen fiber. So that it is the diagnostic marker of PF and can judge the degree of PF.
     The results showed as following: Besides the normal group, the deposit of collagen appeared obviously in the lung tissues in the other groups. Data suggested that the contents of HYP increase in different degrees, furthermore the degree of PF aggravate gradually with the lapse of time. After the herbal compound treatment, HYP contents reduced, thus indirectly decreasing the contents of collagen, and acting on relieving the effect of PF.
     The results:⑴The PF rat model induced by BLM was successfully duplicated.⑵The herb compound of”strengthening earth to support metal and stasis-resolving”can reduce the HYP contents, so that it can improve the degree of fibrosis in PF rats.
     3 The study on the effects of“strengthening earth to support metal and stasis-resolving compound”on the expression of TGF-β1 and MCP-1 protein in PF rats.
     Through the method of immunohistochemistry, combining with image analysis, we observed the expression of TGF-β1 and MCP-1in lung tissues at different phases, further discussing the mechanism of PF from immunohistochemistry.
     The results showed as following: In the different time, the expression of TGF-β1 and MCP-1 protein in lung tissues are higher than the normal group. After“strengthening earth to support metal and stasis-resolving compound”treatment, the expression of TGF-β1 and MCP-1 protein all reduced in different degrees, which suggested that the herbal compound may be through inhibiting the high expression of TGF-β1 and MCP-1 protein, therefore making the degree of PF reduce.
     The results: After the herbal compound of“strengthening earth to support metal and stasis-resolving”, the above makers may be improved effectively, so decreasing the degree of PF from immunohistochemistry.
     4 The study on the effect of the expression of TGF-β1mRNA in lung tissues
     In this study, using the method of RT-PCR and image analysis, we compare the expression of TGF-β1mRNA in lung tissues at different phases in every group, further discussing the mechanism of the herbal compound of”strengthening earth to support metal and stasis-resolving”from molecular biology.
     The results as following: TGF-β1mRNA expressed in lung tissues on different stages of PF, and there was significant difference in the expression intensity between the normal group and other groups. After“strengthening earth to support metal and stasis-resolving compound”treatment, the expression of TGF-β1mRNA in lung tissues was improved in different degrees, which suggested that the herbal compound may inhibit the expression of TGF-β1mRNA on PF rats.
     The results: After the herbal compound of“strengthening earth to support metal and stasis-resolving”treatment, the expression of TGF-β1mRNA obviously decreased, thus reducing the degree of PF from molecular biology.
     In summary, this study, by using BLM to induce PF model on rats, we apply the herbal compound of”strengthening earth to support metal and stasis-resolving”to treat the PF rats, thus discussing the effects of the herbal compound on PF rats. The results suggest that the herbal compound can effectively improve the abnormal status, reduce the content of HYP, suppress the high expression of TGF-β1mRNA, TGF-β1 and MCP-1 in lung tissues, thus relieving the degree of alveoli and fibrosis and blocking the pathological process, which provide the solid theoretical foundation for the clinical treatment in future.
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