黄连生地方防治放射性唾液腺损伤的临床及实验研究
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摘要
目的
1.对放射性唾液腺损伤的文献进行系统整理和总结,分析中医药防治放射性唾液腺损伤的辨证规律和用药特点,以指导临床用药。
2.通过黄连生地方的临床应用,观察本方对患者放射性唾液腺损伤症状的改变,了解黄连生地方对放射性唾液腺损伤的防治作用；
3.通过动物实验观察本方对动物血常规、肝肾功能、唾液腺分泌功能的影响,了解黄连生地方对防治放射性唾液腺损伤确切疗效。
方法
1.通过检索查阅1990年～2010年国内公开发行的医学学术刊物中有明确放射性唾液损伤的中医辨证分型和治疗的论文,就其辨证分型和用药规律进行归纳和统计分析。制定放射性唾液腺损伤辨证分型的标准,为临床辨证分型建立信息数据。
2.临床研究：将30例拟行头颈部放射治疗的肿瘤病患者,随机分为中药+放疗组(中放组)和放疗组(单放组),中放组自放疗开始服用黄连生地方至放疗结束,每日一剂,早晚分服。单放组未予中药,如出现放疗副反应,给予对症处理。分别于放疗前及放疗疗程结束后行唾液腺功能检查。
3.动物实验：将家兔随机分为中药加放疗组(中放组)、氨磷汀加放疗组(氨放组)、单纯放疗组(单放组)、空白对照组(空白组)。中放组：放疗前3天至放疗后3天灌服中药；氨放组：于放疗前30分钟给予氨磷汀200mg／m。腹腔注射；单放组：放疗前后不作特殊处理。放疗前4天、后3天行唾液腺显像,并于放疗后3天统一处死,取腮腺组织做病理检测。
结果
1.对放射性唾液腺损伤的辨证分型及用药规律总结出,阴虚火旺型、阴虚火毒型及热毒炽盛型,三型共占84%,是本病的主要症型。并确立清热解毒、养阴生津的是本病治疗大法
2.临床研究表明中放组患者放疗结束时白细胞明显高于单放组(P<0.05),其余血常规及肝肾功能与单放组比较无明显差异(P>0.05)；放疗前后唾液腺显像检查表明,中放组患者唾液腺功能明显高于单放组,对放射性唾液腺细胞有保护作用。
3.动物实验研究证实黄连生地方对放疗患者的白细胞、淋巴细胞有保护作用,且对肝肾功能未有影响；唾液腺显像检测黄连生地方对家兔唾液腺摄取和排泌功能的影响,得出本方能改善放射性唾液腺损伤,并对动物放射性唾液腺损伤细胞有修复作用。
结论
1.通过文献研究得出：放射性唾液腺损伤的主要病机是毒邪内蕴,本病的基础证型阴虚火旺、阴虚火毒及热毒炽盛型是本病,本病的基本治疗大法是清热解毒、养阴生津。
2.黄连生地方能较好改善阴虚火旺、阴虚火毒及热毒炽盛型急性放射性唾液腺损伤患者的症状和体征,安全性好,毒副作用低,使患者顺利完成放疗计划。
3.黄连生地方能有效治疗家兔急性放射性唾液腺炎症损伤,促进唾液腺细胞的修复,减轻放射性唾液腺损伤症状,对唾液腺结构和功能有保护作用。
Objective
1.Collecting Chinese medicine research literature, looking for the the cause and mechanism of radiation-induced salivary and the distribution law of syndrome type, analizing the using trends in Chinese herbs, and exploring effective treatment of this disease.
2. Observing the changes of radiation-induced xerostomia symptoms in patients, to understand the prevention of radiation-induced sialadenitis with that by the clinical application of HuangLianshengdi decoction.
3. Observing the effect and hematology on salivary secretion by animal experiments,and understanging the mechanism of action about prevention of radiation-induced salivary with HuangLianshengdi decoction,from the microstructure,to provide a theoretical basis in treating radiation damage with Chinese medicine.
Methods
1.Searching on VIP and CNKI network for the medical academic articles about radiation-induced sialadenitis in 1990-2010, in which describe the Chinese syndrome type of the disease, analysize their laws of differentiation syndrome type and Chinese herbs uses.Developing clinical signs and syndromes observed table,collecting four diagnostic information in patients,establishing an information-based syndrome type data.
2. Clinical research:30 cases patients that scheduled for radiotherapy of head and neck cancer were divided into 2 groups:MR and RG. MR group since the beginning of radiotherapy to take until the end,Huanglianshengdi decoction day 1, morning and evening hours service. RG group did not receive medicine and salivary protective drug, side effects such as radiation therapy appears to give symptomatic treatment. Two groups were in the end of treatment before radiotherapy and radiotherapy underwent salivary gland function tests.
3. Animal experiment:28 New Zealand rabbits were randomly divided into Medicine and radiotherapy group (8 cases, administered orally with HuangLianshengdi decoction and radiotherapy,MR), Amifostine and radiotherapy group (7 cases, administered orally with amifostine and radiotherapy,AR), radiotherapy group (7 cases, administered radiotherapy,RG), blank group (6 cases,BG). MR are administered orally with HuangLianshengdi decoction from 3 days before irradiation to 3 days after radiotherapy. AR are administered with amifostine 200mg/m2 intraperitoneal injection 30 minutes before radiotherapy given. RG are not administered before radiotherapy. Each group 3 days before radiotherapy and radiotherapy,1 day and 3 days after,to take blood and salivary gland imaging line. Animals 3 days after radiotherapy uniform were killed, parotid gland tissue for pathological testing.
Results
1. Salivary gland radiation damage our dialectical law of classification and medication summary:asthenic yin causing excessive pyrexia, Yinxuhuodu and Reduzhisheng are the main type of radiation-induced sialadenitis,84%, and have established YangYinShengJin Qingrejiedu treatment。
2. Clinical research:MR radiotherapy patients at the end of white blood cell and lymphocyte counts were significantly higher than the radiation group (P<0.05), the remaining blood and liver and kidney function as compared with radiotherapy alone had no significant difference(P>0.05). Salivary gland scintigraphy before and after radiotherapy that MR was significantly higher than the radiotherapy group, protective effect of salivary gland cells
3. Animal studies confirmed:HuangLianshengdi decoction pair of radiotherapy in patients with white blood cells, lymphocytes can protect, and no effect on the liver and kidney function. Salivary gland scintigraphy showed HuangLianshengdi decoction on experimental rabbit salivary glands uptake and excretion function of impact, come to HuangLianshengdi decoction can improve the radiation damage,and repair radiation damage of salivary gland function.
Conclusion
1.Toxins intrinsic radioactive main pathogenesis of intestinal injury. Yinxuhuowang, Yinxuhuodu and Reduzhisheng are the basis of syndrome type. YangYinShengJin Qingrejiedu is the primary treatment.
2. Modified HuangLianshengdi decoction could improve symptoms and signs of radiation-induced sialadenitis without any side effects, so that patients could complete radiotherapy successfully.
3. The results of the animal study showed that modified HuangLianshengdi decoction could protect intestinal mucosa and accelerate its healing from radiation damages, as well as reduce the salivary inflammatory response and inhibit endotoxin translocation, protect mechanical and immune barrier function of salivary.
1.对放射性唾液腺损伤的文献进行系统整理和总结,分析中医药防治放射性唾液腺损伤的辨证规律和用药特点,以指导临床用药。
2.通过黄连生地方的临床应用,观察本方对患者放射性唾液腺损伤症状的改变,了解黄连生地方对放射性唾液腺损伤的防治作用；
3.通过动物实验观察本方对动物血常规、肝肾功能、唾液腺分泌功能的影响,了解黄连生地方对防治放射性唾液腺损伤确切疗效。
方法
1.通过检索查阅1990年～2010年国内公开发行的医学学术刊物中有明确放射性唾液损伤的中医辨证分型和治疗的论文,就其辨证分型和用药规律进行归纳和统计分析。制定放射性唾液腺损伤辨证分型的标准,为临床辨证分型建立信息数据。
2.临床研究：将30例拟行头颈部放射治疗的肿瘤病患者,随机分为中药+放疗组(中放组)和放疗组(单放组),中放组自放疗开始服用黄连生地方至放疗结束,每日一剂,早晚分服。单放组未予中药,如出现放疗副反应,给予对症处理。分别于放疗前及放疗疗程结束后行唾液腺功能检查。
3.动物实验：将家兔随机分为中药加放疗组(中放组)、氨磷汀加放疗组(氨放组)、单纯放疗组(单放组)、空白对照组(空白组)。中放组：放疗前3天至放疗后3天灌服中药；氨放组：于放疗前30分钟给予氨磷汀200mg／m。腹腔注射；单放组：放疗前后不作特殊处理。放疗前4天、后3天行唾液腺显像,并于放疗后3天统一处死,取腮腺组织做病理检测。
结果
1.对放射性唾液腺损伤的辨证分型及用药规律总结出,阴虚火旺型、阴虚火毒型及热毒炽盛型,三型共占84%,是本病的主要症型。并确立清热解毒、养阴生津的是本病治疗大法
2.临床研究表明中放组患者放疗结束时白细胞明显高于单放组(P<0.05),其余血常规及肝肾功能与单放组比较无明显差异(P>0.05)；放疗前后唾液腺显像检查表明,中放组患者唾液腺功能明显高于单放组,对放射性唾液腺细胞有保护作用。
3.动物实验研究证实黄连生地方对放疗患者的白细胞、淋巴细胞有保护作用,且对肝肾功能未有影响；唾液腺显像检测黄连生地方对家兔唾液腺摄取和排泌功能的影响,得出本方能改善放射性唾液腺损伤,并对动物放射性唾液腺损伤细胞有修复作用。
结论
1.通过文献研究得出：放射性唾液腺损伤的主要病机是毒邪内蕴,本病的基础证型阴虚火旺、阴虚火毒及热毒炽盛型是本病,本病的基本治疗大法是清热解毒、养阴生津。
2.黄连生地方能较好改善阴虚火旺、阴虚火毒及热毒炽盛型急性放射性唾液腺损伤患者的症状和体征,安全性好,毒副作用低,使患者顺利完成放疗计划。
3.黄连生地方能有效治疗家兔急性放射性唾液腺炎症损伤,促进唾液腺细胞的修复,减轻放射性唾液腺损伤症状,对唾液腺结构和功能有保护作用。
Objective
1.Collecting Chinese medicine research literature, looking for the the cause and mechanism of radiation-induced salivary and the distribution law of syndrome type, analizing the using trends in Chinese herbs, and exploring effective treatment of this disease.
2. Observing the changes of radiation-induced xerostomia symptoms in patients, to understand the prevention of radiation-induced sialadenitis with that by the clinical application of HuangLianshengdi decoction.
3. Observing the effect and hematology on salivary secretion by animal experiments,and understanging the mechanism of action about prevention of radiation-induced salivary with HuangLianshengdi decoction,from the microstructure,to provide a theoretical basis in treating radiation damage with Chinese medicine.
Methods
1.Searching on VIP and CNKI network for the medical academic articles about radiation-induced sialadenitis in 1990-2010, in which describe the Chinese syndrome type of the disease, analysize their laws of differentiation syndrome type and Chinese herbs uses.Developing clinical signs and syndromes observed table,collecting four diagnostic information in patients,establishing an information-based syndrome type data.
2. Clinical research:30 cases patients that scheduled for radiotherapy of head and neck cancer were divided into 2 groups:MR and RG. MR group since the beginning of radiotherapy to take until the end,Huanglianshengdi decoction day 1, morning and evening hours service. RG group did not receive medicine and salivary protective drug, side effects such as radiation therapy appears to give symptomatic treatment. Two groups were in the end of treatment before radiotherapy and radiotherapy underwent salivary gland function tests.
3. Animal experiment:28 New Zealand rabbits were randomly divided into Medicine and radiotherapy group (8 cases, administered orally with HuangLianshengdi decoction and radiotherapy,MR), Amifostine and radiotherapy group (7 cases, administered orally with amifostine and radiotherapy,AR), radiotherapy group (7 cases, administered radiotherapy,RG), blank group (6 cases,BG). MR are administered orally with HuangLianshengdi decoction from 3 days before irradiation to 3 days after radiotherapy. AR are administered with amifostine 200mg/m2 intraperitoneal injection 30 minutes before radiotherapy given. RG are not administered before radiotherapy. Each group 3 days before radiotherapy and radiotherapy,1 day and 3 days after,to take blood and salivary gland imaging line. Animals 3 days after radiotherapy uniform were killed, parotid gland tissue for pathological testing.
Results
1. Salivary gland radiation damage our dialectical law of classification and medication summary:asthenic yin causing excessive pyrexia, Yinxuhuodu and Reduzhisheng are the main type of radiation-induced sialadenitis,84%, and have established YangYinShengJin Qingrejiedu treatment。
2. Clinical research:MR radiotherapy patients at the end of white blood cell and lymphocyte counts were significantly higher than the radiation group (P<0.05), the remaining blood and liver and kidney function as compared with radiotherapy alone had no significant difference(P>0.05). Salivary gland scintigraphy before and after radiotherapy that MR was significantly higher than the radiotherapy group, protective effect of salivary gland cells
3. Animal studies confirmed:HuangLianshengdi decoction pair of radiotherapy in patients with white blood cells, lymphocytes can protect, and no effect on the liver and kidney function. Salivary gland scintigraphy showed HuangLianshengdi decoction on experimental rabbit salivary glands uptake and excretion function of impact, come to HuangLianshengdi decoction can improve the radiation damage,and repair radiation damage of salivary gland function.
Conclusion
1.Toxins intrinsic radioactive main pathogenesis of intestinal injury. Yinxuhuowang, Yinxuhuodu and Reduzhisheng are the basis of syndrome type. YangYinShengJin Qingrejiedu is the primary treatment.
2. Modified HuangLianshengdi decoction could improve symptoms and signs of radiation-induced sialadenitis without any side effects, so that patients could complete radiotherapy successfully.
3. The results of the animal study showed that modified HuangLianshengdi decoction could protect intestinal mucosa and accelerate its healing from radiation damages, as well as reduce the salivary inflammatory response and inhibit endotoxin translocation, protect mechanical and immune barrier function of salivary.
引文
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[52]Huncharek M,KupeInjck B.Combined chemoradiation versus radiation therarpy alone in loncally adbanced nasopharyngeal carcinoma:results of a meta-analysis of 1,528 patients from six randomized trials[J].Am J Clin Onclo,2002,25(3):219-223.
[53]Lee AW,Tung SY,Chan AT,et al.Preliminary results of a randomized study(NPC-9902 Trial)on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma[J].Int J Radiat Onclo Biol Phys,2006,66(1):142-151.
[54]Samer G,Hartwig Kosmehl,et al.A comparative study on the protection profile of Lidocaine. Amifostine, and Pilocarpin on the parotid gland during radiotherapy[J].Cancer Res2005;65:10486-10493.
[55]Lindegaard JC,Grau C.Has the outlook improved for amifostine as a clinical radioprotector[J].Radiother Oncol,2000,57(2):113.
[56]John R,Kouvaris,Vassilis E,Kouloulias,et al.Amifostine:The first selective-target and broad-spectrum radioprotector[J].The oncologist 2007; 12:738-747.
[57]Shen H,Chen ZJ,et al.Ethyol WR-1065 administrated with transfer factor affect the reaction of cell to anticancer drugs[J].Pharmacol Exp Ther,2001,297(3):1063-1073.
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[1]郑红刚,朴炳奎.浅议放化疗毒副作用的中医病因[J].中国中医基础医学杂志,2007,13(10)：751-752.
[2]李运伦.毒邪的源流及其分类诠释[J].中医药学刊,2001,18(1)：44-45.
[3]谭萍.鼻咽癌放疗与中医药的结合[J].福建中医药.1998,29(4)；27-28.
[4]张悦红.辨证治疗鼻咽癌放疗后口腔干燥症145例[J].湖南中医杂志,2002,18(1)：35-36.
[5]李红梅.辨证分型治疗放射性口咽炎160例[J].新中医,2007,39(9)：69.
[6]金红,吴湘玮,李东芳.中药减低两证型鼻咽癌放射反应50例疗效对比[J].辽宁中医杂志,2002,12：718-719.
[7]陈瑶舟,张锦龙.芦荟蜜糖液在鼻咽癌放疗病人中的应用[J].现代护理,2007,13(21)：2037.
[8]邓卓霞,周富铃.金银花含漱液对鼻咽癌放疗所致口咽并发症预防作用的探讨[J].广西医 学,2002,24(11)：1744-1745.
[9]田建明,张欢英.自拟养阴解毒汤防治头颈肿瘤放射损伤[J].光明中医,2008,23(9)：1306-1307.
[10]王旺胜.养阴清热口服液对鼻咽癌放疗所致唾液腺损伤影响的临床研究[J].时珍国医国药,2008,19(3)：729-730.
[11]蒋泽先,钱永,蒋李懿.自制中药生津剂在头颈部肿瘤放疗中对涎腺流率的影响[J].江西医学院学报,2006,46(2)：68-69,72.