程序性细胞死亡蛋白-1及其配体抑制剂免疫相关不良反应的中医病因病机及治法  

Etiology and Pathogeny Analysis and Treatment Exploration in Traditional Chinese Medicine of Immune-related Adverse Reactions of PD-1/PD-L1 Inhibitors

作　　者：陈泓志 梁伟林 顾瞻 张慧卿 CHEN Hongzhi;LIANG Weilin;GU Zhan;ZHANG Huiqing(Basic Medicine College,Naval Medical University,Shanghai 200433,China;Department of General Internal Medicine,West Medical District of Chinese PLA General Hospital,Beijing 100041,China;Department of Integrative Medicine,Shanghai Pulmonary Hospital Affiliated to Tongji University,Shanghai 200433,China;Department of Traditional Chinese Medicine,Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学基础医学院,上海200433 [2]解放军总医院京西医疗区综合内科,北京100041 [3]同济大学附属上海市肺科医院中西医结合科,上海200433 [4]海军军医大学中医系,上海200433

出　　处：《世界中医药》2021年第9期1386-1390,1399,共6页World Chinese Medicine

基　　金：国家自然科学基金青年基金项目(82004115);海军军医大学本科学员创新实践能力孵化基地(中药方剂教研室)项目(FH2018155,FH2019155)。

摘　　要：程序性细胞死亡蛋白-1及其配体(PD-1/PD-L1)抑制剂可引发与既往治疗手段不同的免疫相关不良反应。根据中医基础理论及药性理论的相关知识,尝试对PD-1/PD-L1抑制剂进行中药化性能分析,认为PD-1/PD-L1抑制剂的药物性能属辛温之品,趋向升浮,归于肺、脾、胃经,其免疫相关不良反应的主要病因为"免疫药毒",主要病机为风邪兼杂湿邪与热毒合阻于肌肤,脾胃虚弱以及气血亏虚,并提出了相应的治法,以期对免疫治疗的临床疗效及安全性的提升起到积极作用。Programmed cell death-1 and its ligand(PD-1/PD-L1)inhibitors could cause immune-related adverse reactions different from previous treatments.According to the relevant knowledge of traditional Chinese medicine(TCM)basic theories and medicinal property theories,we try to analyze the Chinese herbal properties of PD-1/PD-L1 inhibitors and think that they are warm in four qi and pungent in five flavors,have the ascending and floating nature,and enter the lung,spleen and stomach meridians.The main etiology of immune-related adverse reactions is"immune drug toxicity".The main pathogenies respectively are the exogenous pathogenic wind with dampness and heat toxicity which blocks the skin,the deficiency of spleen and stomach and the deficiency of qi and blood.Also,we propose the corresponding treatments in order to improve the clinical efficacy and safety of immunotherapy.

关 键 词：免疫治疗 免疫相关不良反应 病因分析 病机分析 中药性能 

分 类 号：R242[医药卫生—中医临床基础]