免疫检查点抑制剂相关性肺炎发病及治疗的中医思考  

Pathogenesis Analysis and Treatment Exploration in Traditional Chinese Medicine of Immune Checkpoint Inhibitor-related Pneumonitis

作　　者：陈晨[1] 贾立群[2] 娄彦妮[2] 索菲娅 郑佳彬 Chen Chen;Jia Liqun;Lou Yanni;Suo Feiya;Zheng Jiabin(Beijing University of Chinese Medicine,Beijing 100000,China)

机构地区：[1]北京中医药大学,北京100000 [2]中日友好医院,北京100000

出　　处：《中国中医急症》2022年第3期425-428,432,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金青年科学基金项目(81904003);北京市自然科学基金项目(7202184)。

摘　　要：免疫检查点抑制剂相关性肺炎是恶性肿瘤患者免疫治疗的常见不良反应,目前机制尚未明确,治疗效果不理想。本文结合免疫治疗药物的中药化属性、免疫治疗相关肺炎易感人群的特征及其临床表现等,探讨免疫治疗相关肺炎的中医病机及治法。免疫治疗药物的中药属性为性阳热、升浮,味辛,归肺、脾、胃、肝经,易伤阴而生内热。免疫治疗相关肺炎的病机以肺之气阴两虚,或肺肾两虚,兼有肺中痰瘀阻滞络脉,络脉不通为主。治疗原则包括扶正与通络;扶正以益气养阴及补肺益肾为主;通络以化瘀通络、祛痰通络为主。本文探讨免疫治疗相关性肺炎的发病及治疗的中医认识,以期为临床应用提供参考。Immune checkpoint inhibitor-related pneumonitis is a common adverse reaction of immunotherapy in patients with malignant tumors.At present,the mechanism is not clear,and the treatment effect is not ideal.This paper aims to discuss the pathogenesis and traditional Chinese medicine treatment of immunotherapy-related pneumonitis by combining the Chinese herbal properties of immunotherapy drugs,the characteristics of susceptible population of immunotherapy-related pneumonitis and its clinical manifestations.The traditional Chinese medicine properties of immunotherapeutic drugs are heat in four qi,and pungent in five flavors,having the nature of ascending and floating,and entering the lung,spleen,stomach and liver meridians,which may hurt yin and produce internal heat.The pathogenesis of immunotherapy-related pneumonitis is mainly deficiency of qi and yin of lung,or deficiency of lung and kidney,with phlegm and blood stasis in the lung blocking the collaterals,which causes collateral obstruction.The treatment principles include strengthening body resistance and removing collateral obstruction.The principle of strengthening body resistance includes replenishing qi and nourishing yin,and nourishing kidney and lung.The principle of removing collateral obstruction includes removing stasis and removing phlegm.This article discusses the pathogenesis and treatment of immunotherapy associated pneumonitis in traditional Chinese medicine,in order to provide reference for clinical application.

关 键 词：肺炎 免疫检查点抑制剂 中医 理论研究 

分 类 号：R563.1[医药卫生—呼吸系统]