免疫检查点抑制剂相关口腔黏膜炎的病机及治法  

Pathogenesis and Treatment of Oral Mucosal Immune Related Oral Mucosal Inflammation

作　　者：吴静远 朱潇雨 李杰[2] WU Jingyuan;ZHU Xiaoyu;LI Jie(Graduate School of Beijing University of Chinese Medicine,Beijing China 100029;Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijing China 100053)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中国中医科学院广安门医院,北京100053

出　　处：《中医学报》2025年第4期723-727,共5页Acta Chinese Medicine

基　　金：国家重点研发计划“中医药现代化”专项资助项目(2023YFC3503300);国家中医药传承创新团队项目(ZYYCXTD-C-202205);首都卫生发展科研专项重点攻关项目(首发2022-1-4151);中国中医科学院科技创新工程重大攻关项目(CI2021A01802)。

摘　　要：免疫检查点抑制剂相关口腔黏膜炎可归属于中医“口糜”范畴。基于《黄帝内经》“火气内发,上为口糜”条文,口糜的发生是外来免疫药物药性偏热,过量引动体内气机妄动,内火上犯于口。结合免疫治疗的周期性,将口糜分为症状发作期、间歇期和复发期,对应T细胞窜动肆虐-实火上炎、T细胞蕴积蛰伏-郁火耗气、T细胞弥散难遏-相火复燃3个阶段。治疗时以气火并治为指导原则,以清火降气、升阳益气、引火纳气分期治之。Oral mucosal inflammation associated with immune checkpoint inhibitors can be attributed to the category of"aphthous stomatitis"in traditional Chinese medicine.Based on the article that"Fire Qi internal production inducing aphthous stomatitis"in Huang Di Nei Jing,the occurrence of the disease is attributed to the Heat of foreign immune drugs,which overdose triggers the internal Qi to move,and the internal Fire goes up to the mouth.Combined with the cycle of immunotherapy,it is divided into symptomatic onset,intermittent and recurrent phases,corresponding to the three phases of T cell movement and rampage-excess Fire inflammation,T cell accumulation and hibernation-depressed Fire consuming Qi,and T cell dispersion and difficult to curb-Xiang Fire rekindling.The treatment is guided by the principle of simultaneous treatment of Qi and Fire,with methods of clearing Fire and lowering Qi,elevating Yang and benefiting Qi as well as inducing Fire and inducing Qi.

关 键 词：免疫检查点抑制剂 口腔黏膜炎 火气内发 恶性肿瘤 T细胞 病机 治疗 口糜 

分 类 号：R276.881.5[医药卫生—中医五官科学]