放射性肺损伤

Radiation induced lung injury

放射性肺损伤是胸部肿瘤放射治疗引起的并发症,一般有两种表现形式,早期急性放射性肺炎和后期放射性纤维化。发病机理研究主要为病理学观察,归纳起来主要有分子生物学机制、肺Ⅱ型上皮细胞损伤、血管内皮细胞受损和自由基等。损伤的发生与照射野、放射剂量、分割方式等有关。总照射剂量低于36GY无放射性肺炎发生,低于40GY无纤维化发生。其病理改变随着照射后时间延长逐渐加重,肺泡是主要受损部位。基本病变为肺充血、水肿、肺间质增厚纤维化。CT、X线是临床最常用检查方法,表现为毛玻璃样斑片状高密度影,与正常组织分界清。放射性肺损伤不可逆转,预防比治疗更为重要。本文综述了近几年放射性肺损伤各方面研究进展。

Radiation induced lung injury is a kind of complication by radiotherapy of thoracic region tumour . There are two patte.rns of manifestation in general ,early stage of acute radiation pneumonia and later stage of radiation fibrosis. Pathogeny investigation is mainly wall pathology observation, which include molecular biology mechanism, lung Ⅱ epithelial damage , vascular endothelial cell damage , free radical and so on. The damage is related with exposure field, radiation dose, dissection modality and so on. There is no radiation pneumonia while total irradiation dose is lower than 36Gy, and no fibrosis lower than 40Gy. The pathology change aggravate gradually with postradiation time extension, pulmonary alveolus is the main damage location. Fundamental pathological changes are pulmonary congestion, edema,lung interstitial tissue thickening and fibrosis. CT, X-ray are the most frequently used examination method , which findings are observed with ground-glass opacity, patchy high density fibrosis, and demarcation is dear with normal tissue. Induced lung injury can not be reversed, so to prevent beforehand is more important than to treat. This article overviews all around investigation advancement in recent several years.