放射性肺损伤研究进展

Research progress of radiation-induced lung toxicity

放射性肺损伤(radiation-induced lung toxicity,RILT)是肺癌、食管癌等胸部肿瘤放射治疗引起的常见且较为严重的副反应,包括早期的急性放射性肺炎和晚期的放射性肺纤维化。由于肺对放射线较为敏感,当其接受一定的放疗剂量时就可能发生放射性损伤。目前放射性肺损伤的发生机制尚不清楚,且缺乏有效的预测指标和治疗措施,不仅限制了肿瘤的放疗剂量,而且严重影响患者的后续治疗及生活质量,成为提高胸部肿瘤放疗疗效的瓶颈。近年来的研究发现放射性肺损伤不仅与肺的受照剂量和体积密切相关,也与多种细胞因子的表达及信号传导有关,如炎症细胞浸润、炎性细胞因子失衡、氧化损伤等均参与了放射性肺损伤的发病过程。此外,患者的体能状况也与放射性肺损伤的发生有关。因此,放射性肺损伤的发生是多种因素相互作用的复杂过程。目前临床上主要是通过抗菌药物及糖皮质激素等应用来对症处理肺的放射性炎症,总体效果欠佳,更缺少对放射性肺纤维化确切有效的防治办法,因此放射性肺损伤的机制及临床防治研究具有重要的意义。近年来,放射性肺损伤的研究已成为热点,人们对放射性肺损伤发生机制有了更深入的研究,在临床防治方面的研究也有了一定的突破,如应用细胞因子抑制剂、基因治疗、中西医药物、干细胞移植等。本文就放射性肺损伤的发生机制、临床相关影响因素及临床防治研究进展等综述如下。

Radiation-induced lung toxicity(RILT),caused by lung,esophageal thoracic tumor radiation therapy,the common and serious side effects,include the early acute radiation pneumonia and late radiation pulmonary fibrosis.Because the lungs are sensitive to radiation,radiation damage may occur when they receive a certain dose of radiation.At present,the mechanism of radioactive lung toxicity is still unclear,and there is a lack of effective prediction indicators and treatment measures,which not only limits the radiotherapy dose of tumor,but also seriously affects the follow-up treatment and quality of life of patients,becoming a bottleneck to improve the efficacy of radiotherapy for chest tumor.Recent studies have found that radioactive lung toxicity is not only closely related to the exposed dose and volume of the lung,but also related to the expression and signal transduction of various cytokines,such as inflammatory cell infiltration,inflammatory cytokine imbalance,and oxidative injury,which are all involved in the pathogenesis of radioactive lung toxicity.In addition,the patient’s physical condition is also related to the occurrence of radioactive lung toxicity.Therefore,the occurrence of radioactive lung toxicity is a complex process of interaction of many factors.At present,antibiotics and glucocorticoids are mainly used in clinical treatment of lung radiation inflammation,but the overall effect is not good.Because of the lack of effective prevention and treatment of radioactive pulmonary fibrosis,so the mechanism of radioactive lung toxicity and clinical prevention and treatment research is of great significance.In recent years,the research on radioactive lung toxicity has become a hot spot.People have made more in-depth research on the mechanism of radioactive lung injury and made certain breakthroughs in clinical prevention and treatment,such as the application of cytokine inhibitors,gene therapy,Chinese and western medicine,stem cell transplantation,etc.This article reviews the mechanism,clinical factors and clinical prevention and treatment of radioactive lung toxicity.