放射性肺炎的诊断和治疗

Diagnosis and treatment of radiation pneumonia

放射性肺炎(RP)为放射性肺损伤的一部分,其损伤与修复是由众多细胞和细胞因子等参与和相互作用的复杂的病理生理过程,给予早期诊断和治疗可减轻肺损伤,保护肺功能。临床症状和体征与感染性肺炎没有明显特异性差别,但症状轻,白细胞总数升高不明显或仅中性分类稍高。糖皮质激素有刺激白细胞升高的作用,宜使用前行检查。CT扫描诊断RP敏感,可用于分期、指导治疗和预后的判断,其肺损伤改变可能会落后于症状7~10 d。RP的治疗除了止咳祛痰等对症处理外,糖皮质激素的治疗是关键。建议使用长效的地塞米松或泼尼松,个体化较小剂量开始,依病情调整至有效的剂量并维持至3~4周,激素缓慢减量以避免病情反复。冲击疗法容易导致剂量过量或不足,而不足可导致反复性RP的发生。

Radiation pneumonia is a part of radiation-induced lung injury,and its injury and repair is a complex pathophysiological process involving with the participation and interaction among numerous cells and cytokines.Early diagnosis and treatment of radiation pneumonia can alleviate lung injury and protect lung fuction.Compared with infectious pneumonia,there is no obvious difference in symptoms and physical signs.However,the symptoms are relatively mild,the total count of white blood cells is not significantly elevated or only the classification of neutrophils is relatively high.Hormone can stimulate the increase of white blood cells,which should be delivered prior to relevant examination.CT scan is a sensitive tool to make the diagnosis of radiation pneumonia,which can be utilized for staging,guiding treatment and prognosis evaluation.The lung injury changes of radiation pneumonia on CT scan can be observed 7-10 d later than relevant symptoms.Besides symptomatic treatment,such as cough relief and phlegm elimination,hormone is the key treatment of radiation pneumonia.It is recommended to deliver long-acting dexamethasone or prednisone with an initial small dose,adjusted to effective dose according to disease condition,maintained for 3-4 weeks,and gradually reduced to avoid the recurrence of radiation pneumonia.Pulse therapy for hormone is likely to lead to insufficient or excessive dose and affect the therapeutic effect.Insufficient dose can cause the occurrence of recurrent radiation pneumonia.