中医药调控肺癌辐射治疗作用机制研究进展

Regulatory Mechanism of Radiation Therapy for Lung Cancer with Traditional Chinese Medicine:A Review

肺癌是全球范围内发病率和死亡率增长最快的癌症类型,对于人群生命健康构成巨大威胁。辐射治疗是肺癌治疗的主要方法之一,肺癌的局部控制率与辐射剂量呈明显的剂量-效应学关系,但肺为辐射剂量受限器官,肺癌组织的辐射抵抗和正常组织的辐射损伤限制了肺癌辐射疗效。肺癌中医病机为正气先虚,邪气内侵,渐积而成。肺癌辐射治疗后,机体正气愈虚,痰凝气滞、瘀血阻络更甚,导致肺癌组织辐射抗性产生并增强。因此,使用药物提升肺癌细胞的辐射敏感性和改善正常肺组织的辐照耐受性是显著提高肺癌患者辐射治疗临床疗效的关键问题。中医药作为辐射增敏剂,通过调节细胞周期增加辐射敏感期细胞比例、促进促凋亡基因上调及抗凋亡基因下调诱导细胞凋亡、增强辐照引起的脱氧核糖核酸(DNA)损伤和抑制损伤修复、改善血液循环及组织供氧等机制提高肿瘤细胞对辐照的敏感性,放大辐射对肿瘤组织的损伤。中医药也可作为辐射防护剂,通过抑制细胞损伤、调节细胞因子和免疫平衡、减少炎症因子和纤维化因子释放及抑制相关信号通路激活等方面发挥防治放射性肺损伤的作用。该文对近年来中医药肺癌辐射增敏及辐射防护相关研究成果进行系统梳理,旨在阐明中医药调控肺癌辐射治疗作用机制,为中医药参与肺癌辐射治疗改善肺癌患者预后提供更多的理论和实践依据。

Lung cancer is the fastest-growing cancer type in terms of incidence and mortality worldwide,posing a huge threat to the health and life of the population.Radiation therapy is one of the main methods for treating lung cancer,and there is a clear dose-effect relationship between the radiation dose and local control rate of lung cancer.However,the lung is a radiation dose-limiting organ,and the radiation resistance of lung cancer tissues and the radiation damage to normal tissues limit the radiation efficacy for lung cancer.The pathogenesis of lung cancer in traditional Chinese medicine(TCM)is characterized by an initial deficiency in vital Qi,followed by the internal invasion and gradual accumulation of pathogenic Qi.After radiation therapy for lung cancer,the body's vital Qi becomes weaker,and syndromes of phlegm coagulation,Qi stagnation,and static blood blocking collaterals become more severe,leading to radiation resistance of lung cancer tissues.Therefore,the key issue to better clinical efficacy of radiation therapy for lung cancer patients is to use drugs to enhance the radiation sensitivity of lung cancer cells and improve the radiation tolerance of normal lung tissues.TCM can be used as a radiation sensitizer by regulating the cell cycle to increase the proportion of cells in the radiationsensitive phase,promoting upregulation of pro-apoptotic genes and downregulation of anti-apoptotic genes to induce cell apoptosis,enhancing DNA damage caused by radiation and inhibiting damage repair,improving blood circulation and tissue oxygen supply,and so on,to enhance the sensitivity of tumor cells to radiation and amplify the toxicity of radiation to tumor tissues.TCM can also be used as a radiation protector by inhibiting cell damage,regulating cytokines and immune balance,reducing the release of inflammatory and fibrotic factors,and inhibiting the activation of related signaling pathways to prevent and treat radiation-induced lung injury.This article systematically reviewed the research results of TCM on radiation sensitization and radiation protection in lung cancer in recent years,aiming to elucidate the mechanism of TCM in regulating the effect of radiation therapy for lung cancer and provide more theoretical and practical basis for TCM to participate in improving the prognosis of lung cancer patients undergoing radiation therapy.