抗肿瘤药物诱导的机化性肺炎的研究进展

doi:10.12114/j.issn.1007-9572.2021.01.035

中国全科医学 ›› 2022, Vol. 25 ›› Issue (14): 1772-1778.DOI: 10.12114/j.issn.1007-9572.2021.01.035

所属专题：呼吸疾病文章合辑；肿瘤最新文章合辑；用药最新文章合辑

抗肿瘤药物诱导的机化性肺炎的研究进展

潘婷¹^,², 孙铁英¹^,²^,^*()

1. 100730　北京市，北京医院呼吸与危重症医学科国家老年医学中心　中国医学科学院老年医学研究院
2. 100730　北京市，北京协和医学院研究生院　中国医学科学院

收稿日期:2021-12-19 修回日期:2022-01-15 出版日期:2022-03-24 发布日期:2022-04-07
通讯作者: 孙铁英
潘婷，孙铁英.抗肿瘤药物诱导的机化性肺炎的研究进展[J].中国全科医学，2022，25（14）：1772-1778. [www.chinagp.net]
作者贡献：潘婷进行文章的构思与设计、资料收集整理、撰写论文并对文章负责；孙铁英负责文章的质量控制和审校，对文章整体负责，监督管理。

Progress of Anticancer Drug-induced Organizing Pneumonia

Ting PAN¹^,², Tieying SUN¹^,²^,^*()

1. Department of Respiratory Medicine and Critical Care, Beijing Hospital, National Center of Gerontology/Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
2. Graduate School of Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing 100730, China

Received:2021-12-19 Revised:2022-01-15 Published:2022-03-24 Online:2022-04-07
Contact: Tieying SUN
About author:
PAN T, SUN T Y. Progress of anticancer drug-induced organizing pneumonia[J]. Chinese General Practice, 2022, 25 (14) : 1772-1778.

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摘要/Abstract

摘要： 药物引起的肺损害越来越受到重视，其中最常见的表现是间质性肺疾病（ILD），已有不少研究探讨药物诱导的ILD（DIILD）的诊断、治疗及预后，但DIILD中仍有很多亚型，根据病理不同可分为普通型间质性肺炎、非特异性间质性肺炎、机化性肺炎（OP）、过敏性肺炎、弥漫性肺泡损伤等，每一亚型的治疗和管理策略可能存在差异，需要进一步阐明。本文聚焦于DIILD中较为常见的OP亚类，定义药物诱导的OP（DIOP），对药物中最常见的抗肿瘤药物进行研究，了解抗肿瘤药物潜在的致OP机制，研究DIOP的诊断、鉴别诊断、治疗及预后，旨在更好地指导抗肿瘤药物诱导的OP相关诊疗。

关键词: 肺疾病，间质性, 机化性肺炎, 抗肿瘤药, 糖皮质激素类, 综述

Abstract:

Drug-induced lung injury has received more and more attention. The most common pattern is interstitial lung disease. The diagnosis, treatment and prognosis of drug-induced interstitial lung disease (DIILD) have been explored in many researches. However, there are still many subtypes of DIILD, including usual interstitial pneumonia, non-specific interstitial pneumonia, organizing pneumonia, hypersensitivity pneumonia and diffuse alveolar damage depending on the pathology. Each subtype may be different in treatment and management and further clarification is needed. This paper focused on the common subcategory of organizing pneumonia, naming it as drug-induced organizing pneumonia (DIOP) , explored the most common anticancer drugs, understood the potential mechanism of anticancer drugs to cause OP, and explored the diagnosis, differential diagnosis, treatment and prognosis of DIOP, so as to make a better guide on the diagnosis and treatment of organizing pneumonia induced by anticancer drugs.

Key words: Lung diseases, interstitial, Organizing pneumonia, Antineoplastic agents, Glucocorticoids, Review

潘婷,孙铁英. 抗肿瘤药物诱导的机化性肺炎的研究进展[J]. 中国全科医学, 2022, 25(14): 1772-1778. DOI: 10.12114/j.issn.1007-9572.2021.01.035.
Ting PAN,Tieying SUN. Progress of Anticancer Drug-induced Organizing Pneumonia[J]. Chinese General Practice, 2022, 25(14): 1772-1778. DOI: 10.12114/j.issn.1007-9572.2021.01.035.

图/表 8

表1 诱导OP的抗肿瘤药物分类

Table 1 Classification of anticancer drugs inducing organizing pneumonia

	种类	代表药物
传统化疗药物	抗肿瘤抗生素抗代谢药铂类拓扑异构酶抑制剂蛋白酶体抑制剂	博来霉素阿扎胞苷、吉西他滨、地西他滨奥沙利铂伊立替康硼替佐米
分子靶向药物	mTOR抑制剂 TKI抑制剂 EGFR抑制剂 ALK抑制剂抗CD20抑制剂	雷帕霉素、依维莫司西妥昔单抗、吉非替尼克唑替尼、塞来替尼利妥昔单抗
免疫治疗药物	CTLA-4抑制剂 PD-1抑制剂 PD-L1抑制剂	ipilimumab nivolumab，pembrolizumab durvalumab
临床试验新药^a	抗体药物偶联物 PI3K/AKT/mTOR抑制剂表观遗传学药物

图1 阿扎胞苷使用21 d后CT：邻近胸膜的实变影伴周围磨玻璃影及支气管充气征（引自文献[47]）

Figure 1 CT after 21 days of azacitidine use：consolidation of adjacent pleura with surrounding ground-glass shadow and bronchial inflation sign

图2 依维莫司使用4周后CT：支气管中心性实变伴双侧广泛轻微网状影及间隔增厚（引自文献[25]）

Figure 2 CT after 4 weeks of everolimus use：central bronchial consolidation with bilateral extensive slight reticular shadow and septal thickening

图3 Nivolumab使用4个月后CT：中下肺外周及胸膜下多发实变影（引自文献[36]）

Figure 3 CT after nivolumab use for 4 months：multiple consolidations in the periphery of the middle and lower lung and subpleural

图4 另一患者nivolumab使用4个月后CT：外周及胸膜下为主的多发实变影（引自文献[36]）

Figure 4 Another patient's CT after using nivolumab for 4 months：multiple consolidations predominantly in the periphery and under the pleura

图5 阿扎胞苷，CT引导下穿刺活检病理：机化性肺炎，慢性非特异性炎症伴巨噬细胞（引自文献[15]）

Figure 5 Azacitidine，CT-guided needle biopsy pathology：organizing pneumonia，chronic non-specific inflammation with macrophages

图6 依维莫司，肺楔叶切除组织病理：机化性肺炎，伴急性肺损伤的特征（引自文献[25]）

Figure 6 Everolimus，pulmonary cuneiectomy histopathology：organizing pneumonia，with features of acute lung injury

图7 Pembrolizumab，支气管镜下肺活检病理：机化性肺炎，肺泡间隔增厚，轻度慢性炎症（引自文献[49]）

Figure 7 Pembrolizumab，pathology of lung biopsy under bronchoscopy：organizing pneumonia，thickening of the alveolar compartment，mild chronic inflammation

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抗肿瘤药物诱导的机化性肺炎的研究进展

Progress of Anticancer Drug-induced Organizing Pneumonia

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