药源性肺间质纤维化常见病因及其防治
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摘要
药物诱发肺间质纤维化是较为常见的药物不良反应,治疗用药是否会诱发或加重肺间质纤维化是临床医务人员需要关注的问题。文献报道很多细胞毒类药物和非细胞毒类药物均可引起肺损伤,前者主要包括烷化剂(白消安、卡莫司汀、环磷酰胺)、抗肿瘤抗菌药物(博来霉素、丝裂霉素)、抗代谢类药物(甲氨蝶呤)等;后者包括抗心律失常药物(胺碘酮)及抗菌药物(呋喃妥因)等。此外,吉非替尼、利妥西单抗等新型靶向抗肿瘤药物的肺纤维化亦较为明确。本文对这些药物导致的肺损伤从作用机制、发生率、防治措施等方面进行归纳总结,为临床合理用药提供参考依据。
Drug-induced pulmonary fibrosis is a commonly adverse drug reaction. Medical staff should pay more attention to the medications which can induce or aggravate pulmonary fibrosis. It has been reported that both cytotoxic drugs and non-cytotoxic drugs can cause lung injury. The former mainly includes alkylating agents(busulfan, carmustine, cyclophosphamide), antitumor antibiotics(bleomycin, mitomycin) and antimetabolite drugs(methotrexate). The latter includes anti-arrhythmic drug(amiodarone) and antibiotics(nitrofurantoin). In addition, pulmonary fibrosis caused by new targeted anticancer drugs such as gefitinib, rituximab were also reported. Here we summarized these medications from the aspects of mechanism, incidence and prevention, aiming at providing evidence and reference for appropriate drug application.
Drug-induced pulmonary fibrosis is a commonly adverse drug reaction. Medical staff should pay more attention to the medications which can induce or aggravate pulmonary fibrosis. It has been reported that both cytotoxic drugs and non-cytotoxic drugs can cause lung injury. The former mainly includes alkylating agents(busulfan, carmustine, cyclophosphamide), antitumor antibiotics(bleomycin, mitomycin) and antimetabolite drugs(methotrexate). The latter includes anti-arrhythmic drug(amiodarone) and antibiotics(nitrofurantoin). In addition, pulmonary fibrosis caused by new targeted anticancer drugs such as gefitinib, rituximab were also reported. Here we summarized these medications from the aspects of mechanism, incidence and prevention, aiming at providing evidence and reference for appropriate drug application.
引文
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[12]张宝玺,赵晓庆,马夫天.儿童急性淋巴细胞白血病化疗后急性肺损伤1例[J].中国小儿血液与肿瘤杂志,2008,13(3):131-132.
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[14]徐钦星,任振义,王利民.药物性肺损伤三例[J].中华临床医师杂志(电子版),2012,6(2):517-518.
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[17]吴志勇,张肖,孙胜杰,等.吉非替尼致间质性肺炎并囊样薄壁空洞形成一例[J].中国临床药理学与治疗学,2012,17(3):280-281.
[18]张闽光,王建萍,殷晓聆,等.吉非替尼所致致死性间质性肺病临床和CT表现(附2例报告及文献复习)[J].中国中西医结合影响学杂志,2008,6(4):241-243.
[19]王超颖.常用抗肿瘤药物相关性肺损伤[J].中国肺癌杂志,2009,12(7):826-830.
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[21]熊海林.分子靶向抗肿瘤药物与间质性肺疾病[J].肿瘤防治研究,2011,38(5):597-600.
[22]钱炎均,郭随章,顾海娟.小分子靶向抗肿瘤药物的不良反应以及防治[R].2010-2010年第五次中美医院药学服务高级论坛.
[23]刘一,胡小龙,王东,等.利妥昔单抗致肺损伤五例及文献复习[L].中国呼吸与危重监护杂志,2012,11(3):262-266.
[24]Kimby E.Tolerability and safety of rituximab(MabTheral)[J].Caner Treat Rev,2005,31:456-473.
[25]Huang YC,Liu CJ,Liu CY,et al.Low absolute lymphocyte count and addition of rituximab confer high risk for interstitial pneumonia in patients with diffuse large B-cell lymphoma[J].Ann Hematol,2011,90:1145-1151.
[26]窦文琴,顾秋君,陈志高.利妥昔单抗致间质性肺炎一例[J].中国药学杂志,2013,48(13):1130
[27]Liote H,Liote F,Seroussib,et al.Rituximab induced lung disease:A systematic literature review[J].Eur Respir J,2010,35(3):681-687.
[28]韩佳容,邹梅娟,程刚.西妥昔单抗联合放疗的不良反应及其防治[J].中国新药与临床杂志,2013,32(7):589-594.
[29]邓玲慧,陶敏.常用抗肿瘤药物相关肺毒性[J].国际肿瘤学杂志,2012,39(8):584-587.
[30]唐连涛,江涛.特发性肺纤维化治疗进展[J].医学综述,2012,18(9):1309-1311.
[2]张素芬,郭步云,王海林等.白血病肺脏损害的临床及病理[J].中华内科杂志,1994,33(2):99-102.
[3]许志祥,胡华成.抗癌药物的非毒性[J].国外医学内科学分册,1994,21(8):327-329.
[4]王志伟,宋伟安.卡莫司汀致间质性肺炎一例[J].中国肺癌杂志,2008,11(4):607-608.
[5]O'Driscoll BR,Kalra S,Gattamaneni HR,et al.Late carmustine lung?brosis.Age at treatment may in?uence severity and survival[J].Chest.1995,107(5):1355-1357.
[6]张呈菊,钱蓓丽.药物诱导的肺纤维化.世界临床药物,2007,28(8):504-508.
[7]杨聪颖,彭雄群,阳惠湘,等.不同剂量博来霉素诱导小鼠肺纤维化的差异及动态变化[J].中国实验动物学报,2013,21(2):45-51.
[8]任华益,黄平,丁慧萍.博来霉素的肺毒性反应及其防治[J].药物不良反应杂志,2002,5:312-314.
[9]杨梅,汤致强.抗肿瘤药物的不良反应及防治措施[J].中国新药杂志,2008,17(21):1889-1893.
[10]王慧杰,张湘如,王绿化.抗肿瘤药物的肺损伤[J].国外医学肿瘤学分册,2005,32(5):391-394.
[11]李旭英,欧阳取长,涂晓燕.丝裂霉素引起的非毒性一例[J].中国癌症杂志,2002,12(2):192.
[12]张宝玺,赵晓庆,马夫天.儿童急性淋巴细胞白血病化疗后急性肺损伤1例[J].中国小儿血液与肿瘤杂志,2008,13(3):131-132.
[13]夏洪颖,任晓明.胺碘酮非毒性的研究进展[J].医药导报,2010,29(6):758-760.
[14]徐钦星,任振义,王利民.药物性肺损伤三例[J].中华临床医师杂志(电子版),2012,6(2):517-518.
[15]D'Acry PF.Nitrofurantoin[J].Drug Intell Clin Pharm,1985,19(7-8):540-547.
[16]倪莲芳,刘新民,高莉.吉非替尼致急性肺损伤-附1例报道[J].中国肺癌杂志,2011,14(2):173-175.
[17]吴志勇,张肖,孙胜杰,等.吉非替尼致间质性肺炎并囊样薄壁空洞形成一例[J].中国临床药理学与治疗学,2012,17(3):280-281.
[18]张闽光,王建萍,殷晓聆,等.吉非替尼所致致死性间质性肺病临床和CT表现(附2例报告及文献复习)[J].中国中西医结合影响学杂志,2008,6(4):241-243.
[19]王超颖.常用抗肿瘤药物相关性肺损伤[J].中国肺癌杂志,2009,12(7):826-830.
[20]Yoneda KY,Shelton DK,Beckett LA.Independent review of interstitial lung disease associated with death in TRIBUTE(paclitaxel and carboplatin with or without concurrent erlotinib)in advanced non-small cell lung cancer[J].J Thorac Oncol,2007,2(6):537-543.
[21]熊海林.分子靶向抗肿瘤药物与间质性肺疾病[J].肿瘤防治研究,2011,38(5):597-600.
[22]钱炎均,郭随章,顾海娟.小分子靶向抗肿瘤药物的不良反应以及防治[R].2010-2010年第五次中美医院药学服务高级论坛.
[23]刘一,胡小龙,王东,等.利妥昔单抗致肺损伤五例及文献复习[L].中国呼吸与危重监护杂志,2012,11(3):262-266.
[24]Kimby E.Tolerability and safety of rituximab(MabTheral)[J].Caner Treat Rev,2005,31:456-473.
[25]Huang YC,Liu CJ,Liu CY,et al.Low absolute lymphocyte count and addition of rituximab confer high risk for interstitial pneumonia in patients with diffuse large B-cell lymphoma[J].Ann Hematol,2011,90:1145-1151.
[26]窦文琴,顾秋君,陈志高.利妥昔单抗致间质性肺炎一例[J].中国药学杂志,2013,48(13):1130
[27]Liote H,Liote F,Seroussib,et al.Rituximab induced lung disease:A systematic literature review[J].Eur Respir J,2010,35(3):681-687.
[28]韩佳容,邹梅娟,程刚.西妥昔单抗联合放疗的不良反应及其防治[J].中国新药与临床杂志,2013,32(7):589-594.
[29]邓玲慧,陶敏.常用抗肿瘤药物相关肺毒性[J].国际肿瘤学杂志,2012,39(8):584-587.
[30]唐连涛,江涛.特发性肺纤维化治疗进展[J].医学综述,2012,18(9):1309-1311.