吕梦宇 裘关关 裘淼 熊中奎

[摘要] 放射性肺炎是胸部肿瘤放疗常见的严重并发症，虽然放疗技术有了革命性的提高，但放射性肺炎的发生率仍不低，严重者将危及生命。放射性肺炎一旦发展至放射性肺纤维化将不可逆转，故预防放射性肺炎的发生尤为重要。放射性肺炎的临床表现主要为呼吸困难、咳嗽、发热及肺衰竭，常用糖皮质激素及抗生素治疗。隨着放疗技术的不断发展，放射性肺炎日渐受到重视。本文着重介绍放射性肺炎的诊断、防治手段及相关最新研究进展。

[关键词] 放射性肺炎;放疗;抗肿瘤;防治;综述

[中图分类号] R563.1          [文献标识码] A          [文章编号] 1673-9701（2021）06-0187-06

Advances in diagnosis and treatment of radiation pneumonia

LYU Mengyu1   QIU Guanguan1   QIU Miao2   XIONG Zhongkui2

1.Department of Pharmacy， Shaoxing Second Hospital in Zhejiang Province， Shaoxing   312000， China; 2.Department of Tumor Radiotherapy， Shaoxing Second Hospital in Zhejiang Province， Shaoxing   312000， China

[Abstract] Radiation pneumonia is a common serious complication of chest tumor radiotherapy. Although the radiotherapy technology has a revolutionary improvement， the incidence of radiation pneumonia is still not low， and severe cases will be life-threatening. Radiation pneumonia will be irreversible once it develops into radiation pulmonary fibrosis， so preventing radiation pneumonitis is particularly important. The main clinical manifestations of radiation pneumonia are dyspnea， cough， fever and lung failure. Glucocorticoids and antibiotics are commonly used in treatment. With the continuous development of radiotherapy technology， radiation pneumonitis has been paid more and more attention. This article focuses on the diagnosis， prevention and treatment of radiation pneumonitis and the latest research progress.

[Key words] Radiation pneumonia; Radiotherapy; Anti-tumor; Prevention and treatment; Review

放射性肺炎（Radiation induced pneumonitis，RP）是因接受放射治疗而引起的肺部炎症，为放射性肺损伤（Radiation induced lung injury）的早期阶段。RP是胸部肿瘤放疗，特别是肺癌放疗最常见的并发症之一。RP常导致放疗中断，进而影响放疗疗效或延误治疗，导致患者生活质量下降，严重者可危及生命。RP的发生率为5%～36%，由此造成的呼吸衰竭是放射性肺损伤的主要致死原因之一[1]。虽然随着放疗技术的不断提高及放疗靶区的不断优化，放射性肺损伤的发生率和严重程度已明显下降[2]，但目前其发生率仍无法忽视，且RP一旦发生，将直接影响患者的治疗效果和生存质量。目前针对放射性肺纤维化无特效治疗方法，故如何防治RP是当前胸部肿瘤放疗必须面对的重要课题[3]。

1 RP的发生机制

胸部放疗导致的肺损伤可分为两个阶段，早期阶段，即RP，发生于放疗后6个月以内;晚期阶段，即放射性肺纤维化，发生于放疗后6个月以后。……