陈泓志 梁伟林 顾瞻 张慧卿

摘要 程序性细胞死亡蛋白-1及其配体（PD-1/PD-L1）抑制剂可引发与既往治疗手段不同的免疫相关不良反应。根据中医基础理论及药性理论的相关知识，尝试对PD-1/PD-L1抑制剂进行中药化性能分析，认为PD-1/PD-L1抑制剂的药物性能属辛温之品，趋向升浮，归于肺、脾、胃经，其免疫相关不良反应的主要病因为“免疫药毒”，主要病机为风邪兼杂湿邪与热毒合阻于肌肤，脾胃虚弱以及气血亏虚，并提出了相应的治法，以期对免疫治疗的临床疗效及安全性的提升起到积极作用。

关键词 免疫治疗;免疫相关不良反应;病因分析;病机分析;中药性能

Etiology and Pathogeny Analysis and Treatment Exploration in Traditional Chinese Medicine of Immune-related Adverse Reactions of PD-1/PD-L1 Inhibitors

CHEN Hongzhi1， LIANG Weilin2， GU Zhan3， ZHANG Huiqing4

（1 Basic Medicine College， Naval Medical University， Shanghai 200433， China; 2 Department of General Internal Medicine， West Medical District of Chinese PLA General Hospital， Beijing 100041， China; 3 Department of Integrative Medicine， Shanghai Pulmonary Hospital Affiliated to Tongji University， Shanghai 200433， China; 4 Department of Traditional Chinese Medicine， Naval Medical University， Shanghai 200433， China）

Abstract Programmed cell death-1 and its ligand （PD-1/PD-L1） inhibitors could cause immune-related adverse reactions different from previous treatments. According to the relevant knowledge of traditional Chinese medicine （TCM） basic theories and medicinal property theories， we try to analyze the Chinese herbal properties of PD-1/PD-L1 inhibitors and think that they are warm in four qi and pungent in five flavors， have the ascending and floating nature， and enter the lung， spleen and stomach meridians. The main etiology of immune-related adverse reactions is “immune drug toxicity”. The main pathogenies respectively are the exogenous pathogenic wind with dampness and heat toxicity which blocks the skin， the deficiency of spleen and stomach and the deficiency of qi and blood. Also， we propose the corresponding treatments in order to improve the clinical efficacy and safety of immunotherapy.

Keywords Immunotherapy; Immune-related adverse reactions; Etiology analysis; pathogeny analysis; Properties of Chinese medicinal herbs

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.09.007

肿瘤免疫治疗是一种通过调动机体的免疫系统，增强抗肿瘤免疫力，从而抑制和杀伤肿瘤细胞的治疗方式[1]。近年来，肿瘤的免疫治疗因其对于常规疗法无效的晚期肿瘤具有显著疗效而受到极大关注，并于2013年被Science杂志评为年度十大科技突破之首，为晚期肿瘤治疗带来新的希望[2]。目前免疫治疗，特别是免疫检查点抑制剂在多种恶性肿瘤的治疗中已取得突破性进展，开启了肿瘤免疫治疗的新篇章。免疫检查点抑制剂是一种通过抑制免疫检查点活性，释放肿瘤微环境中的免疫刹车，重新激活对肿瘤的免疫应答效应的新型抗瘤药物[3]。其中，程序性细胞死亡蛋白-1及其配体（PD-1/PD-L1）抑制剂是目前最常用的免疫治疗药物，临床治疗恶性黑色素瘤、非小细胞肺癌、胃癌、肾细胞癌等多……