陈凤　张伟　杨公涛

摘要 细胞自噬是细胞程序性调控的重要生命活动，广泛参与肺纤维化的发生发展过程。通过分析细胞自噬产生的病理生理机制探讨“伏毒”的微观机制，从微观角度揭示特发性肺纤维化中“伏毒”致病的病机及“扶正解毒法”的临床应用。可认为细胞自噬与中医正气亏虚时通过“精气转化”以保证机体的正常生命活动、湿热痰瘀实邪时通过“自我消化”以维持内环境稳态的机制是一致的。阐明中医药能够在特发性肺纤维化不同病期双向调节细胞自噬以维持机体阴阳动态平衡，标本兼治，延缓病情发展，为预防和治疗特发性肺纤维化提供新的思路和方法。

关键词 细胞自噬;伏毒;特发性肺纤维化;微观机制;扶正解毒法;精气转化自我消化;双向调节

Abstract Autophagy is an important life activity of programmed cell regulation，which is widely involved in the occurrence and development of pulmonary fibrosis.By analyzing the pathophysiological mechanism of autophagy，the microscopic mechanism of “virulent” was discussed，and the pathogenesis of “virulent” in idiopathic pulmonary interstitial fibrosis and the clinical application of “strengthening and detoxification method” were revealed from the microscopic perspective.It is believed that autophagy is consistent with the mechanism of “transformation of vital qi” to ensure the normal life activities of the body when the vital qi is deficient，and “self-digestion” to maintain the homeostasis of the internal environment when endogenous dampness and heat are induced by phlegm and blood stasis.It is expounded that Chinese medicine can bidirectionally regulate autophagy in different stages of idiopathic pulmonary fibrosis to maintain the dynamic balance of Yin and Yang，treat both the symptoms and root causes，delay the development of the disease，and provide new ideas and methods for the prevention and treatment of idiopathic pulmonary fibrosis.

Keywords Autophagy; Virulent; Idiopathic pulmonary fibrosis; Micromechanism; Strengthening body and detoxifying; Transformation of vital qi; Self-digestion; Bidirectional regulation

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.18.014

特发性肺纤维化（Idiopathic Pulmonary Fibrosis，IPF）是一种罕见的、进行性的、通常是致命的慢性纤维化性间质性肺病[1]。组织病理学上以间质性肺炎为特征，最终导致正常肺组织结构破坏。临床上多以肺组织顺应性降低，弥散功能障碍，通气/血流比例失调，表现为进行性呼吸困难，病情呈进行性发展，终末期多因呼吸衰竭而死亡[2]。IPF的发病机制尚不完全清楚，预后较差，5年死亡率超过多种癌症[3]。目前世界上用于治疗IPF的吡非尼酮和尼达尼布虽然有助于缓解症状，改善患者的肺功能和生命质量，但尚未有证据说明二者是否有助于提高患者的生存率[4]。然近年来的研究结果证实，细胞自噬（Autophagy）广泛参与了肌成纤维细胞分化、上皮间质转化和细胞外基质沉积等过程，促进肺纤维化的发生、发展，因此调控细胞自噬有可能成为防治本病的重要靶点[5]。……