Cooper J A, Matthay R A
Dis Mon. 1987 Feb;33(2):61-120. doi: 10.1016/0011-5029(87)90021-6.
Administration of more than 40 separate pharmacologic agents has been associated with some form of pulmonary toxicity. This problem is becoming more significant every year. Occasionally, effective modes of therapy must be withdrawn because of undesirable pulmonary side effects, putting patients at risk for potentially lethal diseases. Pulmonary parenchymal damage due to drugs is an especially troublesome problem because irreversible pulmonary disease may occur. Mechanisms of pulmonary parenchymal tissue damage by drugs are unclear. It appears that some drugs induce direct tissue injury in addition to indirect tissue damage through amplification of pulmonary inflammation; other drugs cause pulmonary alterations solely through indirect mechanisms. Common clinical syndromes associated with drug-induced pulmonary parenchymal disease include pneumonitis/fibrosis, hypersensitivity lung disease, and noncardiogenic pulmonary edema. Less common patterns of pulmonary parenchymal injury by drugs include bronchiolitis obliterans and a pulmonary renal syndrome. Risk factors for pulmonary injury due to pharmacologic agents are partially defined but not entirely understood. To date, there are no adequate tests for early detection of pulmonary damage by drugs, although research into this area is active. This review discusses mechanisms and clinical features of drug-induced pulmonary parenchymal injury to aid the clinician in recognizing and understanding these syndromes.
使用40多种不同的药物已被发现与某种形式的肺毒性有关。这个问题正逐年变得更加严重。有时，由于不良的肺部副作用，必须停用有效的治疗方式，使患者面临潜在致命疾病的风险。药物引起的肺实质损伤是一个特别棘手的问题，因为可能会发生不可逆的肺部疾病。药物导致肺实质组织损伤的机制尚不清楚。似乎有些药物除了通过加剧肺部炎症间接造成组织损伤外，还会引起直接的组织损伤；其他药物仅通过间接机制导致肺部改变。与药物性肺实质疾病相关的常见临床综合征包括肺炎/肺纤维化、过敏性肺病和非心源性肺水肿。药物引起的肺实质损伤较少见的类型包括闭塞性细支气管炎和肺肾综合征。药物导致肺损伤的危险因素部分已明确，但尚未完全了解。迄今为止，尚无足够的检测方法可早期发现药物引起的肺损伤，尽管该领域的研究很活跃。本综述讨论药物性肺实质损伤的机制和临床特征，以帮助临床医生识别和理解这些综合征。
