药源性肺间质纤维化常见病因及其防治

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。

Clinical Drug-induced Interstitial Pulmonary Fibrosis and its Prevention

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.