放射性肺损伤的机制与预测标志物研究进展
Recent Progress in Understanding the Mechanisms and Predictive Biomarkers of Radiation-Induced Lung Injury
DOI: 10.12677/acm.2025.15102799, PDF,   
作者: 刘煜芬：西安医学院研究生工作部，陕西 西安；张 亮*：西安市第三医院胸外科，陕西 西安
关键词: 放射性肺损伤；生物标志物；预测模型；影像组学；Radiation-Induced Lung Injury； Biomarkers； Predictive Models； Radiomics
摘要: 放射性肺损伤(Radiation-Induced Lung Injury, RILI)是胸部肿瘤患者接受放疗后的常见并发症，主要表现为早期的放射性肺炎(Radiation Pneumonitis, RP)和晚期的肺纤维化(Radiation-Induced Lung Fibrosis, RILF)，严重影响患者的生活质量和预后。尽管随着放疗技术的发展，尽管现代放疗技术已显著提升，但RILI的发生率仍不容忽视。RILI的发生是一个由多因素、多机制构成的复杂病理生理过程，始于辐射诱导的氧化应激与DNA损伤，继而触发免疫炎症级联反应，最终在多种信号通路的驱动下导致肺组织纤维化。同时，RILI的预测策略也从依赖传统的剂量学参数，发展到整合血清生物标志物、影像组学特征以及人工智能相关的多组学预测模型。本文将围绕RILI的发病机制、潜在的预测生物标志物以及人工智能在预测模型中的应用等方面进行系统综述，旨在为RILI的早期预警、个体化治疗方案的制定以及未来研究方向提供理论依据和前沿展望。
Abstract: Radiation-induced lung injury (RILI) is a frequent complication in patients with thoracic malignancies undergoing radiotherapy. Clinically, it manifests as early-phase radiation pneumonitis (RP) and late-phase radiation-induced lung fibrosis (RILF), both of which markedly compromise quality of life and long-term prognosis. Although modern radiation techniques have substantially improved dose conformity and normal-tissue sparing, the incidence of RILI remains non-negligible. Pathophysiologically, RILI is a multifactorial process that begins with radiation-induced oxidative stress and DNA damage, followed by a cascade of immune-inflammatory responses and, ultimately, fibrotic remodeling of lung tissue driven by diverse signaling pathways. Correspondingly, predictive strategies have evolved from reliance on traditional dosimetric indices to integrative models that combine circulating biomarkers, radiomic features, and artificial-intelligence-enabled multi-omics approaches. This review comprehensively summarizes current knowledge on the mechanistic underpinnings of RILI, potential predictive biomarkers, and the application of artificial intelligence in predictive modeling. Our goal is to provide a theoretical foundation and forward-looking perspective to facilitate early warning, individualized treatment planning, and future research directions for RILI.
文章引用：刘煜芬, 张亮. 放射性肺损伤的机制与预测标志物研究进展[J]. 临床医学进展, 2025, 15(10): 619-626. https://doi.org/10.12677/acm.2025.15102799

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