中西医治疗特发性肺纤维化的研究进展

Research Progress in Integrative Chinese and Western Medicine for the Treatment of Idiopathic Pulmonary Fibrosis

摘要: 特发性肺纤维化(IPF)是一类病因不明、进展缓慢但预后较差的间质性肺疾病，其病理核心为肺泡上皮反复损伤后的异常修复、成纤维细胞增殖与细胞外基质过度沉积。现代研究显示，免疫炎症、氧化应激、自噬及内质网应激等多重分子信号通路共同参与纤维化进程，IL-17A、SLC19A2、IFI44等分子或成为潜在干预靶点。西医治疗方面，尼达尼布、吡非尼酮等抗纤维化药物可延缓疾病进展，但疗效有限且个体差异明显；N-乙酰半胱氨酸等辅助治疗在早期炎症期可能具有一定意义。中医将IPF归属“肺痿”“肺痹”范畴，病机以虚、痰、瘀、毒及络病理论为核心，强调扶正祛邪、益气养阴。补阳还五汤、清燥救肺汤、络通纤溶饮等方剂在实验中显示可调控抗氧化、自噬及血管生成通路。中西医结合治疗在改善症状、提高肺功能及生活质量方面具有优势，但机制关联与安全性仍需更多循证研究。本文综述特发性肺纤维化的病因病机、现代西医与中医的治疗进展及中西医结合的机制研究与临床应用前景，为基于证型–分子标志物的个体化治疗与高质量临床试验提供理论依据与研究方向。

Abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterized by unknown etiology, progressive fibrosis, and poor prognosis. The core pathological processes include repeated alveolar epithelial injury followed by abnormal repair, fibroblast proliferation, and excessive extracellular matrix deposition. Current evidence indicates that immune dysregulation, oxidative stress, autophagy imbalance, and endoplasmic reticulum stress jointly drive fibrosis progression, while molecules such as IL-17A, SLC19A2, and IFI44 may serve as emerging therapeutic targets. In Western medicine, antifibrotic agents such as nintedanib and pirfenidone have shown efficacy in slowing lung function decline, though clinical benefit varies and disease reversal remains limited. N-acetylcysteine may provide early-phase anti-inflammatory protection. Traditional Chinese medicine (TCM) classifies IPF under “Feiwei” or “Feibi,” attributing pathogenesis to deficiency, phlegm, blood stasis, toxicity, and collateral impairment. Classical prescriptions including Buyang Huanwu Decoction, Qingzao Jiufei Decoction, and Luotong Xianrong Yin have demonstrated regulatory effects on oxidative stress, autophagy, and angiogenesis in experimental studies. Integrated TCM-WM therapy offers potential advantages in symptom relief, pulmonary function improvement, and quality-of-life enhancement. This article mainly reviews the etiology and pathogenesis of IPF, advances in Western medicine and traditional Chinese medicine treatments, and the mechanistic and clinical prospects of integrative therapy, providing a theoretical basis and research directions for pattern-based, biomarker-driven individualized treatments and high-quality clinical trials.