{"id":4854,"date":"2023-02-19T19:33:11","date_gmt":"2023-02-19T11:33:11","guid":{"rendered":"http:\/\/dh.oncolab.cn\/index.php\/2023\/02\/19\/%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac18%e7%ab%a0%ef%bc%9a%e8%82%bf%e7%98%a4%e9%9d%b6%e5%90%91%e6%80%a7%e6%8a%97%e4%bd%93%ef%bc%88%e4%b8%8a%ef%bc%89\/"},"modified":"2023-02-19T19:33:11","modified_gmt":"2023-02-19T11:33:11","slug":"%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac18%e7%ab%a0%ef%bc%9a%e8%82%bf%e7%98%a4%e9%9d%b6%e5%90%91%e6%80%a7%e6%8a%97%e4%bd%93%ef%bc%88%e4%b8%8a%ef%bc%89","status":"publish","type":"post","link":"http:\/\/dh.oncolab.cn\/index.php\/2023\/02\/19\/%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac18%e7%ab%a0%ef%bc%9a%e8%82%bf%e7%98%a4%e9%9d%b6%e5%90%91%e6%80%a7%e6%8a%97%e4%bd%93%ef%bc%88%e4%b8%8a%ef%bc%89\/","title":{"rendered":"\u80bf\u7624\u514d\u75ab\u5b66-\u7b2c18\u7ae0\uff1a\u80bf\u7624\u9776\u5411\u6027\u6297\u4f53\uff08\u4e0a\uff09"},"content":{"rendered":"
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18.1 \u4ecb\u7ecd<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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1894\u5e74\uff0c\u5df4\u9ece\u5df4\u65af\u5fb7\u7814\u7a76\u6240\u7684Pierre-Paul Emile Roux\u535a\u58eb\u8bc1\u660e\u4e86\u901a\u8fc7\u8840\u6e05\u7597\u6cd5\u6cbb\u7597\u767d\u5589\u5177\u6709\u4e00\u5b9a\u7684\u4e34\u5e8a\u7597\u6548\u3002\u4e00\u4e2a\u4e16\u7eaa\u540e\uff0c1994\u5e74\uff0c\u7f8e\u56fd\u52a0\u5229\u798f\u5c3c\u4e9a\u5dde\u65af\u5766\u798f\u5927\u5b66\u7684Ronald Levy\u6559\u6388\u8bc1\u660e\u4e86\u6297\u4f53\u4e5f\u53ef\u4ee5\u6cbb\u7597\u764c\u75c7\u3002\u4ece\u90a3\u65f6\u8d77\uff0c\u6297\u4f53\u7684\u8bbe\u8ba1\u548c\u751f\u4ea7\u6709\u4e86\u91cd\u5927\u7684\u6539\u8fdb\uff0c\u73b0\u5728\u5b83\u4eec\u662f\u8bb8\u591a\u764c\u75c7\u7684\u5e38\u89c4\u7597\u6cd5\u7684\u4e00\u90e8\u5206\u3002<\/p>\n

\u6700\u8fd1\uff0c\u6709\u7814\u7a76\u8868\u660e\uff0c\u6297\u4f53\u4e5f\u53ef\u4ee5\u901a\u8fc7\u9776\u5411T\u7ec6\u80de\u8868\u9762\u8868\u8fbe\u7684\u5171\u6291\u5236\u53d7\u4f53\uff0c\u5728\u764c\u75c7\u60a3\u8005\u4e2d\u4ea7\u751f\u6297\u80bf\u7624\u9002\u5e94\u6027\u514d\u75ab\u3002\u5229\u7528\u8fd9\u79cd\u514d\u75ab\u8c03\u8282\u6297\u4f53\u83b7\u5f97\u7684\u4ee4\u4eba\u53ef\u559c\u7684\u7ed3\u679c\u4e3a\u80bf\u7624\u9776\u5411\u6027\u6297\u4f53\u548c\u514d\u75ab\u9776\u5411\u6027\u6297\u4f53\u7684\u534f\u540c\u7ec4\u5408\u5f00\u8f9f\u4e86\u9053\u8def\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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18.2 \u4ece\u591a\u514b\u9686\u6297\u4f53\u5230\u5355\u514b\u9686\u6297\u4f53<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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B\u7ec6\u80de\u5728\u5206\u5316\u4e3a\u6d46\u7ec6\u80de\u540e\uff0c\u4f1a\u5206\u6ccc\u53ef\u6eb6\u6027\u6297\u4f53\u5f62\u5f0f\u7684B\u7ec6\u80de\u53d7\u4f53(BCR)\u3002\u8fd9\u4e2a\u6297\u4f53\u662f\u7531\u4e24\u6761\u76f8\u540c\u7684\u91cd\u94fe\u548c\u4e24\u6761\u76f8\u540c\u7684\u8f7b\u94fe\u7ec4\u6210\u7684\u514d\u75ab\u7403\u86cb\u767d(Fig. 18.1<\/span>)<\/span>\u3002<\/p>\n

\u5728\u4eba\u4f53\u4e2d\uff0c\u514d\u75ab\u7403\u86cb\u767d\u7684\u8f7b\u94fe\u6709\u4e24\u79cd\u7c7b\u578b(\u03ba\u548c\u03bb)\uff0c\u91cd\u94fe\u6709\u4e94\u79cd\u7c7b\u578b(\u03b1\uff0c\u03b4\uff0c\u03b5\uff0c\u03b3\u548c\u03bc)\u3002\u6309\u5176\u91cd\u94fe\u7ed3\u6784\uff0c\u514d\u75ab\u7403\u86cb\u767d\u53ef\u5206\u4e3a\u4e94\u7c7b\uff1aIgA\u3001IgD\u3001IgE\u3001IgG\u548cIgM\u3002\u5176\u4e2d\uff0cIgG\u662f\u6700\u4e3b\u8981\u7684\u4e00\u7c7b\uff0c\u7ea6\u5360\u4eba\u4f53\u8840\u6e05\u4e2d\u514d\u75ab\u7403\u86cb\u767d\u768480%\u3002\u5728\u4eba\u4f53\u4e2d\uff0cIgG\u7684\u56db\u4e2a\u4e9a\u7c7b(IgG1\u3001IgG2\u3001IgG3\u548cIgG4)\u5177\u6709\u7279\u5b9a\u7684\u751f\u7269\u5b66\u7279\u6027\u3002<\/p>\n

\u514d\u75ab\u7403\u86cb\u767d\u7684\u76f8\u5bf9\u5206\u5b50\u8d28\u91cf\u7ea6\u4e3a150 kDa\u3002\u8fd9\u4e9b\u5927\u5206\u5b50\u86cb\u767d\u8d28\u53ef\u4ee5\u88ab\u86cb\u767d\u9176\u5207\u5272\u6210\u4e24\u4e2a\u90e8\u5206\uff1aFab\u7ed3\u6784\u57df\u548cFc\u7ed3\u6784\u57df\uff0cFab\u7ed3\u6784\u57df\u5305\u542b\u6297\u4f53\u7684\u76ee\u6807\u8bc6\u522b\u7ed3\u6784\u57df\uff0cFc\u7ed3\u6784\u57df\u53ef\u4ee5\u6839\u636e\u514d\u75ab\u7403\u86cb\u767d\u7c7b\u578b\u7684\u4e0d\u540c\u800c\u5177\u6709\u4e0d\u540c\u7684\u5f62\u5f0f(Fig. 18.1<\/span>)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig. 18.1<\/span> <\/span>\u6297\u4f53\u7684\u5206\u5b50\u7ed3\u6784\u3002IgA\u3001IgD\u3001IgE\u548cIgG\u7684\u6297\u4f53\u6709\u4e24\u4e2a\u6297\u539f\u7ed3\u5408\u8868\u4f4d\u3002IgA\u6297\u4f53\u53ef\u4ee5\u662f\u4e8c\u805a\u4f53\uff0cIgM\u6297\u4f53\u662f\u4e94\u805a\u4f53\u3002\u5355\u4f53\u5f62\u5f0f\u7684\u6297\u4f53\u6bcf\u4e2a\u5206\u5b50\u6709\u4e24\u4e2a\u6297\u539f\u7ed3\u5408\u4f4d\u70b9\u3002\u6297\u539f\u7ed3\u5408\u90e8\u4f4d\u4f4d\u4e8e\u6297\u4f53Fab\u90e8\u5206\u7684\u8d85\u53d8\u533a(CDR)\u3002Fab\u90e8\u5206\u53ef\u4e0e\u76f8\u5e94\u7684\u6297\u539f\u7ed3\u5408\uff0c\u7531\u4e0e\u8f7b\u94fe\u76f8\u5173\u7684\u7ed3\u6784\u57df(VL\uff0cCL)\u548c\u4e0e\u91cd\u94fe\u76f8\u5173\u7684\u7ed3\u6784\u57df(VH\uff0cCH1)\u7ec4\u6210\u3002\u6297\u4f53\u7684Fc\u90e8\u5206\u542b\u6709\u91cd\u94fe\u7684CH2\u548cCH3\u7ed3\u6784\u57df\u3002\u8be5\u6297\u4f53\u533a\u57df\u53ef\u4e0e\u591a\u79cd\u7ec6\u80de\u76f8\u5173\u53d7\u4f53(\u5982Fc\u53d7\u4f53)\u7ed3\u5408\u3002<\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u6700\u521d\u7684\u6cbb\u7597\u6027\u6297\u4f53<\/span>\u662f\u901a\u8fc7\u76ee\u7684\u6297\u539f(\u4f8b\u5982\u767d\u5589\u6bd2\u7d20)\u514d\u75ab\u5927\u578b\u52a8\u7269(\u4f8b\u5982\u9a6c)\u83b7\u5f97\u7684\uff0c\u514d\u75ab\u6548\u5e94\u53d1\u751f\u540e\uff0c\u673a\u4f53\u4f1a\u5728\u8840\u6e05\u4e2d\u4ea7\u751f\u591a\u514b\u9686\u6297\u4f53\uff0c\u8fd9\u79cd\u591a\u514b\u9686\u6297\u4f53\u53ef\u4e13\u95e8\u8bc6\u522b\u76ee\u7684\u6297\u539f\u7684\u591a\u4e2a\u8868\u4f4d\u3002\u7136\u540e\u8fd9\u4e9b\u52a8\u7269\u7684\u8840\u6e05\u53ef\u88ab\u7528\u6765\u6cbb\u7597\u75c5\u4eba(\u4f8b\u5982\u767d\u5589)\u3002\u4f46\u8be5\u591a\u514b\u9686\u6297\u4f53\u4f1a\u5bfc\u81f4\u60a3\u8005\u4ea7\u751f\u8bb8\u591a\u4e0d\u826f\u53cd\u5e94\uff0c\u4e3b\u8981\u662f\u56e0\u4e3a\u5b83\u4eec\u7684\u5f02\u4f53\u6027\u53ef\u4ee5\u88ab\u4eba\u4f53\u7684\u514d\u75ab\u7cfb\u7edf\u8bc6\u522b\u5e76\u6392\u65a5\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u79d1\u52d2\u548c\u7c73\u5c14\u65af\u5766\u57281975\u5e74\u53d1\u660e\u4e86\u6742\u4ea4\u7624\u6280\u672f\uff0c\u8be5\u6280\u672f\u53ef\u4ee5\u5f97\u5230\u5177\u6709\u6297\u539f\u7279\u5f02\u6027\u7684\u5355\u514b\u9686\u6297\u4f53\u3002\u8fd9\u9879\u6280\u672f\u662f\u901a\u8fc7\u7ed9\u556e\u9f7f\u7c7b\u52a8\u7269\uff08\u8001\u9f20\u3001\u4ed3\u9f20\u7b49\uff09\u63a5\u79cd\u4e00\u79cd\u7279\u5b9a\u7684\u6297\u539f\uff0c\u7136\u540e\u4ece\u514d\u75ab\u52a8\u7269\u7684\u813e\u4e2d\u6536\u96c6B\u7ec6\u80de\uff0c\u518d\u5c06\u8fd9\u4e9bB\u7ec6\u80de\u4e0e\u9aa8\u9ad3\u4e2d\u51fa\u73b0\u5f02\u5e38\u7684\u6d46\u7ec6\u80de(\u9aa8\u9ad3\u7624\u7ec6\u80de)\u878d\u5408\u3002<\/p>\n

\u521d\u7ea7B\u6dcb\u5df4\u7ec6\u80de\u548c\u9aa8\u9ad3\u7624\u7ec6\u80de\u4e4b\u95f4\u7684\u76f8\u4e92\u878d\u5408\u88ab\u79f0\u4e3a\u201c\u6742\u4ea4\u7624\u201d\u3002\u6742\u4ea4\u7624\u7ec6\u80de\u7684\u6df7\u5408\u7269\u7531\u591a\u4e2a\u4e0d\u540c\u7684\u521d\u7ea7B\u7ec6\u80de\u514b\u9686\u7ec4\u6210\uff0c\u6bcf\u4e2a\u514b\u9686\u53ef\u5206\u6ccc\u4e00\u79cd\u7279\u5b9a\u7684\u6297\u4f53\uff0c\u5c06\u5176\u5206\u79bb\u5230\u5355\u72ec\u7684\u7ec6\u80de\u57f9\u517b\u5b54\u4e2d\u3002\u7136\u540e\u5bf9\u8fd9\u4e9b\u5b54\u8fdb\u884c\u7b5b\u9009\uff0c\u4ece\u800c\u9274\u522b\u51fa\u542b\u6709\u5206\u6ccc\u6240\u9700\u6297\u4f53\u7684\u6742\u4ea4\u7624\u7684\u5b54\u3002\u6742\u4ea4\u7624\u53ef\u5728\u4f53\u5916\u57f9\u517b\u6269\u589e\uff0c\u5e76\u53ef\u4ece\u57f9\u517b\u4e0a\u6e05\u6db2\u4e2d\u6d53\u7f29\u548c\u7eaf\u5316\u6297\u4f53\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u81ea\u4ece\u6742\u4ea4\u7624\u6280\u672f\u88ab\u53d1\u660e\u4ee5\u6765\uff0c\u8fd8\u5f00\u53d1\u4e86\u8bb8\u591a\u5176\u4ed6\u76f8\u5173\u7684\u6280\u672f\uff0c\u76ee\u7684\u4e0d\u4ec5\u4ec5\u662f\u4e3a\u4e86\u63d0\u9ad8\u5355\u514b\u9686\u6297\u4f53\u7684\u4ea7\u91cf\uff0c\u8fd8\u4e3a\u4e86\u964d\u4f4e\u5355\u514b\u9686\u6297\u4f53\u7684\u514d\u75ab\u539f\u6027\u3002<\/p>\n

\u4e8b\u5b9e\u4e0a\uff0c\u556e\u9f7f\u52a8\u7269\u6765\u6e90\u7684\u5355\u514b\u9686\u6297\u4f53\u53ef\u4ee5\u88ab\u4eba\u7c7b\u514d\u75ab\u7cfb\u7edf\u8bc6\u522b\u4e3a\u5916\u6765\u6297\u4f53\uff0c\u4ece\u800c\u4ea7\u751f\u4eba\u7c7b\u6297\u9f20\u6297\u4f53(HAMAs)\u3002\u53d1\u5c55\u4e3a\u9ad8\u6c34\u5e73HAMA\u7684\u60a3\u8005\u4f1a\u63d0\u9ad8\u5355\u514b\u9686\u6297\u4f53\u5728\u8840\u6db2\u4e2d\u7684\u6e05\u9664\u901f\u5ea6\u3002HAMAs\u8fd8\u53ef\u80fd\u4e0e\u4e25\u91cd\u7684\u8fc7\u654f\u6216\u7c7b\u8fc7\u654f\u4e0d\u826f\u53cd\u5e94\u6709\u5173\u3002<\/p>\n

\u56e0\u6b64\uff0c\u4eba\u4eec\u60f3\u51fa\u4e86\u8bb8\u591a\u7b56\u7565\u6765\u964d\u4f4e\u556e\u9f7f\u52a8\u7269\u5355\u6297\u7684\u514d\u75ab\u539f\u6027\uff0c\u8fd9\u4e9b\u5355\u6297\u53ef\u4ee5\u4ea7\u751f\u5d4c\u5408\u7684\u9f20\/\u4eba\u5355\u6297\u6216\u4eba\u6e90\u5316\u7684\u5355\u6297\uff0c\u6700\u7ec8\u751a\u81f3\u53ef\u4ee5\u4ea7\u751f\u5168\u4eba\u6e90\u5355\u6297\u3002\u5355\u6297\u7684\u4eba\u6e90\u5316\u7a0b\u5ea6\u5728\u5176\u540d\u79f0\u4e2d\u6709\u8be6\u7ec6\u8bf4\u660e(Fig 18.2<\/span>)\u3002<\/p>\n

\u5d4c\u5408\u7684\u5355\u6297\u542b\u6709\u9f20\u7c7bFab\u7ec4\u5206\u7684\u91cd\u94fe\u548c\u8f7b\u94fe\u7684\u53ef\u53d8\u533a\uff0c\u4ece\u800c\u4fdd\u7559\u4e86\u6700\u521d\u7684\u9f20\u7c7b\u5355\u6297\u7684\u6297\u539f\u7ed3\u5408\u7279\u5f02\u6027\u3002\u8fd9\u4e9b\u53ef\u53d8\u90e8\u5206\u5728\u57fa\u56e0\u4e0a\u4e0e\u4eba\u514d\u75ab\u7403\u86cb\u767d\u6052\u5b9a\u533a(\u6052\u5b9aFab\u533a\u548c\u6052\u5b9aFc\u533a)\u878d\u5408\u5728\u4e00\u8d77\u3002         <\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u8fd9\u79cd\u5d4c\u5408\u5316\u662f\u4e00\u79cd\u4fdd\u7559\u6297\u4f53\u7684\u7279\u5f02\u6027\u548c\u4eb2\u548c\u529b\u7684\u65b9\u6cd5\uff0c\u540c\u65f6\u964d\u4f4e\u4e86\u5176\u5728\u60a3\u8005\u4f53\u5185\u7684\u514d\u75ab\u539f\u6027\u3002\u4eba\u6e90\u5316\u7684\u5355\u6297\u662f\u5c06\u4eba\u7684\u6297\u4f53\u9aa8\u67b6\u533a\u79fb\u690d\u5230\u53ef\u53d8\u533a\uff0c\u4ee5\u4fbf\u53ea\u4fdd\u7559\u5177\u6709\u6297\u539f\u7ed3\u5408\u80fd\u529b\u7684\u5c0f\u9f20\u8d85\u53d8\u533a(CDRs)\u3002<\/p>\n

\u7531\u4e8e\u8f6c\u57fa\u56e0\u5c0f\u9f20\u643a\u5e26\u4e86\u4eba\u7c7b\u514d\u75ab\u7403\u86cb\u767d\u57fa\u56e0\uff0c\u56e0\u6b64\u8fd9\u7c7b\u5c0f\u9f20\u5728\u673a\u4f53\u53d1\u751f\u514d\u75ab\u53cd\u5e94\u540e\u53ef\u4ea7\u751f\u5168\u4eba\u6e90\u5355\u6297\u3002\u5168\u4eba\u6e90\u5355\u6297\u5927\u5927\u964d\u4f4e\u4e86\u6297\u4f53\u7684\u514d\u75ab\u539f\u6027\uff0c\u56e0\u6b64\u4ec5\u4f1a\u8bf1\u53d1\u60a3\u8005\u4ea7\u751f\u8f83\u4f4e\u6c34\u5e73\u7684\u4eba\u7c7b\u6297\u4eba\u6297\u4f53(HAHAs)\u3002<\/p>\n

\u4f4e\u6548\u4ef7\u7684HAHAs\u901a\u5e38\u4e0d\u4f1a\u660e\u663e\u5f71\u54cd\u4eba\u7c7b\u5355\u6297\u7684\u836f\u4ee3\u52a8\u529b\u5b66\u7279\u5f81\uff0c\u4f46\u662f\u4f1a\u4ea7\u751f\u8f83\u4f4e\u6c34\u5e73\u7684\u8f93\u6ce8\u76f8\u5173\u53cd\u5e94(<5%\u7684\u60a3\u8005)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig. 18.2<\/span> \u5355\u6297\u540d\u79f0\u7684\u547d\u540d\u548c\u610f\u4e49\u3002\u4e0e\u9f20\u6e90\u6027\u6216\u5d4c\u5408\u578b\u5355\u6297\u76f8\u6bd4\uff0c\u4eba\u6e90\u5316\u548c\u5168\u4eba\u6e90\u5355\u6297\u7684\u514d\u75ab\u539f\u6027\u8f83\u5dee\uff0c\u56e0\u6b64\u8010\u53d7\u6027\u66f4\u597d\uff0c\u5177\u6709\u66f4\u597d\u7684\u836f\u4ee3\u52a8\u529b\u5b66\u7279\u5f81\u3002<\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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18.3 \u80bf\u7624\u6cbb\u7597\u7684\u901a\u7528\u5e73\u53f0–\u5355\u6297<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u57281982\u5e74\uff0cLevy \u7b49\u4eba\u9996\u6b21\u8bc1\u660e\u4e86B\u7ec6\u80de\u6dcb\u5df4\u7624\u60a3\u8005\u5728\u6ce8\u5c04\u4e86\u4e00\u79cd\u4ee5\u5176B\u7ec6\u80de\u6076\u6027\u80bf\u7624\u7684BCR\u4e3a\u9776\u70b9\u7684\u6297\u80bf\u7624\u5355\u6297\u540e\uff0c\u53ef\u4ee5\u6fc0\u53d1\u5bf9\u80bf\u7624\u7684\u53cd\u5e94\u3002\u8fd9\u4e9b\u6700\u521d\u7684\u6cbb\u7597\u6027\u5355\u6297\u5f00\u521b\u4e86\u80bf\u7624\u9776\u5411\u6cbb\u7597\u548c\u4e2a\u6027\u5316\u836f\u7269\u7684\u6982\u5ff5\uff0c\u4f46\u8fd9\u79cd\u65b9\u6cd5\u7684\u5c40\u9650\u6027\u5728\u4e8e\u5b83\u9700\u8981\u4e3a\u6bcf\u4e2a\u60a3\u8005\u4ea7\u751f\u4e00\u79cd\u4e2a\u6027\u5316\u7684\u6297BCR\u5355\u6297\u3002<\/p>\n

\u4e3a\u4e86\u514b\u670d\u8fd9\u4e00\u7f3a\u70b9\uff0c\u5c31\u751f\u6210\u4e86\u4e00\u79cd\u9488\u5bf9CD20\u7684\u5355\u6297\uff0cCD20\u662f\u4e00\u79cd\u901a\u5e38\u7531B\u7ec6\u80de\u8868\u8fbe\u7684\u6297\u539f\uff0c\u56e0\u6b64\u8be5\u5355\u6297\u4e5f\u53ef\u4ee5\u7528\u4e8e\u6cbb\u7597B\u7ec6\u80de\u6dcb\u5df4\u7624\u3002rituximab\uff08\u5229\u59a5\u6614\u5355\u6297\uff09\u662f\u9996\u4e2a\u83b7\u5f97FDA\u6279\u51c6\u53ef\u4ee5\u88ab\u7528\u4e8e\u764c\u75c7\u6cbb\u7597\u7684\u5355\u6297\u3002\u4ece\u90a3\u65f6\u8d77\uff0c\u8bb8\u591a\u5176\u4ed6\u80bf\u7624\u7684\u9776\u5411\u5355\u6297\u4e5f\u90fd\u5df2\u7ecf\u5728\u80bf\u7624\u5b66\u548c\u5176\u4ed6\u9002\u5e94\u75c7\u4e2d\u5f97\u5230\u6279\u51c6(Fig 18.3)<\/span>\u3002\u6700\u5e38\u89c1\u7684\u80bf\u7624\u9776\u5411\u6297\u4f53\u6709\u5728B\u7ec6\u80de\u6076\u6027\u80bf\u7624\u4e2d\u9488\u5bf9CD20\u7684\u6297\u4f53(\u5982rituximab)\uff0c\u5728HER2\u9633\u6027\u4e73\u817a\u764c\u4e2d\u9488\u5bf9HER-2\u7684\u6297\u4f53(\u5982trastuzumab)\uff0c\u4ee5\u53ca\u5728\u5934\u9888\u90e8\u9cde\u764c\u548cRAS\u91ce\u751f\u578b\u7ed3\u76f4\u80a0\u764c\u4e2d\u9488\u5bf9EGFR\u7684\u6297\u4f53(\u5982cetuximab\u897f\u59a5\u6614\u5355\u6297)\u3002<\/p>\n

\u7406\u8bba\u4e0a\uff0c\u6240\u6709\u7c7b\u578b\u7684\u6297\u539f\u90fd\u53ef\u4ee5\u6210\u4e3a\u6297\u4f53\u7684\u9776\u70b9\uff0c\u5305\u62ec\u795e\u7ecf\u8282\u82f7\u8102\u7b49\u975e\u80bd\u7c7b\u7269\u8d28\u3002\u795e\u7ecf\u8282\u82f7\u8102\u662f\u7531\u795e\u7ecf\u9798\u7cd6\u8102(\u795e\u7ecf\u9170\u80fa\u548c\u5be1\u7cd6)\u548c\u7cd6\u94fe\u4e0a\u8fde\u63a5\u7684\u4e00\u4e2a\u6216\u591a\u4e2a\u553e\u6db2\u9178\u7ec4\u6210\u7684\u5206\u5b50\u3002\u6700\u8fd1\uff0c\u5df2\u7ecf\u6709\u5b9e\u9a8c\u8bc1\u660e\u9488\u5bf9\u795e\u7ecf\u8282\u82f7\u8102GD2\u7684\u5355\u6297\u53ef\u4ee5\u63d0\u9ad8\u9ad8\u5371\u795e\u7ecf\u6bcd\u7ec6\u80de\u7624\u513f\u7ae5\u7684\u5b58\u6d3b\u7387\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 18.3<\/span> FDA\u6279\u51c6\u7684\u5355\u6297<\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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18.3.1 \u80bf\u7624\u9776\u5411\u6027\u6297\u4f53\u7684\u4f5c\u7528\u673a\u5236<\/span><\/strong><\/p>\n<\/section>\n

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\u5355\u6297\u5177\u6709\u591a\u79cd\u56fa\u6709\u7279\u6027\uff0c\u53ef\u4ee5\u7528\u6765\u5bf9\u6297\u764c\u7ec6\u80de\u3002\u6297\u80bf\u7624\u5355\u6297\u4e0e\u80bf\u7624\u7ec6\u80de\u5916\u819c\u8868\u8fbe\u7684\u80bf\u7624\u7279\u5f02\u6027\u6297\u539f\u7ed3\u5408\u540e\uff0c\u53ef\u76f4\u63a5\u8bf1\u5bfc\u80bf\u7624\u7ec6\u80de\u6b7b\u4ea1\uff0c\u4ece\u800c\u5bf9\u80bf\u7624\u7ec6\u80de\u4ea7\u751f\u76f4\u63a5\u7684\u7ec6\u80de\u6bd2\u4f5c\u7528\u3002<\/p>\n

\u7531\u4e8e\u5355\u6297\u5bf9\u80bf\u7624\u751f\u957f\u56e0\u5b50\u540c\u6837\u53ef\u53d1\u6325\u62ee\u6297\u4f5c\u7528\uff0c\u6240\u4ee5\u53ef\u4ee5\u7528\u6765\u7ed3\u5408\u8fd9\u4e9b\u751f\u957f\u56e0\u5b50\u6216\u963b\u65ad\u5b83\u4eec\u76f8\u5e94\u7684\u53d7\u4f53(Fig 18.4)<\/span>\u3002\u56e0\u6b64\uff0c\u4e5f\u53ef\u4ee5\u56e0\u5355\u6297\u5bf9\u80bf\u7624\u751f\u957f\u56e0\u5b50\u7684\u62ee\u6297\u7279\u6027\u800c\u9009\u62e9\u4e0d\u540c\u7684\u5355\u6297\u4ee5\u83b7\u5f97\u66f4\u597d\u7684\u7597\u6548\u3002<\/p>\n

\u6b64\u5916\uff0c\u5f53\u5355\u6297\u901a\u8fc7\u8c03\u7406\u4f5c\u7528\u9ecf\u9644\u5230\u764c\u7ec6\u80de\u8868\u9762\u65f6\uff0c\u5176\u8fdc\u7aef\u90e8\u5206(Fc\u7ed3\u6784\u57df)\u53ef\u5728\u5bbf\u4e3b\u514d\u75ab\u6548\u5e94\u673a\u5236\u4f5c\u7528\u4e0b\u5bf9\u9776\u7ec6\u80de\u8fdb\u884c\u7834\u574f\u3002<\/p>\n

\u9996\u5148\uff0c\u5b83\u4eec\u53ef\u4ee5\u6fc0\u6d3b\u8865\u4f53\u7cfb\u7edf\u7684\u9176\uff0c\u8fd9\u4e9b\u9176\u53ef\u4ee5\u76f4\u63a5\u653b\u51fb\u764c\u7ec6\u80de\u7684\u819c\uff0c\u6216\u8005\u901a\u8fc7\u8865\u4f53\u53d7\u4f53\u62db\u52df\u514d\u75ab\u6548\u5e94\u7ec6\u80de(CDC)\u3002<\/p>\n

\u5176\u6b21\uff0c\u5b83\u4eec\u8fd8\u53ef\u80fd\u901a\u8fc7\u6fc0\u6d3b\u5176Fc\u03b3\u53d7\u4f53(ADCC\uff0c\u6297\u4f53\u4ecb\u5bfc\u7684\u7ec6\u80de\u6bd2\u4f5c\u7528)\u6765\u6fc0\u6d3b\u7ec6\u80de\u6bd2\u6027\u5929\u7136\u514d\u75ab\u6548\u5e94\u5668\uff0c\u5982NK\u7ec6\u80de(Fig18.4)<\/span>\u3002<\/p>\n

\u6700\u540e\uff0c\u5728\u9776\u7ec6\u80de\u53d1\u751f\u8c03\u7406\u4f5c\u7528\u540e\uff0c\u5355\u6297\u7684Fc\u7ed3\u6784\u57df\u53ef\u4ee5\u901a\u8fc7\u6fc0\u6d3b\u8868\u8fbe\u5728\u5355\u6838\/\u5de8\u566c\u7ec6\u80de\u4e0a\u7684Fc\u03b3\u53d7\u4f53(Fc\u03b3R)\u6765\u8bf1\u5bfc\u5176\u5bf9\u764c\u7ec6\u80de\u7684\u541e\u566c\u4f5c\u7528(ADCP\uff0c\u6297\u4f53\u4ecb\u5bfc\u7684\u7ec6\u80de\u541e\u566c\u4f5c\u7528)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig. 18.4<\/span> \u80bf\u7624\u9776\u5411\u6027\u5355\u6297\u7684\u4f5c\u7528\u673a\u5236<\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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18.3.2 \u80bf\u7624\u9776\u5411\u6027\u5355\u6297\u7684\u5de5\u7a0b\u5316\u6539\u9020<\/strong><\/p>\n<\/section>\n

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Fc\u7ed3\u6784\u57df\u4ecb\u5bfc\u7684\u764c\u7ec6\u80de\u6b7b\u4ea1\u7684\u4f5c\u7528\u5df2\u7ecf\u5728\u56de\u987e\u6027\u4e34\u5e8a\u7814\u7a76\u4e2d\u5f97\u5230\u8bc1\u5b9e\u3002\u8fd9\u4e9b\u7814\u7a76\u8868\u660e\uff0c\u5728\u63a5\u53d7\u6297\u03b3\u5355\u6297\u6cbb\u7597\u7684B\u7ec6\u80de\u6dcb\u5df4\u7624\u60a3\u8005\u548c\u63a5\u53d7\u6297GD2\u5355\u6297\u6cbb\u7597\u7684\u513f\u7ae5\u795e\u7ecf\u6bcd\u7ec6\u80de\u7624\u60a3\u8005\u4e2d\uff0cFc\u03b3R\u57fa\u56e0\u591a\u6001\u6027\u5bf9\u9884\u540e\u6709\u4e00\u5b9a\u7684\u4ef7\u503c\u3002\u56e0\u6b64\uff0c\u5927\u591a\u6570\u80bf\u7624\u9776\u5411\u6297\u4f53\u90fd\u662f\u8bbe\u8ba1\u4e3aIgG1\u578b\u6297\u4f53\uff0c\u5176\u4e0eFc\u03b3\u53d7\u4f53CD16A(Fc\u03b3RIIIa)\u5177\u6709\u826f\u597d\u4eb2\u548c\u529b\uff0c\u5e76\u80fd\u591f\u6fc0\u6d3bNK\u7ec6\u80de\u4ee5\u6267\u884cADCC\u3002\u867d\u7136\u4f7f\u7528IgG1\u7684\u7406\u8bba\u57fa\u7840\u4e3b\u8981\u5efa\u7acb\u5728\u8840\u6db2\u7684NK\u7ec6\u80de\u4e0a\uff0c\u4f46\u6700\u8fd1\u7684\u6570\u636e\u8868\u660e\uff0cIgG2\u4e5f\u53ef\u4ee5\u901a\u8fc7\u8868\u8fbe\u9ad3\u7cfb\u7ec6\u80de\u7684Fc\u03b3R\u6765\u6267\u884cADCC\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u5728\u6297\u4f53Fc\u7ed3\u6784\u57df\u7684CH2\u533a\u57df\u5185\uff0c\u6c28\u57fa\u9178(\u7279\u522b\u662fAsn297)\u53ef\u4ee5\u53d1\u751f\u7cd6\u57fa\u5316\u3002\u6297\u4f53\u7684\u7cd6\u57fa\u5316\u7c7b\u578b\u5f71\u54cd\u6297\u4f53Fc\u03b3R\u7684\u4eb2\u548c\u529b\u53ca\u5176\u89e6\u53d1ADCC\u7684\u80fd\u529b\u3002\u76ee\u524d\u53ef\u4ee5\u6539\u9020\u5355\u6297\u7684\u7cd6\u57fa\u5316\u72b6\u6001\uff0c\u4ee5\u589e\u5f3aADCC(Fig. 18.5<\/span>)\u3002\u4f8b\u5982\uff0cobinutuzumab\uff08\u963f\u6bd4\u59a5\u73e0\u5355\u6297\uff09\u662f\u4e00\u79cd\u8131\u7cd6\u7684\u6297CD20\u5355\u6297\uff0c\u4e0erituximab\uff08\u5229\u59a5\u6614\u5355\u6297\uff09\u76f8\u6bd4\uff0c\u5176ADCC\u6548\u529b\u66f4\u5f3a\uff0c\u5df2\u4e8e2013\u5e74\u88abFDA\u6279\u51c6\u7528\u4e8e\u6cbb\u7597\u6162\u6027\u6dcb\u5df4\u7ec6\u80de\u767d\u8840\u75c5\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u7531\u4e8e\u5355\u6297\u6709\u80fd\u529b\u7279\u5b9a\u5730\u9776\u5411\u764c\u7ec6\u80de\uff0c\u56e0\u6b64\u73b0\u5728\u5b83\u4eec\u4e5f\u7528\u4e8e\u76f4\u63a5\u5c06\u6cbb\u7597\u6027\u5206\u5b50\u9776\u5411\u6027\u7684\u9012\u9001\u5230\u764c\u7ec6\u80de\u3002\u4e8b\u5b9e\u4e0a\uff0c\u5355\u6297\u53ef\u4ee5\u4e0e\u7ec6\u80de\u6bd2\u6027\u5206\u5b50\u76f8\u5173\u8054\uff0c\u4f8b\u5982\u76ee\u524d\u5728\u6025\u6027\u9ad3\u7cfb\u767d\u8840\u75c5\u4e2d\u5f00\u53d1\u7684\u6297CD33 getuzumab ozogamicin (Mylotarg*)\uff0c\u6216\u76ee\u524d\u88ab\u6279\u51c6\u7528\u4e8e\u970d\u5947\u91d1\u6dcb\u5df4\u7624\u7684\u65b0\u7684\u6297CD30 Brentuximab vedotin\uff08\u5e03\u59a5\u6614\u5355\u6297\uff09(Adcetris\u00ae<\/sup>)\u3002\u5355\u6297\u4e5f\u53ef\u5236\u5907\u6210\u5177\u6709\u653e\u5c04\u6027\u6807\u8bb0\u7684\u5206\u5b50\uff0c\u4f8b\u598290Y-ibritumomab(Zvalin\u00ae<\/sup>)\uff0c\u8fd9\u662f\u4e00\u79cd\u5728\u975e\u970d\u5947\u91d1\u6dcb\u5df4\u7624\u4e2d\u5f00\u53d1\u4e14\u6539\u826f\u7684\u6297CD20\u6297\u4f53\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 18.5<\/span> \u5355\u6297\u7684\u7cd6\u57fa\u5316\u72b6\u6001\u3002\u5c06N-\u4e59\u9170\u6c28\u57fa\u8461\u8404\u7cd6\u4e00\u5206\u4e3a\u4e8c(\u7ea2\u8272)\u53ef\u589e\u5f3aFc\u53d7\u4f53\u5355\u6297\u7684\u4eb2\u548c\u529b\uff0c\u5e76\u589e\u5f3a\u5176\u89e6\u53d1\u6297\u4f53\u884d\u751f\u7ec6\u80deADCC\u7684\u80fd\u529b\u3002<\/span><\/span><\/p>\n

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\u672c<\/span>\u6587\u7531Oncolab\u5fae\u4fe1\u516c<\/span>\u4f17\u53f7<\/span>\u7ffb\u8bd1\u6574\u7406<\/span>\u81eaOncoimmunology: A Practical Guide for Cancer Immunotherapy\uff0c\u4ec5\u7528\u4e8e\u5b66\u4e60\u4ea4\u6d41\u4f7f\u7528\uff0c\u5982\u9700\u8d2d\u4e70\u539f\u7248\u4e66\u7c4d\u53ef<\/span>\u70b9\u51fb\u9605\u8bfb\u539f\u6587\u8d2d\u4e70\u3002<\/span><\/span><\/section>\n

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\u2014 THE  END \u2014<\/span><\/section>\n

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\u6765\u6e90 |<\/span>Oncoimmunology: A Practical Guide <\/span><\/section>\n
for Cancer Immunotherapy<\/span><\/section>\n
\u4f5c\u8005 | Aur\u00e9lien Marabelle<\/span><\/section>\n
\u7ffb\u8bd1 | \u5f90\u66fc\u65af \u6f58\u541b\u541b \u674e\u5b89\u742a<\/span><\/section>\n
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\u8be5\u661f\u7403\u7528\u4e8eOncoLab\u516c\u4f17\u53f7\u8bfb\u8005\u4ea4\u6d41\u5b66\u4e60\u4f7f\u7528\uff0c\u6c38\u4e45\u514d\u8d39<\/span>\u3002<\/span><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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\u672c\u7bc7\u6587\u7ae0\u6765\u6e90\u4e8e\u5fae\u4fe1\u516c\u4f17\u53f7:OncoLab<\/p>\n<\/blockquote>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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