Koj puas tau pom tias koj tus cwj pwm tso quav hloov pauv, mob plab, lossis muaj ntshav hauv koj cov quav tsis ntev los no? Tsis txhob tsis quav ntsej cov tsos mob no, xav tias lawv yog ib txwm muaj. Tej zaum lawv yog cov cim qhia txog mob qog noj ntshav hauv plab hnyuv. Niaj hnub no, peb tab tom tham txog ib hom mob qog noj ntshav hauv plab hnyuv uas tshwj xeeb me ntsis, tab sis kuj muaj hmoo me ntsis. Nws hu ua MSI-H.
Hais yooj yim xwb, tus mob qog nqaij hlav MSI-H no yog dab tsi?
Yuav kom nkag siab qhov no, cia peb xub saib cov DNA hauv peb lub cev cov cell. Xav txog peb cov DNA zoo li ib txoj saw ntev. Cov saw no muaj cov hlaws dai zoo ib yam txuas rau nws dua thiab dua. Cov ntu DNA rov ua dua no hu ua microsatellites.
Tam sim no, thaum peb lub cev cov cell faib thiab cov cell tshiab tau tsim, cov qauv ntawm cov DNA saw no tau ua. Qee zaum qhov yuam kev (kev hloov pauv) tuaj yeem tshwm sim thaum cov qauv no tau ua. Tab sis tsis txhob txhawj, peb lub cev muaj ib lub kaw lus zoo li 'tub ceev xwm uas nrhiav qhov yuam kev'. Nws hu ua Mismatch Repair (MMR) system. Nws kuaj xyuas qhov yuam kev hauv cov qauv DNA thiab kho lawv tam sim ntawd.
Txawm li cas los xij, hauv qee cov hlwb qog noj ntshav, lub kaw lus MMR no tsis ua haujlwm zoo. Peb hu nws tias dMMR (kev kho DNA tsis sib xws tsis zoo). Tom qab ntawd, vim tias tsis muaj leej twg kho qhov yuam kev hauv cov DNA theej, qhov yuam kev sib sau ua ke thiab DNA dhau los ua tsis ruaj khov heev. Qhov ntawd yog qhov xwm txheej nrog cov microsatellites tsis ruaj khov heev, uas peb hu ua MSI-H (Microsatellite Instability-High) .
Qhov xav tsis thoob yog, qhov "tsis ruaj khov" ntawm DNA no qee zaum yog qhov zoo. Cov mob qog noj ntshav MSI-H teb tau zoo dua rau kev kho mob hu ua immunotherapy dua li lwm hom mob qog noj ntshav. Tsis tas li ntawd xwb, lawv txoj kev xav zoo ib yam.
Cov tsos mob ntawm tus mob qog nqaij hlav MSI-H yog dab tsi?
Tej zaum cov tsos mob yuav tsis tshwm sim tas li, tab sis yog tias cov tsos mob tshwm sim, lawv zoo ib yam li cov mob qog nqaij hlav plab hnyuv.
| Pawg tsos mob | Tej yam yuav tau saib |
|---|---|
| Kev hloov pauv ntawm kev txav mus los ntawm txoj hnyuv | Raws plab, cem quav, lossis xav tias puv nkaus tom qab tso quav. |
| Ntshav hauv cov quav | Cov quav xim av tsaus los yog dub, los yog los ntshav ntawm lub qhov quav. |
| Mob plab tsis xis nyob | Mob plab, o. |
| Lwm yam ntxwv ntawm lub cev | Qaug zog yam tsis paub meej, poob phaus, tsis xav noj mov. |
Tseem Ceeb: Tsis yog txhua tus neeg uas muaj cov tsos mob no muaj mob qog noj ntshav. Txawm li cas los xij , yog tias koj muaj ntshav hauv koj cov quav lossis mob plab hnyav, mus ntsib kws kho mob tam sim ntawd. Yog tias lwm cov tsos mob tseem muaj ntau tshaj ob lub lis piam, koj yuav tsum nrhiav kev pab kho mob.
Qee zaum, thawj qhov cim qhia tias muaj mob qog noj ntshav no yog kev kuaj ntshav uas qhia tias muaj cov qe ntshav liab tsawg (anemia). Qhov no yog vim muaj ntshav hauv cov hnyuv.
Cov ua rau thiab cov yam ntxwv uas ua rau mob qog noj ntshav MSI-H
Qhov ua rau mob qog noj ntshav MSI-H yog qhov tsis zoo ntawm cov noob caj noob ces MMR uas peb tau tham txog ua ntej. Cov no feem ntau tshwm sim thaum lub neej ntawm ib tus neeg, tsis muaj laj thawj tshwj xeeb.
Tiamsis kwv yees li ntawm 5% ntawm cov neeg uas muaj mob qog noj ntshav hauv plab hnyuv, qhov teeb meem no tau kis mus rau ntau tiam neeg. Peb hu qhov no ua Lynch syndrome . Yog tias ib tug neeg hauv koj tsev neeg muaj tus mob no, koj kuj muaj feem yuav mob qog noj ntshav hauv plab hnyuv ntau dua.
Tsis tas li ntawd xwb, muaj tej yam hauv peb txoj kev ua neej uas ua rau muaj kev pheej hmoo ntawm mob qog noj ntshav ntau ntxiv.
| Cov yam ntxwv uas peb tswj tsis tau | Cov yam txaus ntshai uas peb tswj tau |
|---|---|
| Muaj hnub nyoog tshaj 50 xyoo | Kev rog dhau |
| Muaj keeb kwm tsev neeg muaj mob qog nqaij hlav plab hnyuv | Kab mob ntshav qab zib hom 2 |
| Cov kab mob caj ces xws li Lynch syndrome | Haus luam yeeb |
| Muaj cov kab mob xws li Crohn's kab mob | Haus dej cawv ntau dhau |
| Muaj polyps hauv plab hnyuv | Noj nqaij liab thiab nqaij ua tiav ntau dhau |
Yuav kuaj mob li cas?
Yog koj tus kws kho mob xav tias muaj mob qog noj ntshav vim koj cov tsos mob, nws yuav xa koj mus kuaj ntau zaus.
1. Kev kuaj mob plab hnyuv loj: Muab ib lub raj yas uas muaj lub koob yees duab txuas rau hauv lub qhov quav los kuaj tag nrho lub plab hnyuv loj. Lub sijhawm no, yuav muab ib daim nqaij me me los ntawm thaj chaw uas muaj kev xav tias muaj teeb meem coj mus kuaj. Qhov no hu ua kev kuaj nqaij me me .
2. Kev kuaj mob molecular: Kev kuaj tshwj xeeb raug ua los nrhiav kev hloov pauv caj ces, piv txwv li MSI-H xwm txheej, hauv cov qauv nqaij uas tau los ntawm kev kuaj mob. Cov thev naus laus zis xws li IHC , PCR , thiab NGS raug siv rau qhov no.
3. Kev kuaj duab: Cov kev ntsuas xws li CT thiab MRI raug ua los saib seb tus mob qog noj ntshav puas tau kis mus rau lwm lub cev.
Cov kev kho mob rau mob qog noj ntshav MSI-H yog dab tsi?
Kev kho mob nyob ntawm theem ntawm tus mob qog noj ntshav thiab nws kis mus deb npaum li cas. Muaj ob txoj kev xaiv kho mob tseem ceeb.
Kev phais mob
Yog tias tus mob qog tsis tau kis mus rau lwm qhov chaw, thawj kauj ruam yog phais tshem tawm cov qog. Hom kev phais yuav txawv nyob ntawm qhov loj ntawm tus mob qog.
Tshuaj
Qhov no yog qhov uas qhov tshwj xeeb ntawm mob qog noj ntshav MSI-H los ua si.
- Kev kho mob tiv thaiv kab mob: Qhov no yog kev kho mob tseem ceeb thiab ua tiav zoo tshaj plaws rau mob qog noj ntshav MSI-H.Xav txog peb cov hlwb tiv thaiv kab mob zoo li muaj lub khawm 'rau'/'kaw'. Cov hlwb mob qog noj ntshav qee zaum ua ntse kaw lub khawm no thiab nkaum ntawm peb lub cev tiv thaiv kab mob. Cov tshuaj kho mob tiv thaiv kab mob (checkpoint inhibitors) kaw lub khawm 'kaw' ntawd rov qab, pab lub cev tiv thaiv kab mob nrhiav thiab rhuav tshem cov hlwb mob qog noj ntshav.
- Kev Kho Mob Siv Tshuaj Kho Mob: Muab cov tshuaj muaj zog los tua cov hlwb qog noj ntshav. Qee zaum siv ua ntej lossis tom qab phais.
- Kev Kho Mob Targeted: Muab cov tshuaj uas tsom thiab nres cov protein lossis cov txheej txheem tshwj xeeb uas pab cov hlwb qog noj ntshav loj hlob.
Nyob nrog mob qog noj ntshav MSI-H
Nws yog ib qho tseem ceeb heev uas yuav tsum tswj kom muaj kev noj qab haus huv ntawm lub cev thiab lub hlwb zoo thaum lub sijhawm kho mob qog noj ntshav.
- Kev Noj Haus: Tom qab phais mob, ua raws li koj tus kws kho mob cov lus qhia thiab noj zaub mov uas yooj yim zom thiab muaj protein ntau. Nws yog qhov zoo tshaj plaws los txo qhov kev noj cov khoom noj uas ua rau muaj roj (piv txwv li, zaub qhwv, taum) thiab cov nqaij ua tiav.
- Kev Ua Si: Kev ua si yooj yim xws li kev taug kev ntau li ntau tau yuav pab tau koj lub cev thiab lub siab heev. Tab sis nrog koj tus kws kho mob tham ua ntej pib ua ib qho kev tawm dag zog twg.
- Kev noj qab haus huv ntawm lub hlwb: Nws yog ib qho ib txwm muaj uas yuav ntxhov siab thiab ntshai thaum lub sijhawm zoo li no. Tsis txhob khaws koj txoj kev xav cia rau hauv koj lub siab. Tham nrog ib tus neeg uas koj ntseeg siab, koj tsev neeg, thiab nrhiav kev pab los ntawm tus kws pab tswv yim kev noj qab haus huv ntawm lub hlwb yog tias tsim nyog.
Mob qog noj ntshav MSI-H muaj tus nqi kho tau zoo dua piv rau lwm hom mob qog noj ntshav hauv plab hnyuv, tshwj xeeb tshaj yog tias kuaj pom thaum ntxov, thiab kev kho mob xws li kev kho mob tiv thaiv kab mob tuaj yeem ua rau muaj txiaj ntsig zoo heev.
Cov Lus Qhia Txog Kev Coj Mus Tsev
- MSI-H yog ib hom mob qog nqaij hlav hauv plab hnyuv uas cov qe ntshav qog muaj qhov tsis zoo hauv lawv lub cev kho DNA (MMR).
- Vim yog qhov "tsis ruaj khov" no, cov mob qog noj ntshav no teb tau zoo heev rau kev kho mob tiv thaiv kab mob.
- Yog koj muaj cov tsos mob ntsig txog mob qog noj ntshav hauv plab hnyuv (kev hloov pauv ntawm cov quav, mob plab, los ntshav), tsis txhob tso tseg thiab mus ntsib koj tus kws kho mob tam sim ntawd.
- Cov mob qog nqaij hlav MSI-H muaj feem yuav kho tau zoo yog tias kuaj pom thaum ntxov. Yog li ntawd, nws yog ib qho tseem ceeb uas yuav tsum tsis txhob ntshai thiab nrhiav kev kho mob kom zoo.
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Tsis muaj lus teb tau muab tso tawm. Ntxiv koj cov lus tawm ntawm no thawj zaug.
Ntxiv koj cov lus