从分子水平认识和治疗胶质瘤.docVIP

从分子水平认识和治疗胶质瘤 【摘要】nbsp; 　　胶质瘤是神经系统最常见的原发性肿瘤，临床预后还不乐观。我们在临床工作中注意到即使是相同病理类型和级别的胶质瘤，治疗效果存在很大差异。治疗上的差异无疑是重要影响因素，但肿瘤内在的生物学特性，特别是分子水平的差异是关键所在。近年来,神经胶质瘤的诊断和治疗已深入到了分子水平。影像学诊断已不单纯解剖定位,还可以提供分子和功能影像参考；胶质瘤的病理诊断也在组织学分型/分级的基础上进行分子病理分类，并以此为个体化治疗提供参考；治疗开始从传统的手术/放疗/化疗深化到了分子靶向治疗。随着对胶质瘤分子病因/病理机制的深入了解，胶质瘤的临床治疗效果将会进一步提高。 【关键词】nbsp; 胶质瘤　分子病理　分子影像　分子靶向治疗 　　Understanding and Treatment for Glioma with Molecular Aspect nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Abstract: Glioma is the most common primary tumor in central nervous system(CNS) with poor prognosis. It is not uncommon that patient with same pathological profile, but the prognosis is quite different. The reasons might not be only the patient who received different treatment, but the heterogeneity of the tumor itself is also important. Currently, diagnosis and treatment for glioma have been advanced into molecular era. Molecular imaging has been introduced into neurooncology, so that functional imaging information now is available. Molecular neuropathology should become essential for diagnosis of glioma so that individualized therapy become possible. While treatment for glioma have also progressed from conventional surgery, radiation and chemotherapy to targeted molecular therapy. We can foresee that when the detailed molecular etiology has been understood, finally cured glioma should not be impossible. nbsp;nbsp;nbsp; Key words: glioma; molecular neuropathology; molecular imaging; targeted molecular therapy nbsp;nbsp;nbsp; 1 胶质瘤的分子病因 nbsp;nbsp;nbsp; 胶质瘤的确切病因是什么目前还没有明确答案。一般认为与环境、遗传和机体免疫功能失调等综合因素有关。近年胶质瘤的分子生物学研究表明，胶质瘤是一种基因病[4]，体内外各种因素使抑癌基因失活/原癌基因活化是胶质瘤发生、发展的关键。研究发现，血管内皮生长因子受体（vascular endothelial growth factor receptor，VEGFR），血小板源生长因子受体(plateletderived growth factor receptor，PDGFR) 和p53，它们作为转录因子，对细胞周期、DNA修复、遗传稳定性和细胞凋亡起重要调节作用。磷酸酯酶及张力蛋白同源物 (phopsphatase and tensin homology deleted on chromosome ten，PTEN/ mutated in multiple advanced cancers，MMAC)，恶性脑肿瘤删除基因1（gene deleted in malignant brain tumor 1, DMBT1)