作者投稿
专家审稿
编辑办公
邮件订阅
RSS
-
-
北京协和医院感染内科李太生教授等经过4年研究，在国际上率先报道了中国艾滋病病毒(human immunodeficiency virus，HIV)感染者14. 6%合并乙型肝炎病毒(hepatitis B virus，HBV)感染，但高共感率并未影响到目前国产一线抗艾药物的疗效和肝毒性。相关论文5月17日在线发表于全球艾滋病研究领域最著名的杂志《艾滋病》上，与5月10日出版的《新英格兰医学杂志》呼吁全球警惕艾滋病合并乙肝病毒感染带来的肝损伤严重后果形成呼应。
经过长期规范的“鸡尾酒”治疗后，艾滋病患者体内病毒得到有效控制，由机会性感染引发的艾滋病患者死亡率逐年下降。与此同时，合并肝脏、肾脏、心血管及神经系统的疾病以及糖尿病等代谢性疾病，正成为影响艾滋病患者健康状况的主因。2008年，李太生教授意识到，摸清HIV感染人群中究竟有多少人合并HBV感染，合并感染对艾滋病的起病、发展及治疗会带来哪些影响，对乙肝高发的中国乃至东南亚国家和地区的艾滋病防控工作具有重要的现实意义。
自2008年起，李太生带领课题组从全国12个医疗中心募集了550例HIV感染者纳入该项研究，对这些从未接受过“鸡尾酒”疗法和其他抗艾治疗的初治患者免费发放国产一线抗艾药物，并依乙肝“两对半”的情况将患者分为从未感染组、既往感染组、慢性乙肝组以及单纯乙肝核心抗体阳性组4大组别，进行长达48周的随访观察。结果发现，HIV感染人群中14. 6%合并感染慢性乙肝，合并感染者CD4水平相对较低。分析原因，可能是二者感染途径相同、HIV感染后免疫力的下降使乙肝感染率提高所致。值得欣慰的是，研究同时发现，目前国产一线抗艾药物对HIV感染者的治疗效果并不受是否感染HBV的影响，产生肝毒性的几率也较小。
(北京协和医院党委综合办 段文利)
-
[1] Siena S, Sartore-Bianchi A, Di Nicolantonio F, et al. Biomarkers predicting clinical outcome of epidermal growth factor receptor-targeted therapy in metastatic colorectal cancer[J]. J Natl Cancer Inst, 2009, 101 : 1308-1324. DOI: 10.1093/jnci/djp280
[2] Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer[J]. N Engl J Med, 2004, 351:337-345. DOI: 10.1056/NEJMoa033025
[3] Van Cutsem E, Siena S, Humblet Y, et al. An open-label, single-arm study assessing safety and efficacy of panitumumab in patients with metastatic colorectal cancer refractory to standard chemotherapy[J]. Ann Oncol, 2008, 19:92-98. DOI: 10.1093/annonc/mdm399
[4] McCubrey JA, Steelman LS, Chappell WH, et al. Roles of the Ra.MEK/ERK pathway in cell growth, malignant transformation and drug resistance[J]. Biochim Biophys Acta, 2007, 1773:1263-1284. DOI: 10.1016/j.bbamcr.2006.10.001
[5] McCubrey JA, Steelman LS, Abrams SL, et al. Roles of the RAF/MEK/ERK and PI3K/PTEN/AKT pathways in malignant transformation and drug resistance[J]. Adv Enzyme Regul, 2006, 46:249-279. DOI: 10.1016/j.advenzreg.2006.01.004
[6] Lievre A, Bachet JB, Boige V, et al. KRAS mutations as an independent prognostic factor in patients with advanced colorectal cancer treated with cetuximab[J]. J Clin Oncol, 2008, 26:374-379. DOI: 10.1200/JCO.2007.12.5906
[7] Jonker DJ, O'Gallaghan GJ, Karapetis CS, et al. Cetuximab for the treatment of colorectal cancer[J]. N Engl J Med, 2007, 357:2040-2048. DOI: 10.1056/NEJMoa071834
[8] Karapetis CS, Khambata-Ford S, Jonker DJ, et al. K-ras mutations and benefit from cetuximab in advanced colorectal cancer[J]. N Engl J Med, 2008, 359: 1757-1765. DOI: 10.1056/NEJMoa0804385
[9] Bokemeyer C, Bondarenko I, Hartmann JT, et al. K-RAS status and efficacy of first-line treatment of patients with metastatic colorectal cancer with FOLFOX with or without cetuximab : the OPUS experience (abstract)[J]. J Clin Oncol, 2008, 26:178s.
[10] Van Cutsem E, Kohne CH, Hitre E, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer[J]. N Engl J Med, 2009, 360: 1408-1417. DOI: 10.1056/NEJMoa0805019
[11] 蒲兴祥, 邓艳红, 徐菲, 等.KRAS突变对晚期结直肠癌C225联合化疗疗效的影响[J].中华胃肠外科杂志, 2008, 12:594-597. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwcwkzz200906016 [12] 庄荣源, 刘天舒, 周宇红, 等.西妥昔单抗联合化疗治疗转移性结直肠癌疗效与KRAS状态的关系[J].中国癌症杂志, 2009, 19:943-946. DOI: 10.3969/j.issn.1007-3639.2009.12.012 [13] De Roock W, Piessevaux H, De Schutter J, et al. KRAS wild-type state predicts survival and is associated to early radiological response in metastatic colorectal cancer treated with cetuximab[J]. Ann Oncol, 2008, 19: 508-515. DOI: 10.1093/annonc/mdm496
[14] Di Nicolantonio F, Martini M, Molinari F, et al. A wildtype BRAF is required for response to panitumumab or cetuximab in metastatic colorectal cancer[J]. J Clin Oncol, 2008, 26:5705-5712. DOI: 10.1200/JCO.2008.18.0786
[15] Sartore-Bianchi A, Martini M, Molinari F, et al. PIK3CA mutations in colorectal cancer are associated with clinical resistance to EGFR-targeted monoclonal antibodies[J]. Cancer Res, 2009, 69: 1851-1857. DOI: 10.1158/0008-5472.CAN-08-2466
[16] Perrone F, Lampis A, Orsenigo M, et al. PI3KCA/PTEN deregulation contributes to impaired responses to cetuximab in metastatic colorectal cancer patients[J]. Ann Oncol, 2009, 20:84-90. DOI: 10.1093/annonc/mdn541
[17] Razis E, Briasoulis E, Vrettou E, et al. Potential value of PTEN in predicting cetuximab response in colorectal cancer: an exploratory study[J]. BMC Cancer, 2008, 8:234. DOI: 10.1186/1471-2407-8-234
[18] Shia J, Klimstra DS, Li AR, et al. Epidermal growth factor receptor expression and gene amplification in colorectal carcinoma :an immunohistochemical and chromogenic in situ hybridization study[J].Mod Pathol, 2005, 18: 1350-1356. DOI: 10.1038/modpathol.3800417
[19] Scartozzi M, Bearzi I, Berardi R, et al. Epidermal growth factor receptor (EGFR) status in primary colorectal tumors does not correlate with EGFR expression in related metastatic sites: implications for treatment with EGFR-targeted monoclonal antibodies[J]. J Clin Oncol, 2004, 22: 4772-4778. DOI: 10.1200/JCO.2004.00.117
[20] Francoual M, Etienne-Grimaldi MC, Formento JL, et al. EGFR in colorectal cancer: more than a simple receptor[J]. Ann Oncol, 2006, 17:962-967. DOI: 10.1093/annonc/mdl037
[21] Moroni M, Veronese S, Benvenuti S, et al. Gene copy number for epidermal growth factor receptor (EGFR) and clinical response to antiEGFR treatment in colorectal cancer : a cohort study[J]. Lancet Oncol, 2005, 6:279-286. DOI: 10.1016/S1470-2045(05)70102-9
[22] Personeni N, Fieuws S, Piessevaux H, et al. Clinical usefulness of EGFR gene copy number as a predictive marker in colorectal cancer patients treated with cetuximab: a fluorescent in situ hybridization study[J]. Clin Cancer Res, 2008, 14:5869-5876. DOI: 10.1158/1078-0432.CCR-08-0449
[23] Lenz HJ, Van Cutsem E, Khambata-Ford S, et al. Multicenter phase Ⅱ and translational study of cetuximab in metastatic colorectal carcinoma refractory to irinotecan, oxaliplatin, and fluoropyrimidines[J]. J Clin Oncol, 2006, 24: 4914-4921. DOI: 10.1200/JCO.2006.06.7595
[24] Khambata-Ford S, Garrett CR, Meropol NJ, et al. Expression of epiregulin and amphiregulin and K-ras mutation status predict disease control in metastatic colorectal cancer patients treated with cetuximab[J]. J Clin Oncol, 2007, 25 : 3230-3237. DOI: 10.1200/JCO.2006.10.5437
[25] Jacobs B, De Roock W, Piessevaux H, et al. Amphiregulin and epiregulin mRNA expression in primary tumors predicts outcome in metastatic colorectal cancer treated with cetuximab[J]. J Clin Oncol, 2009, 27:5068-5074. DOI: 10.1200/JCO.2008.21.3744
计量
- 文章访问数: 1102
- HTML全文浏览量: 528
- PDF下载量: 26
下载:
