倘若不幸得了癌症，120万一针的“抗癌神药”，真的能够买回一条命吗？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近几年来，有一种新的癌症治疗手段可谓是赚足了<span style="color: black;">大众</span>的眼球。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">你可能不<span style="color: black;">晓得</span>它真正的名字，但你<span style="color: black;">必定</span>看到过“120万一针抗癌神药，<span style="color: black;">能够</span>根治癌症”、“只要一针，2个月清零癌细胞”等热门头条。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">那到底120万一针的“抗癌神药”是什么呢？它真的有如此神奇的疗效吗？我是不是有了120万，打上一针，癌细胞<span style="color: black;">亦</span>能清零呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">带着这些疑问，让<span style="color: black;">咱们</span>今天<span style="color: black;">一块</span>来揭开它的<span style="color: black;">奥秘</span>面纱。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">1、</span>什么是CAR-T疗法<span style="color: black;"></span>?</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">这个120万一针的“抗癌神药”本名叫做</span><strong style="color: blue;"><strong style="color: blue;">CAR-T</strong></strong><strong style="color: blue;"><strong style="color: blue;">疗法</strong></strong><span style="color: black;">，它属于</span><strong style="color: blue;"><strong style="color: blue;">肿瘤免疫治疗</strong></strong><span style="color: black;">的一种手段。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">CAR-T疗法又叫嵌合抗原受体（CAR）T细胞疗法。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">从它的名字<span style="color: black;">咱们</span>不难看出，这种治疗是</span><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;">经过</span></strong><strong style="color: blue;">CAR<span style="color: black;">办法</span>对T细胞进行人工改造</strong></strong><span style="color: black;">，使其<span style="color: black;">拥有</span>特异性，从而来</span><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;">精细</span></strong></strong><span style="color: black;">消灭癌细胞。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">2、</span>CAR-T疗法<span style="color: black;">怎样</span>消灭癌细胞<span style="color: black;"></span>?</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">人体的<span style="color: black;">自己</span>免疫系统<span style="color: black;">拥有</span>抵御病原微生物和抵抗多种<span style="color: black;">疾患</span>的能力。T细胞是人体的免疫细胞，<span style="color: black;">能够</span>调节机体<span style="color: black;">出现</span>免疫反应。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">当免疫功能<span style="color: black;">显现</span><span style="color: black;">反常</span>的时候，机体的免疫平衡被打破，肿瘤细胞<span style="color: black;">经过</span>变异，逃避免疫系统的攻击。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">CAR是一种能够</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">特异性</strong></span></strong><span style="color: black;">识别并结合</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">肿瘤</strong></span></strong><span style="color: black;">抗原的嵌合受体，利用基因工程技术将其与T细胞结合，使T细胞表达特异性的CAR，从而</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">提</strong></span></strong><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">高机体对肿瘤的识别力和杀伤力</strong></span></strong><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">咱们</span><span style="color: black;">能够</span>把抗原和免疫受体之间的关系看成一把锁和一把钥匙的关系。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">癌细胞表面存在着不同的抗原（不同的锁），大部分T细胞表面<span style="color: black;">无</span>与之匹配的受体（<span style="color: black;">无</span>钥匙），故<span style="color: black;">没</span>法附着在抗原表面破坏癌细胞（打不开锁）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">CAR技术给T细胞表面赋予了识别癌细胞抗原的受体（配一把钥匙），进入<span style="color: black;">身体</span>后<span style="color: black;">能够</span></span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">精细</span></strong></span></strong><span style="color: black;">找到癌细胞（打开对应的锁），而不会破坏其他正常细胞，实现了“<span style="color: black;">精细</span>治疗”。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">3、</span><span style="color: black;">病人</span><span style="color: black;">怎样</span>进行CAR-T治疗<span style="color: black;"></span>?</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">首要</span>，在进行治疗前，受治疗者<span style="color: black;">必须</span>进行一次全面<span style="color: black;">检测</span>。</span><strong style="color: blue;"><strong style="color: blue;">抽取</strong></strong><span style="color: black;">满足<span style="color: black;">前提</span>的癌症<span style="color: black;">病人</span>的</span><strong style="color: blue;"><strong style="color: blue;">外周血液，</strong></strong>并<span style="color: black;">将其中的T细胞分离出来。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">其次，把分离出来的T细胞在体外<span style="color: black;">经过</span>CAR的<span style="color: black;">办法</span>，</span><strong style="color: blue;"><strong style="color: blue;">把</strong><strong style="color: blue;">T细胞变成</strong></strong><strong style="color: blue;"><strong style="color: blue;">CAR-T</strong></strong><strong style="color: blue;"><strong style="color: blue;">细胞，</strong></strong><span style="color: black;">并<span style="color: black;">海量</span>复制扩增。这个过程大概<span style="color: black;">必须</span>1~2周。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">最后，将新合成的</span><strong style="color: blue;"><strong style="color: blue;">CAR-T</strong></strong><strong style="color: blue;"><strong style="color: blue;">细胞回输到受治疗者<span style="color: black;">身体</span></strong></strong><span style="color: black;">，观测疗效并<span style="color: black;">定时</span>随访。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">日前</span>，CAR-T疗法<span style="color: black;">重点</span>在治疗</span><strong style="color: blue;"><strong style="color: blue;">血液系统恶性肿瘤</strong></strong>方面颇有成效<span style="color: black;">。<span style="color: black;">包含</span>急性淋巴细胞白血病、急性髓系白血病、非霍奇金淋巴瘤、多发性骨髓瘤等。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">CAR-T疗法为难治性、复发性血液恶性肿瘤<span style="color: black;">病人</span><span style="color: black;">供给</span>了新的治疗机会。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">与血液肿瘤不同，<span style="color: black;">日前</span>治疗</span><strong style="color: blue;"><strong style="color: blue;">实体肿瘤</strong></strong><span style="color: black;">（如胃癌、肝癌、肺癌等）的靶点都是肿瘤<span style="color: black;">关联</span>性抗原，而非肿瘤特异性抗原。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">实体肿瘤</strong></span></strong><span style="color: black;">与健康组织在靶点上存在</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">表达量上的差异</strong></span></strong><span style="color: black;">，CAR-T细胞对某一</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">高表达</strong></span></strong><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">抗原</strong></span></strong><span style="color: black;">的细胞<span style="color: black;">拥有</span></span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">优先杀伤性</strong></span></strong><span style="color: black;">，因此在靶点的<span style="color: black;">选取</span>上<span style="color: black;">一般</span><span style="color: black;">必须</span>一个</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">过度表达</strong></span></strong><span style="color: black;">的表面抗原。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">因为</span>这一特征，CAR-T疗法在实体肿瘤的治疗时存在<span style="color: black;">必定</span>的限制性。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">日前</span>CAR-T疗法<span style="color: black;">能够</span>用于<strong style="color: blue;">原发性</strong></span><strong style="color: blue;"><span style="color: black;">肝癌、</span><span style="color: black;">肺癌、前列腺癌、卵巢癌、神经胶质瘤、神经母细胞瘤、胰腺癌</span></strong><span style="color: black;">等实体肿瘤。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">4、</span>CAR-T疗法的副<span style="color: black;">功效</span><span style="color: black;"></span>?</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">CAR-T细胞回输给<span style="color: black;">病人</span>后可能产生<span style="color: black;">必定</span>的副<span style="color: black;">功效</span>，<span style="color: black;">因此呢</span>在完成CAR-T疗法治疗后<span style="color: black;">必须</span>在医院<strong style="color: blue;">密切观察</strong>一段时间，出院后<span style="color: black;">亦</span><span style="color: black;">必须</span><strong style="color: blue;"><span style="color: black;">定时</span>随访</strong>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其中较为<span style="color: black;">平常</span>和严重的两种副<span style="color: black;">功效</span>是<strong style="color: blue;"><strong style="color: blue;">细胞因子释放<span style="color: black;">综合症</span></strong></strong>（CRS）和<strong style="color: blue;">神经毒性</strong>（NTX）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.<strong style="color: blue;"><strong style="color: blue;">细胞因子释放<span style="color: black;">综合症</span>（</strong><strong style="color: blue;">CRS）</strong></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">CRS是CAR-T治疗后<strong style="color: blue;"><strong style="color: blue;">较<span style="color: black;">平常</span></strong></strong>的不良反应，<span style="color: black;">是由于</span>CAR-T<span style="color: black;">细胞和其他免疫细胞释放大</span></span><span style="color: black;">量炎性细胞因子继发的全身炎症反应。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">CRS<span style="color: black;">重点</span>表现为</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">发热、恶心、头痛、肌肉关节痛</strong></span></strong><span style="color: black;">等，严重时可发展为低血压、心动过速、<span style="color: black;">呼气</span>急促和缺氧等。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/Sr5iaibDlNgUYbsoMSIvAQ1TQ4hvCZ7tva1PibYDZhomLjXy7fgCoicdhF6b7qWhA9dwAfSpJsibhoj7wqIMQnZUsBw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.<strong style="color: blue;"><strong style="color: blue;">神经毒性（</strong><strong style="color: blue;">NTX）</strong></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">CAR-T治疗的神经毒性表现为<strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">CAR-T<span style="color: black;">关联</span>性脑病</strong></span></strong><span style="color: black;">（CRES），<span style="color: black;">包含</span>多种神经系统症状如：</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">认识</span>错乱、谵妄、表达性失语症、<span style="color: black;">肥壮</span>、肌阵挛和癫痫</strong></span></strong><strong style="color: blue;"><span style="color: black;"><span style="color: black;">爆发</span></span></strong><span style="color: black;">等。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">5、</span>CAR-T疗法可以根治癌症吗<span style="color: black;"></span>?</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肿瘤细胞<span style="color: black;">拥有</span><strong style="color: blue;">多样性和逃逸性</strong>，CAR-T治疗针对的是肿瘤表面的某一个特定抗原，<span style="color: black;">因此呢</span>并非传说中的“万能药”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其次，CAR-T疗法的<span style="color: black;">全部</span>过程较为<strong style="color: blue;"><span style="color: black;">繁杂</span></strong>，<span style="color: black;">必须</span><span style="color: black;">每一个</span><span style="color: black;">过程</span>均满足才可实现。<span style="color: black;">因此呢</span><span style="color: black;">是不是</span>能完全消灭癌细胞还要<span style="color: black;">按照</span><span style="color: black;">实质</span><span style="color: black;">状况</span>来判断。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">但据<span style="color: black;">报告</span>，<span style="color: black;">日前</span>国内<span style="color: black;">亦</span>有不少<span style="color: black;">病人</span>在接受</span><span style="color: black;">CAR-T</span><span style="color: black;">治疗后，症状得到<span style="color: black;">显著</span>缓解，<span style="color: black;">存活</span>期<span style="color: black;">显著</span><span style="color: black;">加强</span>。</span></span></p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">虽然CAR-T疗法在临床上仍有不少问题<span style="color: black;">必须</span>攻破，但它确实为肿瘤<span style="color: black;">病人</span>带去了新的治疗福音。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">关于您<span style="color: black;">是不是</span>适合</span><span style="color: black;">CAR-T疗法，<span style="color: black;">最后</span>还<span style="color: black;">必须</span>由专业<span style="color: black;">大夫</span>来决定，千万不要听信<span style="color: black;">流言</span>或<span style="color: black;">选取</span>不正规的治疗途径</span><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">配图均来自：摄图网</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">参考文献：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.张巍,闫丹丹,高莉,等.嵌合抗原受体T细胞治疗原发性肿瘤的<span style="color: black;">优良</span>与<span style="color: black;">科研</span><span style="color: black;">发展</span>.天津医药,2016,44(2):4.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.朱祎静,张仪,尤良顺,等.嵌合抗原受体T细胞治疗淋巴瘤的<span style="color: black;">状况</span>及展望.中国肿瘤,2020,29(10):787-791.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.吴晨曦,孙天盟,李薇, etal.CAR-T细胞疗法在肿瘤免疫治疗中的<span style="color: black;">科研</span><span style="color: black;">发展</span>.第十一届全国免疫学学术大会.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.赵丽平,潘静,冯晓明.CAR-T细胞治疗血液肿瘤的临床<span style="color: black;">发展</span>.中国细胞生物学学报,2022,44(1):214-222.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5.梁家第,李秋妹,樊继强,等.CAR-T疗法在肿瘤临床治疗中的<span style="color: black;">科研</span><span style="color: black;">发展</span>.福建师范大学学报（自然科学版）,2021,37(5):89-95.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6.曹玉环,苑学礼.CAR-T细胞在实体肿瘤治疗中的应用<span style="color: black;">发展</span>.医学综述,2020,26(23):4634-4642.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">温馨提示：本文仅<span style="color: black;">做为</span>科普<span style="color: black;">文案</span>，不<span style="color: black;">供给</span>专业诊疗意见，<span style="color: black;">详细</span>诊疗，请在专业<span style="color: black;">大夫</span><span style="color: black;">指点</span>下进行。</span></p>
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