{"id":35052,"date":"2024-05-27T04:01:06","date_gmt":"2024-05-27T04:01:06","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=35052"},"modified":"2024-05-27T04:01:06","modified_gmt":"2024-05-27T04:01:06","slug":"%e4%b8%ad%e5%9b%bd%e8%82%ba%e7%99%8c%e9%aa%a8%e8%bd%ac%e7%a7%bb%e4%b8%b4%e5%ba%8a%e8%af%8a%e7%96%97%e6%8c%87%e5%8d%97%ef%bc%882024-%e7%89%88%ef%bc%89","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=35052","title":{"rendered":"\u4e2d\u56fd\u80ba\u764c\u9aa8\u8f6c\u79fb\u4e34\u5e8a\u8bca\u7597\u6307\u5357\uff082024 \u7248\uff09"},"content":{"rendered":"<p>\u652f\u4fee\u76ca<sup>1<\/sup>\uff0c\u738b\u6d01<sup>2<\/sup>\uff0c\u5218\u4f26\u65ed<sup>3<\/sup>\uff0c\u8d75\u519b<sup>4<\/sup>\uff0c\u4e2d\u56fd\u533b\u836f\u6559\u80b2\u534f\u4f1a\u80ba\u764c\u533b\u5b66\u6559\u80b2\u59d4\u5458\u4f1a\uff0c\u5317\u4eac\u533b\u5b66\u5956\u52b1\u57fa\u91d1\u4f1a\u80ba\u764c\u533b\u5b66\u9752\u5e74\u4e13\u5bb6\u59d4\u5458\u4f1a\uff0c\u4e2d\u56fd\u8001\u5e74\u4fdd\u5065\u534f\u4f1a\u80ba\u764c\u4e13\u4e1a\u59d4\u5458\u4f1a<sup><\/sup><\/p>\n<p>1. \u9996\u90fd\u533b\u79d1\u5927\u5b66\u5ba3\u6b66\u533b\u9662 \u80f8\u5916\u79d1 \uff08\u5317\u4eac&nbsp; 100053\uff09<\/p>\n<p>2. \u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662\u80bf\u7624\u533b\u9662 \u80bf\u7624\u5185\u79d1\uff08\u5317\u4eac&nbsp; 100021\uff09<\/p>\n<p>3. \u56db\u5ddd\u5927\u5b66\u534e\u897f\u533b\u9662 \u80f8\u5916\u79d1\uff08 \u6210\u90fd\uff08610041\uff09<\/p>\n<p>4. \u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\u66a8\u5317\u4eac\u5e02\u80bf\u7624\u9632\u6cbb\u7814\u7a76\u6240\u80f8\u90e8\u80bf\u7624\u5185\u4e00\u79d1&nbsp; \u6076\u6027\u80bf\u7624\u53d1\u75c5\u673a\u5236\u53ca\u8f6c\u5316\u7814\u7a76\u6559\u80b2\u90e8\u91cd\u70b9\u5b9e\u9a8c\u5ba4\uff08\u5317\u4eac100142\uff09<\/p>\n<p>\u901a\u4fe1\u4f5c\u8005\uff1a\u652f\u4fee\u76ca\uff0cEmail\uff1axiuyizhi2015@163.com\uff1b\u738b\u6d01\uff0cEmail: wangjie_cc@yahoo.com\uff1b\u5218\u4f26\u65ed\uff0cEmail: lunxu_liu@aliyun.com\uff1b\u8d75\u519b\uff0cEmail\uff1aohjerry@163.com<\/p>\n<p>\u5173\u952e\u8bcd\uff1a\u80ba\u764c\uff1b\u9aa8\u8f6c\u79fb\uff1b\u9aa8\u6539\u826f\u6cbb\u7597\uff1b\u4e34\u5e8a\u6307\u5357\uff1b\u63a8\u8350\u610f\u89c1<\/p>\n<p>\u5f15\u7528\u672c\u6587\uff1a\u652f\u4fee\u76ca\uff0c\u738b\u6d01\uff0c\u5218\u4f26\u65ed, \u7b49. \u4e2d\u56fd\u80ba\u764c\u9aa8\u8f6c\u79fb\u4e34\u5e8a\u8bca\u7597\u6307\u5357\uff082024\u7248\uff09. \u4e2d\u56fd\u80f8\u5fc3\u8840\u7ba1\u5916\u79d1\u4e34\u5e8a\u6742\u5fd7, 2024, 31(5): 643-653. doi: 10.7507\/1007-4848.202402042<\/p>\n<p>Zhi XY,&nbsp; Wang J,&nbsp; Liu LX, et al. Chinese clinical guidelines on diagnosis and treatment of lung cancer bone metastasis (version 2024). Chin J Clin Thorac Cardiovasc Surg, 2024, 31(5): 643-653. doi: 10.7507\/1007-4848.202402042<\/p>\n<p>\u6458&nbsp; 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activator for nuclear factor-\u03baB ligand\uff0c RANKL\uff09\uff0cRANKL\u4e0e\u6838\u56e0\u5b50-\u03baB \u53d7\u4f53\u6d3b\u5316\u56e0\u5b50\u53d7\u4f53\uff08receptor activator for nuclear factor-\u03baB\uff0cRANK\uff09\u76f8\u4e92\u4f5c\u7528\u6fc0\u6d3b\u7834\u9aa8\u7ec6\u80de\uff0c\u6fc0\u6d3b\u7684\u7834\u9aa8\u7ec6\u80de\u968f\u540e\u4f7f\u9aa8\u518d\u5438\u6536\uff0c\u5bfc\u81f4\u9aa8\u6eb6\u89e3\uff0c\u540c\u65f6\u91ca\u653e\u751f\u957f\u56e0\u5b50\u8bf1\u5bfc\u80bf\u7624\u7ec6\u80de\u6301\u7eed\u751f\u957f\u3002\u53ef\u89c1\uff0cRANKL\/RANK\u662f\u4ecb\u5bfc\u80ba\u764c\u9aa8\u7834\u574f\u7684\u5173\u952e\u901a\u8def[6]\u3002\u6b64\u5916\uff0cRANKL\u53ef\u80fd\u4f5c\u4e3a\u8d8b\u5316\u56e0\u5b50\uff0c\u4e0e\u8868\u8fbeRANK\u7684\u80bf\u7624\u7ec6\u80de\u76f4\u63a5\u4f5c\u7528\uff0c\u4fc3\u4f7f\u80bf\u7624\u7ec6\u80de\u5411\u9aa8\u7ec4\u7ec7\u5f52\u5de2[6-7]\u3002<\/p>\n<p>3\u3000\u8bca\u65ad<\/p>\n<p>\u80ba\u764c\u9aa8\u8f6c\u79fb\u68c0\u6d4b\u5bf9\u51c6\u786e\u5206\u671f\u548c\u6307\u5bfc\u6cbb\u7597\u81f3\u5173\u91cd\u8981\u3002\u76ee\u524d\u516c\u8ba4\u7684\u9aa8\u8f6c\u79fb\u8bca\u65ad\u6807\u51c6\u4e3a\u4e34\u5e8a\u786e\u8bca\u80ba\u764c\uff0c\u9aa8\u6d3b\u68c0\u9633\u6027\u6216\u6709\u660e\u786e\u7684\u9aa8\u8f6c\u79fb\u5f71\u50cf\u8bca\u65ad\u3002\u5f71\u50cf\u5b66\u68c0\u67e5\u7528\u4e8e\u786e\u5b9a\u9aa8\u8f6c\u79fb\u90e8\u4f4d\uff0c\u4ee5\u53ca\u8bc4\u4f30\u53d7\u7d2f\u90e8\u4f4d\u662f\u5426\u5b58\u5728\u75c5\u7406\u6027\u9aa8\u6298\u548c\/\u6216\u810a\u9ad3\u538b\u8feb\uff08\u6216\u662f\u5b58\u5728\u7684\u53ef\u80fd\u6027\uff09\uff1b\u5fc5\u8981\u65f6\u8fd8\u53ef\u7528\u4e8e\u5f15\u5bfc\u6d3b\u68c0\u3002<\/p>\n<p>\u63a8\u83501\uff1a\u5bf9\u4e8e\u786e\u8bca\u80ba\u764c\u60a3\u8005\u4e14\u6709\u9aa8\u8f6c\u79fb\u9ad8\u5371\u56e0\u7d20\uff0c\u521d\u7b5b\u5e94\u9996\u9009\u653e\u5c04\u6027\u6838\u7d20\u9aa8\u663e\u50cf\uff08bone scintigraphy\uff0cBS\uff09\uff0c\u7279\u522b\u662f\u6709\u9aa8\u8f6c\u79fb\u7684\u9ad8\u5371\u4eba\u7fa4\uff08\u5982\u9aa8\u75db\u3001\u9ad8\u9499\u8840\u75c7\u3001\u9ad8\u78b1\u6027\u78f7\u9178\u9176\u3001\u810a\u9ad3\u538b\u8feb\u75c7\u72b6\u7b49\uff09\uff081A\uff09\u3002<\/p>\n<p>\u63a8\u83502\uff1a\u5bf9\u4e8e\u521d\u7b5bBS\u9633\u6027\u7684\u80ba\u764c\u60a3\u8005\uff0c\u6709\u5fc5\u8981\u884cCT\u3001\u78c1\u5171\u632f\u6210\u50cf\uff08MRI\uff09\u3001\u6b63\u7535\u5b50\u53d1\u5c04\u8ba1\u7b97\u673a\u65ad\u5c42\u663e\u50cf\/\u8ba1\u7b97\u673a\u65ad\u5c42\u663e\u50cf\uff08positron emission computed tomography\/computer tomography\uff0c PET\/CT\uff09\u6216\u9aa8\u6d3b\u68c0\u8fdb\u4e00\u6b65\u8bc4\u4f30\u8f6c\u79fb\u75c5\u7076\uff0c\u8fdb\u4e00\u6b65\u660e\u786e\u8bca\u65ad\uff082A\uff09\u3002<\/p>\n<p>\u63a8\u83503\uff1a\u80ba\u764c\u5982\u4ec5\u51fa\u73b0\u5b64\u7acb\u6027\u9aa8\u7834\u574f\u75c5\u7076\uff0c\u5e94\u79ef\u6781\u884c\u75c5\u7076\u9aa8\u6d3b\u68c0\uff1b\u5982\u786e\u8bca\u80ba\u764c\uff0c\u4f34\u5168\u8eab\u591a\u53d1\u9aa8\u7834\u574f\uff0c\u5219\u4e0d\u5fc5\u8fdb\u884c\u9aa8\u6d3b\u68c0\uff081A\uff09\u3002<\/p>\n<p>3.1&nbsp; &nbsp; \u8bca\u65ad\u65b9\u6cd5<\/p>\n<p>3.1.1&nbsp; &nbsp; \u653e\u5c04\u6027\u6838\u7d20\u9aa8\u663e\u50cf<\/p>\n<p>BS\u901a\u5e38\u88ab\u79f0\u4e3a\u9aa8\u626b\u63cf\uff0c\u539f\u7406\u662f\u5229\u7528\u793a\u8e2a\u5242\uff08\u4e00\u822c\u4e3a<sup>99m<\/sup>Tc\uff09\u5728\u6210\u9aa8\u7ec6\u80de\u6d3b\u6027\u589e\u52a0\u7684\u90e8\u4f4d\u84c4\u79ef\u7684\u7279\u6027\uff0c\u53cd\u6620\u9aa8\u4ee3\u8c22\u53d8\u5316\uff0c\u8fdb\u800c\u63d0\u793a\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u65e9\u671f\u5b58\u5728\u3002\u4e34\u5e8a\u7814\u7a76[8]\u8868\u660e\uff0cBS\u68c0\u6d4b\u9aa8\u8f6c\u79fb\u517c\u5177\u654f\u611f\u6027\uff0879%\uff5e86%\uff09\u548c\u7279\u5f02\u6027\uff0881%\uff5e88%\uff09\uff0c\u5168\u8eab\u6210\u50cf\u4e0d\u6613\u6f0f\u8bca\u3002\u56e0\u6b64\uff0c\u63a8\u8350\u5176\u4f5c\u4e3a\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u4f18\u9009\u521d\u7b5b\u68c0\u6d4b\uff0c\u7279\u522b\u662f\u6709\u9aa8\u8f6c\u79fb\u7684\u9ad8\u5371\u4eba\u7fa4\uff08\u5982\u9aa8\u75db\u3001\u9ad8\u9499\u8840\u75c7\u3001\u9ad8\u78b1\u6027\u78f7\u9178\u9176\u3001\u810a\u9ad3\u538b\u8feb\u75c7\u72b6\u7b49\uff09\u3002<\/p>\n<p>\u4f46BS \u65e0\u6cd5\u68c0\u6d4b\u9aa8\u9ad3\u53d7\u7d2f\u60c5\u51b5\uff0c\u4e14\u975e\u8f6c\u79fb\u6027\u9aa8\u75c5\u53d8\u53ef\u51fa\u73b0\u5047\u9633\u6027[9]\u3002\u6545BS\u9700\u8981\u8054\u5408\u5176\u4ed6\u5f71\u50cf\u624b\u6bb5\uff0c\u624d\u80fd\u8fdb\u4e00\u6b65\u63d0\u9ad8\u8bca\u65ad\u51c6\u786e\u6027\u3002\u6b64\u5916\uff0c\u5728\u9aa8\u8f6c\u79fb\u6cbb\u7597\u540e\u968f\u8bbf\u4e2d\uff0c\u5e94\u6ce8\u610f\u4e0d\u8981\u5c06\u4fee\u590d\u6027\u6210\u9aa8\u7ec6\u80de\u6d3b\u52a8\u9020\u6210\u7684\u95ea\u70c1\u73b0\u8c61\uff08flare phenomenon\uff09\u8bef\u8bca\u4e3a\u75be\u75c5\u8fdb\u5c55\uff0c\u6545BS\u4e0d\u5e38\u89c4\u63a8\u8350\u7528\u4e8e\u8bc4\u4ef7\u7597\u6548\u3002<\/p>\n<p>3.1.2&nbsp; &nbsp; PET\/CT\u548cPET\/MRI<\/p>\n<p>PET\/CT \u5177\u6709\u66f4\u9ad8\u7684\u7a7a\u95f4\u5206\u8fa8\u7387\uff0c\u4e0d\u4ec5\u53cd\u6620\u5168\u8eab\u9aa8\u9abc\u53d7\u7d2f\u60c5\u51b5\uff0c\u8fd8\u53ef\u8bc6\u522b\u66f4\u5c0f\u7684\u75c5\u7076\u3002<\/p>\n<p>PET\/CT\u8bca\u65ad\u9aa8\u8f6c\u79fb\u7684\u7279\u5f02\u6027\u663e\u8457\u9ad8\u4e8eBS[10]\uff1bF-\u6c1f\u8131\u6c27\u8461\u8404\u7cd6\uff0818F-FDG\uff09 PET\/CT\u5bf9\u4e8e\u6eb6\u9aa8\u6027\u53ca\u9aa8\u9ad3\u7684\u8f6c\u79fb\u6700\u654f\u611f\uff0c\u800c18F\u6807\u8bb0\u6c1f\u5316\u94a0\uff0818F-NaF\uff09 PET\/CT\u5bf9\u4e8e\u6210\u9aa8\u6027\u8f6c\u79fb\u6700\u654f\u611f\uff0c\u4f46\u708e\u75c7\u6216\u521b\u4f24\u540e\u4fee\u590d\u7b49\u53ef\u80fd\u5bfc\u81f4\u5047\u9633\u6027[4]\u300218F-FDG PET\/CT\u548c18F-NaF PET\/CT\u5bf9\u4e8e\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u7597\u6548\u8bc4\u4ef7\u51c6\u786e\u7387\u8f83\u9ad8\u3002\u4f46\u8003\u8651\u5230\u4ef7\u683c\u548c\u53ef\u53ca\u6027\uff0c\u4e00\u822c\u4e0d\u63a8\u8350\u5e38\u89c4PET\/CT\u4f5c\u4e3a\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u521d\u59cb\u7b5b\u67e5\u624b\u6bb5\uff0c\u9664\u975e\u6000\u7591\u80ba\u764c\u6709\u9664\u9aa8\u9abc\u4ee5\u5916\u7684\u591a\u53d1\u8f6c\u79fb\u3002<\/p>\n<p>PET\/MRI \u4f5c\u4e3a\u76ee\u524d\u6700\u9ad8\u7aef\u7684\u878d\u5408\u5f71\u50cf\u8bbe\u5907\uff0c\u96c6\u6210\u4e86MRI\u9ad8\u8f6f\u7ec4\u7ec7\u5206\u8fa8\u7387\u3001\u591a\u53c2\u6570\u3001\u591a\u5e8f\u5217\u3001\u4f4e\u8f90\u5c04\u548cPET \u529f\u80fd\u4ee3\u8c22\u7684\u4f18\u52bf\uff0c\u53ef\u4ee5\u63d0\u9ad8\u9605\u7247\u8005\u5bf9\u9aa8\u8f6c\u79fb\u7684\u8bca\u65ad\u4fe1\u5fc3\uff0c\u7279\u522b\u662f\u9488\u5bf9\u65e9\u671f\u9aa8\u9ad3\u6d78\u6da6\u548cPET \u6444\u53d6\u8f83\u4f4e\u7684\u9aa8\u75c5\u53d8\u3002\u4f46PET\/MRI \u5bf9\u4e8e\u9aa8\u786c\u5316\u75c5\u53d8\u7279\u5f02\u6027\u8f83\u4f4e\uff0c\u4e14\u4ef7\u683c\u9ad8\u6602\uff0c\u4e0d\u9002\u5408\u4e34\u5e8a\u5e38\u89c4\u5e94\u7528\u3002<\/p>\n<p>3.1.3&nbsp; &nbsp; X\u7ebf<\/p>\n<p>X\u7ebf\u68c0\u67e5\u7531\u4e8e\u7a7a\u95f4\u5206\u8fa8\u7387\u9ad8\u3001\u64cd\u4f5c\u7b80\u5355\u3001\u8d39\u7528\u4f4e\u5ec9\u3001\u8f90\u5c04\u8f83\u5c0f\u3001\u6709\u4e00\u5b9a\u7279\u5f02\u6027[11]\uff0c\u4e34\u5e8a\u4e0a\u5e38\u7528\u4e8e\u9aa8\u75db\u60a3\u8005\u7684\u521d\u6b65\u5f71\u50cf\u5b66\u68c0\u67e5\u3002\u9aa8\u75c5\u7076\u5728X\u7ebf\u6444\u5f71\u4e0a\u53ef\u80fd\u8868\u73b0\u4e3a\u4f4e\u9aa8\u5bc6\u5ea6\u6216\u65e0\u9aa8\u5bc6\u5ea6\u533a\uff08\u9aa8\u6eb6\u89e3\uff09\uff0c\u9aa8\u5c0f\u6881\u7ed3\u6784\u7834\u574f\u6216\u7f3a\u5931\uff0c\u6216\u8005\u786c\u5316\u6027\u75c5\u53d8\u6216\u8fb9\u7f18\u3002\u9aa8\u8d28\u7834\u574f\u5fc5\u987b\u8fbe\u5230\u4e00\u5b9a\u7a0b\u5ea6\uff08\u9aa8\u5bc6\u5ea6\u964d\u4f4e30%\uff5e75%\uff09\uff0c\u624d\u80fd\u5728X\u7ebf\u7247\u4e0a\u51fa\u73b0\u660e\u663e\u75c5\u53d8\uff0c\u56e0\u6b64X\u7ebf\u5e73\u7247\u76f8\u6bd4BS\u548cPET\/CT\uff0c\u5bf9\u65e9\u671f\u9aa8\u8f6c\u79fb\u7624\u7684\u8bca\u65ad\u5f80\u5f80\u7279\u5f02\u6027\u8f83\u9ad8\u4f46\u654f\u611f\u6027\u8f83\u4f4e[12]\uff0c\u6bd4BS\u663e\u793a\u7684\u9aa8\u8f6c\u79fb\u7076\u665a3\uff5e6 \u4e2a\u6708\u3002\u5f53\u9aa8\u9ad3\u5185\u8f6c\u79fb\u672a\u7d2f\u53ca\u76ae\u8d28\u65f6\uff0c\u6613\u88ab\u9ad8\u5bc6\u5ea6\u76ae\u8d28\u63a9\u76d6\u800c\u6f0f\u8bca\uff1b\u5bf9\u4e8e\u65e9\u671f\u6eb6\u9aa8\u6027\u9aa8\u8d28\u7834\u574f\u8005\uff0c\u5f53\u60a3\u8005\u4f34\u53d1\u9aa8\u8d28\u758f\u677e\u75c7\u6216\u5176\u4ed6\u4f4e\u5bc6\u5ea6\u9aa8\u8d28\u75be\u75c5\u65f6\uff0cX\u7ebf\u68c0\u67e5\u4e0d\u6613\u9274\u522b\uff0c\u6545\u4e0d\u63a8\u8350X\u7ebf\u4f5c\u4e3a\u9aa8\u8f6c\u79fb\u7684\u65e9\u671f\u7b5b\u67e5\u624b\u6bb5\u3002<\/p>\n<p>3.1.4&nbsp; &nbsp; CT<\/p>\n<p>\u4e0eX\u7ebf\u76f8\u6bd4\uff0cCT\u53ef\u66f4\u597d\u5730\u663e\u793a\u9aa8\u7684\u7ec6\u8282\uff0c\u5b9e\u73b0\u9aa8\u76ae\u8d28\u7684\u9ad8\u5206\u8fa8\u7387\u663e\u50cf\uff0c\u5bf9\u9aa8\u8d28\u7834\u574f\u53ca\u5176\u5468\u56f4\u8f6f\u7ec4\u7ec7\u80bf\u5757\u7684\u8bc6\u522b\u66f4\u7cbe\u51c6\u3002CT\u7684\u654f\u611f\u6027\u4e0eBS \u63a5\u8fd1\uff0c\u4e00\u9879Meta\u5206\u6790[13]\u8c03\u67e5\u4e86\u5404\u79cd\u5f71\u50cf\u5b66\u65b9\u6cd5\u5bf9\u8bca\u65ad\u591a\u79cd\u6076\u6027\u80bf\u7624\u9aa8\u8f6c\u79fb\u7684\u4f5c\u7528\uff0c\u5c31\u68c0\u6d4b\u5355\u4e2a\u75c5\u7076\u800c\u8a00\uff0cCT\u7684\u654f\u611f\u6027\u548c\u7279\u5f02\u6027\u5206\u522b\u4e3a77% \u548c83%\uff0c\u800c\u9aa8\u626b\u63cf\u5206\u522b\u4e3a75%\u548c94%\u3002\u56e0\u6b64\uff0c\u63a8\u8350\u5bf9\u4e8eBS\u68c0\u67e5\u9633\u6027\u800cX\u7ebf\u5e73\u7247\u9634\u6027\u60a3\u8005\u8fdb\u884cCT\u68c0\u67e5\u660e\u786e\u8bca\u65ad\uff1b\u7531\u4e8eCT\u5728\u9aa8\u7834\u574f\u5c1a\u672a\u8fbe\u5230X\u7ebf\u7247\u80fd\u591f\u68c0\u51fa\u7684\u7a0b\u5ea6\u4e4b\u524d\u5c31\u80fd\u68c0\u6d4b\u5230\u9aa8\u9ad3\u4e2d\u7684\u6eb6\u9aa8\u6027\u548c\u6210\u9aa8\u6027\u8f6c\u79fb\uff0c\u6545\u5f53\u6000\u7591\u8f6c\u79fb\u7624\u4f4d\u4e8e\u810a\u9ad3\u65f6\uff0c\u4e5f\u63a8\u8350\u884c\u810a\u67f1CT\u89c2\u5bdf\u690e\u4f53\u7a33\u5b9a\u6027\u3002<\/p>\n<p>CT\u5f71\u50cf\u4e5f\u6709\u52a9\u4e8e\u5236\u5b9a\u653e\u7597\u6216\u624b\u672f\u65b9\u6848\u3002\u5f53\u9700\u8981\u4e86\u89e3\u9aa8\u8f6c\u79fb\u7624\u4e0e\u5468\u56f4\u795e\u7ecf\u3001\u8840\u7ba1\u7ed3\u6784\u7684\u5173\u7cfb\u65f6\u53ef\u8003\u8651\u4f7f\u7528\u589e\u5f3aCT[4]\u3002\u5bf9\u4e8e\u90e8\u5206\u6210\u9aa8\u6027\u8f6c\u79fb\u7684\u9274\u522b\uff0c\u6709\u6587\u732e[14-15]\u62a5\u9053\u4f7f\u7528\u80fd\u8c31CT\u68c0\u67e5\u6709\u4e00\u5b9a\u610f\u4e49\u3002\u4f46\u5bf9\u4e8e\u9aa8\u76ae\u8d28\u7684\u65e9\u671f\u8f6c\u79fb\u3001\u9aa8\u8f6c\u79fb\u9aa8\u9ad3\u8d28\u7684\u6d78\u6da6\uff0c\u5c24\u5176\u662f\u5728\u4f34\u6709\u9aa8\u8d28\u758f\u677e\u7684\u60c5\u51b5\u4e0b\uff0cCT\u8bca\u65ad\u7684\u654f\u611f\u6027\u76f8\u5bf9\u8f83\u4f4e[16]\u3002<\/p>\n<p>3.1.5&nbsp; &nbsp; MRI<\/p>\n<p>MRI\u662f\u552f\u4e00\u53ef\u4ee5\u76f4\u63a5\u663e\u793a\u9aa8\u9ad3\u8154\u53ca\u5176\u7ec4\u6210\u7ed3\u6784\u7684\u6210\u50cf\u65b9\u6cd5\uff0c\u662f\u68c0\u6d4b\u9aa8\u9ad3\u75c5\u53d8\u6700\u654f\u611f\u7684\u6280\u672f[17]\u3002\u9aa8\u8f6c\u79fb\u65e9\u671f\uff0c\u5728\u6210\u9aa8\u7ec6\u80de\u6216\u7834\u9aa8\u7ec6\u80de\u6d3b\u5316\u800c\u53d1\u751f\u9aa8\u8d28\u53d8\u5316\u4e4b\u524d\uff0cMRI\u5373\u53ef\u5bf9\u9ad3\u5185\u7684\u65e9\u671f\u8f6c\u79fb\u654f\u611f\u6027\u8f83\u9ad8\uff0c\u662f\u8bca\u65ad\u548c\u9274\u522b\u8bca\u65ad\u9aa8\u9ad3\u8f6c\u79fb\u7684\u9996\u9009\u5f71\u50cf\u5b66\u65b9\u6cd5\u3002MRI \u68c0\u67e5\u8f6c\u79fb\u7076\u7684\u654f\u611f\u6027\u9ad8\u4e8eCT\uff0c\u53ef\u66f4\u51c6\u786e\u5730\u786e\u5b9a\u80bf\u7624\u8303\u56f4\uff0c\u5e76\u4e14\u5bf9\u810a\u67f1\u8f6c\u79fb\u60a3\u8005\u5c24\u4e3a\u6709\u7528\uff0c\u53ef\u8bc4\u4f30\u9ad3\u5185\u548c\u810a\u67f1\u5916\u75c5\u53d8\u8303\u56f4\u3002MRI\u7684\u51c6\u786e\u6027\u9ad8\u4e8eCT\u6216BS\uff0c\u8bca\u65ad\u9aa8\u8f6c\u79fb\u7684\u51c6\u786e\u6027\u4e0eFDG-PET\/CT\u76f8\u5f53[13]\u3002\u56e0\u6b64\uff0c\u5f53BS \u548cX\u7ebf\u65e0\u6cd5\u786e\u8bca\uff0c\u7279\u522b\u662f\u5bf9\u6000\u7591\u9ad3\u5185\u53ca\u810a\u9ad3\u53d7\u7d2f\u7684\u60a3\u8005\uff0c\u63a8\u8350\u884cMRI[4]\u68c0\u67e5\u3002<\/p>\n<p>3.1.6&nbsp; &nbsp; \u6cbb\u7597\u76d1\u6d4b\u7684\u5f71\u50cf\u5b66\u8bc4\u4ef7<\/p>\n<p>\u9aa8\u8f6c\u79fb\u7684\u6cbb\u7597\u76d1\u6d4b\u4e2d\uff0cX\u7ebf\u3001CT\u3001BS \u53caMRI \u7b49\u5747\u662f\u91cd\u8981\u7684\u5f71\u50cf\u5b66\u68c0\u67e5\u624b\u6bb5\u3002\u76ee\u524d\u5c1a\u65e0\u7edf\u4e00\u7684\u7597\u6548\u8bc4\u4ef7\u6807\u51c6\uff0cRECIST 1.1\u7597\u6548\u8bc4\u4ef7\u6709\u4e00\u5b9a\u5c40\u9650\u6027\uff0c\u53ef\u4ee5\u53c2\u7167MD Anderson\u6807\u51c6[18]\u6765\u8bc4\u4ef7\u9aa8\u8f6c\u79fb\uff1b\u89c1\u88681\u3002\u5f53\u6210\u9aa8\u6027\u8f6c\u79fb\u8bca\u65ad\u3001\u8bc4\u4ef7\u56f0\u96be\u65f6\uff0c\u53ef\u7528MRI[19]\u6216PET\/CT[20]\u8f85\u52a9\u3002<\/p>\n<p>3.1.7&nbsp; &nbsp; \u9aa8\u6d3b\u68c0<\/p>\n<p>\u786e\u8bca\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u91d1\u6807\u51c6\u662f\u9aa8\u6d3b\u7ec4\u7ec7\u7684\u75c5\u7406\u68c0\u67e5\u3002\u5982\u4ec5\u51fa\u73b0\u5b64\u7acb\u6027\u9aa8\u7834\u574f\u75c5\u7076\uff0c\u65e0\u8bba\u6709\u65e0\u80ba\u764c\u5747\u5e94\u79ef\u6781\u884c\u75c5\u7076\u9aa8\u6d3b\u68c0\uff1b\u5982\u786e\u8bca\u80ba\u764c\uff0c\u4f34\u5168\u8eab\u591a\u53d1\u9aa8\u7834\u574f\uff0c\u5219\u9aa8\u6d3b\u68c0\u4e3a\u975e\u5fc5\u987b\u64cd\u4f5c[4]\u3002<\/p>\n<p>\u7a7f\u523a\u6d3b\u68c0\u662f\u4e00\u79cd\u5f88\u597d\u7684\u83b7\u53d6\u8db3\u591f\u7ec4\u7ec7\u7684\u65b9\u6cd5\uff0c\u8db3\u4ee5\u660e\u786e\u662f\u5426\u5b58\u5728\u8f6c\u79fb\u6027\u75c5\u53d8\u3002CT\u5f15\u5bfc\u4e0b\u7ec6\u9488\u62bd\u5438\u6d3b\u68c0\u64cd\u4f5c\u7b80\u5355\u4e14\u7ed3\u679c\u51c6\u786e\uff0c\u5728\u6781\u5c11\u6570\u60c5\u51b5\u4e0b\u53ef\u80fd\u9700\u8981\u5f00\u653e\u6d3b\u68c0[4]\u3002\u901a\u5e38\u60c5\u51b5\u4e0b\uff0c\u7a7f\u523a\u6d3b\u68c0\u4e0d\u4f1a\u5f15\u8d77\u75c5\u7406\u6027\u9aa8\u6298\u7684\u53d1\u751f\u3002\u7a7f\u523a\u6d3b\u68c0\u53d6\u6750\u8981\u6c42\u53ca\u6d3b\u68c0\u6807\u672c\u7684\u5904\u7406\u65b9\u6cd5\u8be6\u89c1\u300a\u80ba\u764c\u9aa8\u8f6c\u79fb\u8bca\u7597\u4e13\u5bb6\u5171\u8bc6\uff082019 \u7248\uff09\u300b[4]\u3002<\/p>\n<p>3.2&nbsp; &nbsp; \u8bca\u65ad\u6d41\u7a0b<\/p>\n<p>\u5f53\u80ba\u764c\u60a3\u8005\u5408\u5e76\u9aa8\u8f6c\u79fb\u9ad8\u5371\u56e0\u7d20\u65f6\uff0c\u5e94\u53ca\u65f6\u8fdb\u884cBS \u7b5b\u67e5\uff0c\u5982BS \u9633\u6027\uff0c\u5219\u6709\u5fc5\u8981\u884cMRI\u3001PET\/CT\u6216\u9aa8\u6d3b\u68c0\u8fdb\u4e00\u6b65\u8bc4\u4f30\u8f6c\u79fb\u75c5\u7076\uff0c\u8fdb\u4e00\u6b65\u660e\u786e\u8bca\u65ad\u3002\u8bca\u65ad\u6d41\u7a0b\u89c1\u56fe1\u3002<\/p>\n<p>\u56fe 1&nbsp; &nbsp; &nbsp;\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u8bca\u65ad\u6d41\u7a0b<\/p>\n<p>BS\uff1a\u6838\u7d20\u9aa8\u663e\u50cf\uff1bPET\/CT\uff1a\u6b63\u7535\u5b50\u53d1\u5c04\u8ba1\u7b97\u673a\u65ad\u5c42\u663e\u50cf\uff1bMRI\uff1a\u78c1\u5171\u632f\u6210\u50cf\uff1b*\u9ad8\u5371\u60a3\u8005\u6307\u9aa8\u75db\u3001\u9ad8\u9499\u8840\u75c7\u3001\u9ad8\u78b1\u6027\u78f7\u9178\u9176\u3001\u810a\u9ad3\u538b\u8feb\u75c7\u72b6\u7b49<\/p>\n<p>4\u3000\u6cbb\u7597&nbsp;<\/p>\n<p>\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u9632\u6cbb\u76ee\u6807\u4e3a\u75c7\u72b6\u7f13\u89e3\u3001\u9884\u9632\u6216\u5ef6\u7f13SREs\u3001\u6700\u7ec8\u5ef6\u957f\u751f\u5b58\u671f\u5e76\u63d0\u9ad8\u751f\u6d3b\u8d28\u91cf\uff1b\u5fc5\u8981\u65f6\u8fd8\u5e94\u8fdb\u884c\u5fc3\u7406\u5e72\u9884\u3002<\/p>\n<p>\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u6cbb\u7597\u63a8\u8350\u9075\u5faaMDT\u5236\u5b9a\u4e2a\u4f53\u5316\u65b9\u6848\u3002\u63a8\u8350\u4ee5\u80ba\u764c\u7684\u5168\u8eab\u6cbb\u7597\u4e3a\u4e3b\uff0c\u540c\u65f6\u8054\u5408\u53cc\u81a6\u9178\u76d0\u548cRANKL\u6291\u5236\u5242\u7b49\u9aa8\u6539\u826f\u836f\u7269\uff0c\u9884\u9632\u548c\u5ef6\u7f13SREs\uff1b\u5bf9\u75c7\u6b62\u75db\u6cbb\u7597\u53ef\u7f13\u89e3\u75c7\u72b6\uff0c\u6539\u5584\u751f\u6d3b\u8d28\u91cf\uff1b\u6b64\u5916\uff0c\u5305\u62ec\u624b\u672f\u548c\u653e\u7597\u5728\u5185\u7684\u5c40\u90e8\u6cbb\u7597\u53ef\u4ee5\u66f4\u597d\u5730\u63a7\u5236\u9aa8\u8f6c\u79fb\u76f8\u5173\u75c7\u72b6\u3002<\/p>\n<p>\u63a8\u83504\uff1a\u5bf9\u786e\u8bca\u80ba\u764c\u9aa8\u8f6c\u79fb\u60a3\u8005\uff0c\u63a8\u8350MDT\uff0c\u4e2a\u4f53\u5316\u5236\u5b9a\u7efc\u5408\u6cbb\u7597\u65b9\u6848\uff081A\uff09\u3002<\/p>\n<p>\u63a8\u83505\uff1a\u5bf9\u786e\u8bca\u80ba\u764c\u9aa8\u8f6c\u79fb\u60a3\u8005\uff0c\u5982\u65e0\u7981\u5fcc\u8bc1\uff0c\u5747\u63a8\u8350\u5e94\u7528\u9aa8\u6539\u826f\u836f\u7269\u6cbb\u7597\uff081A\uff09\uff0c\u4f46\u4e0d\u63a8\u8350\u5e38\u89c4\u4f7f\u7528\u9aa8\u6539\u826f\u836f\u7269\u4f5c\u4e3a\u9884\u9632\u6027\u6cbb\u7597\uff082B\uff09\u3002<\/p>\n<p>\u63a8\u83506\uff1a\u5982\u65e0\u7981\u5fcc\uff0c\u63a8\u8350\u53cc\u81a6\u9178\u76d0\u6216RANKL\u6291\u5236\u5242\u964d\u4f4e\u80ba\u764c\u9aa8\u8f6c\u79fb\u60a3\u8005\u7684SREs\u98ce\u9669\uff081A\uff09\u3002<\/p>\n<p>\u63a8\u83507\uff1a\u6b63\u5728\u63a5\u53d7\u53cc\u81a6\u9178\u76d0\u6cbb\u7597\u7684\u60a3\u8005\uff0c\u5982\u51fa\u73b0\u4e8c\u6b21SREs\u4e0d\u5efa\u8bae\u7acb\u5373\u505c\u7528\u53cc\u81a6\u9178\u76d0\uff081B\uff09\uff0c\u4e5f\u53ef\u4ee5\u8003\u8651\u6362\u7528RANKL\u6291\u5236\u5242\u6216\u53e6\u5916\u4e00\u79cd\u53cc\u81a6\u9178\u76d0\uff082B\uff09\u3002<\/p>\n<p>\u63a8\u83508\uff1a\u5728\u63a5\u53d7\u9aa8\u6539\u826f\u836f\u7269\u524d\u540e\uff0c\u5747\u5e94\u5e38\u89c4\u68c0\u67e5\u53e3\u8154\uff0c\u4ee5\u964d\u4f4e\u988c\u9aa8\u574f\u6b7b\uff08osteonecrosis of the jaw\uff0cONJ\uff09\u98ce\u9669\uff081B\uff09\u3002<\/p>\n<p>\u63a8\u83509\uff1a\u5bf9\u4e8e\u591a\u53d1\u6027\u9aa8\u8f6c\u79fb\u60a3\u8005\uff0c\u5e94\u4f18\u5148\u8003\u8651\u5168\u8eab\u7cfb\u7edf\u6cbb\u7597\u548c\u53ca\u65e9\u3001\u6301\u7eed\u3001\u6709\u6548\u5730\u8fdb\u884c\u9636\u68af\u9547\u75db\uff081C\uff09\u3002<\/p>\n<p>\u63a8\u835010\uff1a\u5bf9\u7ecf\u5168\u8eab\u6cbb\u7597\u540e\u4ecd\u65e0\u6cd5\u6539\u5584\u7684\u987d\u56fa\u6027\u9aa8\u75db\u3001\u75c5\u7406\u6027\u9aa8\u6298\u548c\u810a\u9ad3\u538b\u8feb\u7684\u60a3\u8005\uff0c\u5c40\u90e8\u4f53\u5916\u653e\u5c04\u6cbb\u7597\uff0c\u7279\u522b\u662f\u7acb\u4f53\u5b9a\u5411\u653e\u5c04\u6cbb\u7597\uff08SBRT\uff09\u5e94\u4f5c\u4e3a\u9996\u9009\u6cbb\u7597\uff081B\uff09\u3002<\/p>\n<p>\u63a8\u835011\uff1a\u5bf9\u4e8e\u5168\u8eab\u6cbb\u7597\u6709\u6548\u3001\u4f46\u5c40\u90e8\u6216\u5b64\u7acb\u6027\u9aa8\u8f6c\u79fb\u75c5\u7076\u3001\u6709\u810a\u67f1\u53d7\u7d2f\u7684\u60a3\u8005\uff0c\u53ef\u5728\u5916\u79d1\u5145\u5206\u8bc4\u4f30\u7684\u60c5\u51b5\u4e0b\u8fdb\u884c\u5916\u79d1\u5e72\u9884\uff082B\uff09\u3002<\/p>\n<p>\u63a8\u835012\uff1a\u5bf9\u4e8e\u80ba\u764c\u6eb6\u9aa8\u6027\u9aa8\u8f6c\u79fb\u75c5\u7076\uff0c\u53ef\u4f7f\u7528\u6d88\u878d\u8054\u5408\u9aa8\u6210\u5f62\u672f\uff08\u9aa8\u6c34\u6ce5\uff09\u7684\u4ecb\u5165\u6cbb\u7597\uff0c\u63a7\u5236\u8f6c\u79fb\u75c5\u7076\u7684\u540c\u65f6\u6062\u590d\u9aa8\u7ed3\u6784\u7684\u7a33\u5b9a\u6027\uff082B\uff09\u3002<\/p>\n<p>4.1&nbsp; &nbsp; \u9aa8\u6539\u826f\u836f\u7269<\/p>\n<p>\u80ba\u764c\u9aa8\u8f6c\u79fb\u786e\u8bca\u540e\u5e94\u7acb\u5373\u8fdb\u884c\u9aa8\u6539\u826f\u836f\u7269\u6cbb\u7597\u3002\u9aa8\u6539\u826f\u836f\u7269\u4e5f\u88ab\u79f0\u4e3a\u201c\u7834\u9aa8\u7ec6\u80de\u6291\u5236\u5242\u201d\uff0c\u4e34\u5e8a\u5e38\u7528\u7684\u9aa8\u6539\u826f\u836f\u7269\u4e3a\u53cc\u81a6\u9178\u76d0\u7c7b\u548cRANKL\u6291\u5236\u5242\u3002<\/p>\n<p>4.1.1&nbsp; &nbsp; \u53cc\u81a6\u9178\u76d0<\/p>\n<p>\u5728\u80ba\u764c\u9aa8\u8f6c\u79fb\u60a3\u8005\u4e2d\uff0c\u53cc\u81a6\u9178\u76d0\u5e38\u4e0e\u6297\u80bf\u7624\u6cbb\u7597\u8054\u5408\u4f7f\u7528\uff0c\u662f\u9aa8\u6539\u826f\u7684\u57fa\u7840\u7528\u836f\u4e4b\u4e00\u3002\u53cc\u81a6\u9178\u76d0\u901a\u8fc7\u6291\u5236\u7834\u9aa8\u7ec6\u80de\u6d3b\u6027\u800c\u51cf\u5c11\u9aa8\u8d28\u5438\u6536\u548c\u589e\u52a0\u77ff\u5316\uff0c\u963b\u6b62\u80bf\u7624\u8f6c\u79fb\u5f15\u8d77\u7684\u6eb6\u9aa8\u578b\u75c5\u53d8\u3001\u51cf\u5c11\u9aa8\u5438\u6536\u3001\u51cf\u8f7b\u9aa8\u75db\u53ca\u7531\u9aa8\u8f6c\u79fb\u6240\u81f4\u7684\u9ad8\u9499\u8840\u75c7\u53ca\u5176\u4ed6SREs[21-22]\u3002\u76ee\u524d\uff0c\u53cc\u81a6\u9178\u76d0\u7c7b\u836f\u7269\u5df2\u7ecf\u53d1\u5c55\u81f3\u7b2c\u4e09\u4ee3\uff0c\u4ee5\u5511\u6765\u81a6\u9178\u3001\u4f0a\u73ed\u81a6\u9178\u94a0\u548c\u56e0\u5361\u81a6\u9178\u4e8c\u94a0\u4e3a\u4ee3\u8868\uff1b\u76f8\u6bd4\u524d\u4e24\u4ee3\uff0c\u9664\u51cf\u8f7b\u75c7\u72b6\u3001\u5ef6\u7f13SREs \u83b7\u76ca\u5916\uff0c\u8fd8\u53ef\u663e\u8457\u964d\u4f4e\u9ad8\u9499\u8840\u75c7\u98ce\u9669\u3001\u63d0\u5347\u9aa8\u5bc6\u5ea6\u3001\u6539\u5584\u9aa8\u4ee3\u8c22\u3002\u4f0a\u73ed\u81a6\u9178\u8d1f\u8377\u5242\u91cf\u53ef\u5feb\u901f\u7f13\u89e3\u9aa8\u8f6c\u79fb\u60a3\u8005\u7684\u75bc\u75db[4,23-24]\u3002\u56e0\u5361\u81a6\u9178\u76f8\u6bd4\u5176\u4ed6\u7b2c\u4e09\u4ee3\u53cc\u81a6\u9178\u76d0\uff0c\u53d1\u70ed\u3001\u80be\u6bd2\u6027\u53ca\u4e0b\u988c\u9aa8\u574f\u6b7b\u7b49\u4e0d\u826f\u53cd\u5e94\u53d1\u751f\u7387\u66f4\u4f4e[25]\u3002\u5404\u7c7b\u53cc\u81a6\u9178\u76d0\u836f\u7269\u7684\u7528\u6cd5\u7528\u91cf\u8be6\u89c1\u300a\u80ba\u764c\u9aa8\u8f6c\u79fb\u8bca\u7597\u4e13\u5bb6\u5171\u8bc6\uff082019 \u7248\uff09\u300b[4]\u3002&nbsp;<\/p>\n<p>4.1.2&nbsp; &nbsp; RANKL\u6291\u5236\u5242<\/p>\n<p>\u5728\u6076\u6027\u80bf\u7624\u9aa8\u8f6c\u79fb\u7684\u8fc7\u7a0b\u4e2d\uff0cRANK\/RANKL\u662f\u5173\u952e\u901a\u8def\uff0c\u56e0\u800c\u9488\u5bf9\u9aa8\u8f6c\u79fb\u7684\u6cbb\u7597\uff0c\u9776\u5411RANKL\u662f\u4e00\u4e2a\u5f88\u597d\u7684\u9009\u62e9\u3002&nbsp;<\/p>\n<p>4.1.2.1&nbsp; &nbsp; \u5730\u8212\u5355\u6297<\/p>\n<p>\u5730\u8212\u5355\u6297\u662fRANKL\u6291\u5236\u5242\u7684\u4ee3\u8868\u836f\u7269\uff0c\u9776\u5411\u6291\u5236\u7834\u9aa8\u7ec6\u80de\u7684\u5206\u5316\u3001\u6d3b\u5316\uff0c\u6253\u7834\u764c\u75c7\u9aa8\u8f6c\u79fb\u7684\u6076\u6027\u5faa\u73af\u8fc7\u7a0b[26]\u3002\u867d\u7136\u76ee\u524d\u6ca1\u6709\u5730\u8212\u5355\u6297\u4e0e\u53cc\u81a6\u9178\u76d0\u5728\u80ba\u764c\u9aa8\u8f6c\u79fb\u4eba\u7fa4\u4e2d\u7684\u5934\u5bf9\u5934\u6bd4\u8f83\u7814\u7a76\uff0c\u4f46\u5728\u5176\u4ed6\u80bf\u7624\u9aa8\u8f6c\u79fb\u7814\u7a76\u4e2d\uff0c\u5730\u8212\u5355\u6297\u76f8\u6bd4\u53cc\u81a6\u9178\u76d0\u53ef\u5ef6\u957f\u9996\u6b21\u51fa\u73b0SREs \u7684\u65f6\u95f4\uff0c\u663e\u8457\u964d\u4f4e\u9996\u6b21SREs \u53d1\u751f\u98ce\u9669\uff0c\u663e\u8457\u5ef6\u7f13\u75c5\u7406\u6027\u9aa8\u6298\u3001\u9aa8\u624b\u672f\u548c\/\u6216\u9aa8\u653e\u7597\u53ca\u810a\u9ad3\u538b\u8feb\uff0c\u5ef6\u7f13\u6076\u6027\u9ad8\u9499\u8840\u75c7\u53d1\u751f\u65f6\u95f4\uff0c\u90e8\u5206\u7814\u7a76[24,27-30]\u663e\u793a\u53ef\u5ef6\u957f\u751f\u5b58\u65f6\u95f4\uff0c\u751f\u5b58\u8d28\u91cf\u4e5f\u66f4\u6709\u4f18\u52bf[31]\u3002\u5730\u8212\u5355\u6297\u76ee\u524d\u5df2\u7ecf\u83b7\u6279\u5728\u4e2d\u56fd\u4e0a\u5e02\uff0c\u7528\u4e8e\u9884\u9632\u5b9e\u4f53\u7624\u9aa8\u8f6c\u79fb\u548c\u591a\u53d1\u6027\u9aa8\u9ad3\u7624\u5f15\u8d77\u7684SREs\uff0c\u63a8\u8350\u7684\u4f7f\u7528\u65b9\u6cd5\u4e3a\u76ae\u4e0b\u7ed9\u836f\uff0c\u6bcf4 \u54681\u6b21\uff0c\u6bcf\u6b21120 mg\u3002<\/p>\n<p>4.1.2.2&nbsp; &nbsp; \u5176\u4ed6RANKL\u6291\u5236\u5242<\/p>\n<p>\u7eb3\u9c81\u7d22\u62dc\u5355\u6297\u662f\u6211\u56fd\u539f\u7814\u7684\u5168\u7403\u9996\u4e2a\u5168\u4eba\u6e90IgG4 RANKL\u6291\u5236\u5242\uff0c\u662f\u56fd\u5bb61\u7c7b\u751f\u7269\u5236\u5242\u3002\u7eb3\u9c81\u7d22\u62dc\u5355\u6297\u4e0eRANKL\u7684\u4eb2\u548c\u529b\u8f83\u5730\u8212\u5355\u6297\u66f4\u5f3a\uff0c\u7ed3\u5408\u6548\u7387\u63d0\u53472.5\u500d\u3002\u5df2\u5728\u80ba\u764c\u9aa8\u8f6c\u79fb\u60a3\u8005\u4e2d\u5b8c\u6210\u2160\u671f\u53ca\u2160b\u671f\u4e34\u5e8a\u8bd5\u9a8c\u3002\u5728\u9aa8\u5de8\u7ec6\u80de\u7624\u5173\u952e\u2161\u671f\u4e0a\u5e02\u7814\u7a76\u4e2d\uff0c\u7eb3\u9c81\u7d22\u62dc\u5355\u6297\u5bf9\u6bd4\u5730\u8212\u5355\u6297\u663e\u73b0\u51fa\u80bf\u7624\u53cd\u5e94\u7387\u9ad8\uff0c\u8d77\u6548\u901f\u5ea6\u5feb\u7684\u8d8b\u52bf[32]\u3002<\/p>\n<p>4.1.3&nbsp; &nbsp; \u9aa8\u6539\u826f\u836f\u7269\u4f7f\u7528\u7597\u7a0b\u53ca\u505c\u836f\u6307\u5f81<\/p>\n<p>\u867d\u7136\u9aa8\u6539\u826f\u836f\u7269\u53ef\u5728\u77ed\u65f6\u95f4\u5185\u6539\u5584\u9aa8\u75db\u75c7\u72b6[33]\uff0c\u4f46\u5bf9\u4e8eSREs\u5219\u9700\u8981\u8d85\u8fc76 \u4e2a\u6708\u7684\u6cbb\u7597\u65f6\u95f4[34]\u3002\u7cfb\u7edf\u8bc4\u4ef7[35]\u53d1\u73b0\uff0c\u9aa8\u6539\u826f\u6cbb\u7597\u8d85\u8fc72\u5e74\uff0cSREs\u98ce\u9669\u964d\u4f4e\uff0c\u4f46ONJ \u7b49\u4e0d\u826f\u53cd\u5e94\u7684\u7d2f\u79ef\u98ce\u9669\u589e\u52a0\u3002\u56e0\u6b64\u9aa8\u6539\u826f\u836f\u7269\u4e0d\u5b9c\u77ed\u671f\u6cbb\u7597\uff0cASCO\u591a\u53d1\u6027\u9aa8\u9ad3\u7624\u6307\u5357[36]\u8ba4\u4e3a\uff0c\u5bf9\u4e8e\u5be1\u8f6c\u79fb\u6027\u75be\u75c5\u63a7\u5236\u826f\u597d\u7684\u60a3\u8005\u57282\u5e74\u540e\u4e2d\u65ad\u53cc\u81a6\u9178\u76d0\u6cbb\u7597\u53ef\u884c\uff0c\u4f46\u5176\u6700\u4f73\u4f7f\u7528\u65f6\u95f4\u76ee\u524d\u5c1a\u65e0\u5b9a\u8bba[27-38]\u3002\u4ece\u4e34\u5e8a\u7ecf\u9a8c\u7684\u89d2\u5ea6\uff0c\u5982\u60a3\u8005\u53ef\u8010\u53d7\u4e14\u6cbb\u7597\u7b26\u5408\u60a3\u8005\u548c\u533b\u751f\u5171\u540c\u6cbb\u7597\u76ee\u6807\u65f6\uff0c\u53ef\u914c\u60c5\u9009\u62e9\u957f\u671f\u6cbb\u7597\u3002<\/p>\n<p>\u51fa\u73b0\u4e25\u91cd\u4e0d\u826f\u53cd\u5e94\u6216\u533b\u751f\u8ba4\u4e3a\u7ee7\u7eed\u7528\u836f\u65e0\u6cd5\u4ece\u6cbb\u7597\u4e2d\u83b7\u76ca\u662f\u9aa8\u6539\u826f\u836f\u7269\u7684\u505c\u836f\u6307\u5f81\u3002\u4f46\u5982\u679c\u53cc\u81a6\u9178\u76d0\u6cbb\u7597\u671f\u95f4\u9aa8\u75db\u52a0\u91cd\u6216\u51fa\u73b0SREs\u65f6\uff0c\u5e94\u7ee7\u7eed\u7528\u836f\u4ee5\u964d\u4f4e\u4e8c\u6b21SREs\u98ce\u9669[5]\uff0c\u4e5f\u53ef\u4ee5\u8003\u8651\u6362\u7528\u5730\u8212\u5355\u6297\u6216\u53e6\u5916\u4e00\u79cd\u53cc\u81a6\u9178\u76d0\uff0c\u4f46\u4ecd\u9700\u540e\u7eed\u7814\u7a76\u8fdb\u4e00\u6b65\u660e\u786e\u3002<\/p>\n<p>4.1.4&nbsp; &nbsp; \u4e0d\u826f\u53cd\u5e94\u53ca\u7528\u836f\u6ce8\u610f\u4e8b\u9879<\/p>\n<p>\u53cc\u81a6\u9178\u76d0\u548c\u5730\u8212\u5355\u6297\u90fd\u53ef\u5f15\u8d77ONJ\u3001\u4f4e\u9499\u8840\u75c7\u548c\u5176\u4ed6\u7535\u89e3\u8d28\u5f02\u5e38\u4ee5\u53ca\u975e\u5178\u578b\u9aa8\u6298\u7b49\u5e76\u53d1\u75c7\u3002\u53cc\u81a6\u9178\u76d0\u72ec\u6709\u7684\u5e76\u53d1\u75c7\u5305\u62ec\u80be\u529f\u80fd\u4e0d\u5168\u3001\u6025\u6027\u671f\u53cd\u5e94\u3001\u773c\u6bd2\u6027\u3001\u808c\u8089\u9aa8\u9abc\u75bc\u75db\u548c\u5fc3\u623f\u98a4\u52a8\u7b49\uff1b\u5730\u8212\u5355\u6297\u5e38\u89c1\u7684\u4e0d\u826f\u53cd\u5e94\u4e3a\u808c\u8089\u3001\u9aa8\u9abc\u75bc\u75db\uff0c\u5076\u89c1\u8702\u7a9d\u7ec7\u611f\u67d3\u7b49\u75c5\u4f8b\u62a5\u9053\uff0c ONJ\u548c\u975e\u5178\u578b\u6027\u80a1\u9aa8\u9aa8\u6298\u76f8\u5bf9\u7f55\u89c1[23]\u3002<\/p>\n<p>4.1.4.1&nbsp; &nbsp; \u988c\u9aa8\u574f\u6b7b<\/p>\n<p>\u9aa8\u6539\u826f\u836f\u7269\u7684\u4f7f\u7528\u662fONJ\u53d1\u751f\u7684\u5371\u9669\u56e0\u7d20\u4e4b\u4e00\uff0c\u4e8e2002 \u5e74\u9996\u6b21\u63cf\u8ff0\u3002ONJ\u7684\u7279\u5f81\u8868\u73b0\u4e3a\u9aa8\u66b4\u9732\u548c\u574f\u6b7b\uff0c\u5176\u53ef\u5728\u6570\u5468\u3001\u6570\u6708\u751a\u81f3\u6570\u5e74\u5185\u65e0\u75c7\u72b6\uff1b\u76f4\u81f3\u5468\u56f4\u8f6f\u7ec4\u7ec7\u53d1\u708e\u65f6\u75c5\u53d8\u51fa\u73b0\u76f8\u5173\u75c7\u72b6\uff0c\u5305\u62ec\u957f\u65f6\u95f4\u7684\u988c\u90e8\u75bc\u75db\u3001\u7259\u9f7f\u677e\u52a8\u3001\u9aa8\u81a8\u5927\u3001\u7259\u9f88\u80bf\u80c0\u3001\u53d1\u7ea2\u548c\u6e83\u75a1\u3002\u6709\u4e9b\u8868\u73b0\u53ef\u80fd\u81ea\u53d1\u51fa\u73b0\uff0c\u4e5f\u53ef\u80fd\u5728\u65e2\u5f80\u7259\u79d1\u624b\u672f\u90e8\u4f4d\u51fa\u73b0\u3002ONJ\u7ee7\u53d1\u611f\u67d3\u540e\uff0c\u8fd8\u53ef\u80fd\u53d1\u751f\u53e3\u5185\u6216\u53e3\u5916\u7618\u3002ONJ\u4e3b\u8981\u53d1\u751f\u673a\u5236\u5c1a\u4e0d\u660e\u786e\uff0c\u4f46\u53ef\u80fd\u4e0e\u4e25\u91cd\u4e14\u957f\u671f\u7684\u9aa8\u5438\u6536\u6291\u5236\u4f34\u9aa8\u91cd\u5851\u8fc7\u5ea6\u6291\u5236\u4ee5\u53ca\u611f\u67d3\u6709\u5173[39]\u3002<\/p>\n<p>\u4e00\u9879\u7eb3\u51654.2\u4e07\u4f8b\u80bf\u7624\u60a3\u8005\u7684\u7cfb\u7edf\u8bc4\u4ef7[40]\u6307\u51fa\uff0c\u4f7f\u7528\u9aa8\u6539\u826f\u836f\u7269\u540e\u53d1\u751fONJ\u7684\u53d1\u751f\u7387\u4e3a2.08%\uff0c\u5730\u8212\u5355\u6297\u7684ONJ\u53d1\u751f\u7387\u7565\u9ad8\u4e8e\u53cc\u81a6\u9178\u76d0\uff083% vs. 1.6%\uff09\u3002\u4f46\u4e5f\u6709\u7814\u7a76[41]\u6307\u51fa\uff0c\u66f4\u77ed\u7684\u7ed9\u836f\u95f4\u9694\u4e5f\u4f1a\u589e\u52a0\u53cc\u81a6\u9178\u76d0\u53d1\u751fONJ\u98ce\u9669\uff085 \u5468 vs. \u2265 5\u5468\uff09\u3002\u5730\u8212\u5355\u6297\u6cbb\u7597\u7b2c1\u5e74ONJ\u53d1\u751f\u7387\u4e3a1.1%\uff0c\u7b2c2\u5e74\u4e3a3.7%\uff0c\u968f\u540e\u6bcf\u5e74\u4e3a4.6%\u3002\u56e0\u6b64\uff0c\u5728\u5f00\u59cb\u8fdb\u884c\u9aa8\u6539\u826f\u836f\u7269\u6cbb\u7597\u4e4b\u524d\uff0c\u63a8\u8350\u8fdb\u884c\u53e3\u8154\u68c0\u67e5\uff0c\u6cbb\u7597\u671f\u95f4\u5e94\u5b9a\u671f\u8fdb\u884c\u53e3\u8154\u68c0\u67e5\uff0c\u5e76\u7ed9\u4ee5\u9002\u5f53\u7684\u9884\u9632\u6027\u7259\u79d1\u62a4\u7406\u3002\u60a3\u8005\u5728\u6cbb\u7597\u671f\u95f4\u5e94\u907f\u514d\u8fdb\u884c\u4fb5\u5165\u6027\u7684\u7259\u79d1\u624b\u672f\uff0c\u5982\u679c\u5fc5\u987b\u8fdb\u884c\u53ef\u8003\u8651\u6682\u505c\u9aa8\u6539\u826f\u836f\u7269\u6cbb\u7597\u3002\u5982\u51fa\u73b0ONJ\uff0c\u5bf9\u4e8e\u5927\u90e8\u5206\u60a3\u8005\u5efa\u8bae\u6700\u5f00\u59cb\u91c7\u7528\u4fdd\u5b88\u6cbb\u7597\uff08\u6297\u83cc\u542b\u6f31\u5242\u3001\u6709\u4e34\u5e8a\u6307\u5f81\u65f6\u4f7f\u7528\u6297\u751f\u7d20\u3001\u6709\u6548\u4fdd\u6301\u53e3\u8154\u536b\u751f\uff0c\u4ee5\u53ca\u6709\u9650\u7684\u6e05\u521b\uff09\uff0c\u800c\u4e0d\u662f\u79ef\u6781\u7684\u624b\u672f\u5207\u9664\uff1b\u5173\u4e8eONJ\u60a3\u8005\u662f\u5426\u505c\u7528\u9aa8\u6539\u826f\u836f\u7269\uff0c\u8bf7\u53c2\u80034.1.3\u3002<\/p>\n<p>4.1.4.2&nbsp; &nbsp; \u80be\u6bd2\u6027<\/p>\n<p>\u80be\u529f\u80fd\u4e0d\u5168\u662f\u53cc\u81a6\u9178\u76d0\u7684\u5e38\u89c1\u4e0d\u826f\u53cd\u5e94\u4e4b\u4e00\uff0c\u65e9\u671f\u65e0\u660e\u663e\u75c7\u72b6\uff0c\u8868\u73b0\u4e3a\u86cb\u767d\u5c3f\u6216\u7ba1\u578b\u5c3f\uff0c\u5c11\u6570\u53ef\u53d1\u5c55\u81f3\u6025\u6027\u80be\u8870\u7aed[4]\u3002\u4f46\u9aa8\u6539\u826f\u836f\u7269\u5bfc\u81f4\u80be\u529f\u80fd\u4e0d\u5168\u7684\u6570\u636e\u591a\u89c1\u4e8e\u591a\u53d1\u6027\u9aa8\u9ad3\u7624\u7814\u7a76\uff0c\u80ba\u764c\u9aa8\u8f6c\u79fb\u4eba\u7fa4\u9c9c\u6709\u62a5\u9053\u3002\u5bf9\u4e8e\u5e74\u9f84&gt;65 \u5c81\u3001\u5408\u5e76\u7cd6\u5c3f\u75c5\u3001\u670d\u7528\u975e\u753e\u4f53\u6297\u708e\u836f\uff08NSAIDs\uff09\u6216\u6b63\u5728\u8fdb\u884c\u542b\u987a\u94c2\u5316\u7597\u7684\u60a3\u8005\u5e94\u5f53\u8b66\u60d5\u80be\u529f\u80fd\u4e0d\u5168\u751a\u81f3\u6025\u6027\u80be\u635f\u4f24\u7684\u53d1\u751f[4]\u3002\u636e\u6587\u732e[42]\u62a5\u9053\uff0c\u4e00\u822c\u80be\u529f\u80fd\u4e0d\u5168\u4e2d\u4f4d\u53d1\u751f\u65f6\u95f4\u4e3a4.7\uff5e5.4 \u4e2a\u6708\uff0c\u5f53\u8840\u6e05\u808c\u9150\u6e05\u9664\u7387&lt;60 mL\/min \u65f6\uff0c\u51fa\u73b0\u6025\u6027\u80be\u529f\u80fd\u4e0d\u5168\u98ce\u9669\u663e\u8457\u5347\u9ad8\u3002\u5bf9\u4e8e\u80be\u529f\u80fd\u4e0d\u5168\u60a3\u8005\u4f7f\u7528\u53cc\u81a6\u9178\u76d0\u9700\u8c03\u6574\u5242\u91cf\uff08\u88682\uff09\u3002\u56e0\u5361\u81a6\u9178\u7ed9\u836f\u540e\u5728\u80be\u810f\u6c89\u79ef\u91cf\u66f4\u5c11\uff0c\u4e14\u6613\u88ab\u5feb\u901f\u6e05\u9664\uff0c\u4e0e\u5511\u6765\u81a6\u9178\u76f8\u6bd4\uff0c\u53ef\u4e00\u5b9a\u7a0b\u5ea6\u964d\u4f4e\u80be\u6bd2\u6027\u98ce\u9669\u3002RANKL\u6291\u5236\u5242\uff08\u5730\u8212\u5355\u6297\uff09\u5206\u5b50\u91cf\u5927\u4e8e\u80be\u5c0f\u7403\u6ee4\u8fc7\u9608\u503c\uff0c\u51e0\u4e4e\u4e0d\u7ecf\u80be\u810f\u6d88\u9664\u3002\u56e0\u6b64\uff0c\u65e2\u4e0d\u9700\u8981\u4e5f\u4e0d\u63a8\u8350\u5bf9\u65e2\u5b58\u80be\u635f\u4f24\u60a3\u8005\u76d1\u6d4b\u80be\u529f\u80fd\u548c\u8c03\u6574\u5242\u91cf\u3002<\/p>\n<p>4.1.4.3&nbsp; &nbsp; \u4f4e\u9499\u8840\u75c7<\/p>\n<p>\u4e0d\u540c\u9aa8\u6539\u826f\u836f\u7269\u7684\u4f4e\u9499\u8840\u75c7\u53d1\u751f\u7387\u6709\u5dee\u5f02\uff0c\u5982\u5511\u6765\u81a6\u9178\u53d1\u751f\u7387\u4e3a5%\uff5e10%\uff0c\u4f0a\u73ed\u81a6\u9178\u4e3a1%\uff5e10%\uff0c\u5730\u8212\u5355\u6297\u4e3a18%\u3002\u867d\u7136\u8f7b\u5ea6\u548c\/\u6216\u6162\u6027\u4f4e\u9499\u8840\u75c7\u51e0\u4e4e\u6ca1\u6709\u75c7\u72b6\uff0c\u4f46\u91cd\u5ea6\u6216\u6025\u6027\u4f4e\u9499\u8840\u75c7\u4f1a\u5f15\u53d1\u62bd\u6410\u3001\u652f\u6c14\u7ba1\u75c9\u631b\u7b49\u6025\u75c7\uff0c\u751a\u81f3\u5371\u53ca\u751f\u547d\u3002\u56e0\u6b64\u5728\u7ed9\u4e88\u5730\u8212\u5355\u6297\u524d\uff0c\u6709\u5fc5\u8981\u5e38\u89c4\u76d1\u6d4b\u4f4e\u9499\u8840\u75c7\u5e76\u5c06\u5176\u7ea0\u6b63\uff0c\u751a\u81f3\u9884\u9632\u6027\u8865\u9499\u3002\u6709\u8bc1\u636e\u8868\u660e\uff0c\u9aa8\u6539\u826f\u836f\u7269\u670d\u7528\u671f\u95f4\u8865\u9499\uff08\u542b\u7ef4\u751f\u7d20D\uff09\uff0c\u53ef\u663e\u8457\u964d\u4f4e\u4f4e\u9499\u8840\u75c7\u98ce\u9669[43]\u3002\u56e0\u6b64\uff0c\u9664\u975e\u6709\u9ad8\u9499\u8840\u75c7\u7b49\u7981\u5fcc\u8bc1\uff0c\u63a8\u8350\u4f7f\u7528\u9aa8\u6539\u826f\u836f\u7269\u7684\u60a3\u8005\u989d\u5916\u8865\u51451 000 mg \u9499\u53ca800\uff5e1 200 IU \u7ef4\u751f\u7d20D\u3002<\/p>\n<p>4.2&nbsp; &nbsp; \u5168\u8eab\u6cbb\u7597<\/p>\n<p>\u7531\u4e8e\u7edd\u5927\u591a\u6570\u80ba\u764c\u9aa8\u8f6c\u79fb\u60a3\u8005\u4e3a\u80ba\u764c\u665a\u671f\uff0c\u5e38\u591a\u53d1\u9aa8\u8f6c\u79fb\u7076\uff0c\u4e3a\u4e86\u5ef6\u957f\u603b\u751f\u5b58\u671f\uff0c\u540c\u65f6\u7ef4\u6301\u751f\u5b58\u8d28\u91cf\uff0c\u665a\u671f\u975e\u5c0f\u7ec6\u80de\u80ba\u764c\uff08NSCLC\uff09\u4e00\u822c\u9700\u8981\u5e8f\u8d2f\u7cfb\u7edf\u6cbb\u7597\u548c\u8f85\u52a9\u6027\u9547\u75db\u6cbb\u7597\uff0c\u5e76\u4f18\u5148\u4e8e\u5916\u79d1\u548c\u653e\u7597\u7b49\u5c40\u90e8\u6cbb\u7597[44]\u3002\u5728\u80ba\u764c\u7684\u7cfb\u7edf\u6027\u6cbb\u7597\u4e2d\uff0c\u4f20\u7edf\u5316\u7597\u4f9d\u65e7\u91cd\u8981\uff0c\u4f46\u57fa\u4e8e\u751f\u7269\u6807\u5fd7\u7269\u7684\u4e2a\u4f53\u5316\u6cbb\u7597\u548c\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7b49\u65b0\u7b56\u7565\u6b63\u9010\u6e10\u53d7\u5230\u91cd\u89c6\uff0c\u5e76\u63a2\u7d22\u51fa\u591a\u79cd\u8054\u5408\u6cbb\u7597\u65b9\u6848\u3002\u7136\u800c\uff0c\u7531\u4e8e\u9aa8\u8f6c\u79fb\u7684\u590d\u6742\u751f\u7269\u5b66\u7279\u6027\u548c\u8bc4\u4f30\u56f0\u96be\uff0c\u5e76\u6ca1\u6709\u7279\u6b8a\u7684\u5185\u79d1\u6cbb\u7597\u836f\u7269\u80fd\u7279\u5f02\u6027\u6539\u5584\u9aa8\u8f6c\u79fb\u7684\u7597\u6548\uff0c\u51cf\u8f7bSREs \u7684\u53d1\u751f\uff0c\u66f4\u591a\u7684\u662f\u9700\u8981MDT\u3002<\/p>\n<p>4.2.1&nbsp; &nbsp; \u5316\u7597<\/p>\n<p>\u65e0\u8bba\u662f\u5c0f\u7ec6\u80de\u80ba\u764c\u8fd8\u662fNSCLC\u9aa8\u8f6c\u79fb\uff0c\u5747\u5f3a\u8c03\u7efc\u5408\u6cbb\u7597\u7b56\u7565\u7684\u91cd\u8981\u6027\u3002\u4f20\u7edf\u5316\u7597\u957f\u671f\u4ee5\u6765\u4e00\u76f4\u662f\u6807\u51c6\u6cbb\u7597\uff0c\u9009\u62e9\u5316\u7597\u65b9\u6848\u65f6\u5e94\u8003\u8651\u60a3\u8005\u7684\u5168\u8eab\u72b6\u51b5\u548c\u80bf\u7624\u7684\u751f\u7269\u5b66\u7279\u6027\u3002\u94c2\u7c7b\u836f\u7269\u4e3a\u57fa\u7840\u7684\u53cc\u8054\u65b9\u6848\u662f\u6b64\u7c7b\u60a3\u8005\u4e00\u7ebf\u5316\u7597\u7684\u4e3b\u8981\u9009\u62e9\uff0c\u53ef\u6839\u636e\u60a3\u8005\u8010\u53d7\u6027\u548c\u75be\u75c5\u7279\u70b9\u8c03\u6574\u3002<\/p>\n<p>4.2.2&nbsp; &nbsp; \u514d\u75ab\u6cbb\u7597<\/p>\n<p>\u57fa\u4e8e\u751f\u7269\u6807\u5fd7\u7269\u7684\u4e2a\u6027\u5316\u7597\u6cd5\u548c\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\uff08immune checkpoint inhibitors\uff0c ICIs\uff09\u4e3a\u6cbb\u7597\u63d0\u4f9b\u4e86\u65b0\u65b9\u5411\uff0c\u4f46\u9aa8\u8f6c\u79fb\u901a\u5e38\u4e0d\u4f1a\u88ab\u5217\u5165\u4e9a\u7ec4\u5206\u6790\u3002NSCLC\u60a3\u8005\u5728\u53d1\u751f\u9aa8\u8f6c\u79fb\u65f6\uff0c\u5bf9ICIs\u7684\u6cbb\u7597\u53cd\u5e94\u8868\u73b0\u51fa\u660e\u663e\u7684\u590d\u6742\u6027\u3002\u90e8\u5206\u7814\u7a76[45-46]\u663e\u793a\u9884\u540e\u6076\u5316\uff0c\u800c\u6709\u4e9b\u7814\u7a76[47-49]\u53d1\u73b0\u9aa8\u8f6c\u79fb\u5bf9\u751f\u5b58\u5f71\u54cd\u4e0d\u660e\u663e\u3002\u8fd9\u79cd\u5dee\u5f02\u53ef\u80fd\u6e90\u4e8e\u9aa8\u7684\u514d\u75ab\u5fae\u73af\u5883[45,47-49]\u548c\u9aa8\u8f6c\u79fb\u7684\u751f\u7269\u5b66\u5dee\u5f02[50]\u3002\u4f46\u5982\u679cICIs\u4e0eRANKL\u6291\u5236\u5242\uff08\u5730\u8212\u5355\u6297\uff09\u8054\u5408\u5e94\u7528\u65f6\uff0c\u76f8\u6bd4ICIs\u5355\u836f\uff0c\u6291\u5236\u665a\u671fNSCLC\u60a3\u8005\u9aa8\u8f6c\u79fb\u7684\u8fdb\u5c55\u6548\u679c\u66f4\u4f18\uff0c\u5ef6\u957f\u603b\u751f\u5b58\u671f\u3002<\/p>\n<p>\u4e3a\u63d0\u5347\u9aa8\u8f6c\u79fb\u76f8\u5173NSCLC\u60a3\u8005\u7597\u6548\uff0c\u7efc\u5408\u8fd0\u7528\u5316\u7597\u8054\u5408\u5176\u4ed6\u6cbb\u7597\u6bd4\u5982\u6297\u8840\u7ba1\u751f\u6210\u7597\u6cd5\u3001ICIs\u548c\u9aa8\u6539\u826f\u836f\u7269\u6210\u4e3a\u8d8b\u52bf[51]\u3002\u4f46\u9aa8\u8f6c\u79fb\u7684\u72ec\u7279\u6027\uff0c\u5982\u7279\u5b9a\u5fae\u73af\u5883\u3001\u8bc4\u4f30\u6311\u6218\u4ee5\u53ca\u751f\u7269\u5b66\u5f02\u8d28\u6027\u548cPD-L1\u7684\u52a8\u6001\u8868\u8fbe\uff0c\u4f7f\u6cbb\u7597\u8fc7\u7a0b\u590d\u6742\u5316\uff0c\u76ee\u524d\u4ecd\u7136\u96be\u4ee5\u7ed9\u51fa\u524d\u77bb\u6027\u3001\u4e2a\u4f53\u5316\u7684\u65b9\u6848\u3002<\/p>\n<p>4.2.3&nbsp; &nbsp; \u9776\u5411\u6cbb\u7597<\/p>\n<p>\u9aa8\u8f6c\u79fb\u5728NSCLC\u4e2d\u4e0e\u591a\u5668\u5b98\u8f6c\u79fb\u3001\u9891\u7e41\u7684\u590d\u53d1\u6027\u7a81\u53d8\u53ca\u590d\u6742\u57fa\u56e0\u5f02\u5e38\u76f8\u5173\u3002\u65e2\u5f80\u6587\u732e[4]\u62a5\u9053\u8868\u76ae\u751f\u957f\u56e0\u5b50\u53d7\u4f53\u916a\u6c28\u9178\u6fc0\u9176\u6291\u5236\u5242\uff08epidermal growth factor receptor-tyrosine kinase inhibitors\uff0cEGFR-TKIs\uff09\u5bf9\u9aa8\u8f6c\u79fb\u8868\u73b0\u51fa\u6cbb\u7597\u6f5c\u529b\uff0c\u4f8b\u5982TKIs\u53ef\u4ee5\u901a\u8fc7\u8c03\u8282\u9aa8\u9ad3\u57fa\u8d28\u7ec6\u80de\uff08BMSC\uff09\u964d\u4f4e\u7834\u9aa8\u7ec6\u80de\u7684\u5206\u5316\uff0c\u4ece\u800c\u5ef6\u7f13\u80bf\u7624\u9aa8\u8f6c\u79fb\u75c5\u7076\u7684\u9aa8\u7834\u574f\uff0c\u8fdb\u800c\u51cf\u5c11SREs\uff0c\u5ef6\u957f\u9996\u6b21SREs \u65f6\u95f4\uff1b\u4f46\u51fa\u73b0\u9aa8\u8f6c\u79fb\u4ecd\u662f\u4e0d\u826f\u9884\u540e\u7684\u72ec\u7acb\u5371\u9669\u56e0\u7d20\u3002\u73b0\u884c\u6cbb\u7597\u503e\u5411\u4e8e\u6574\u5408\u9776\u5411\u6cbb\u7597\u3001\u53cc\u81a6\u9178\u76d0\u53ca\u9aa8\u5438\u6536\u6291\u5236\u5242\u6765\u4f18\u5316\u6cbb\u7597[4]\u3002<\/p>\n<p>4.2.4&nbsp; &nbsp; \u6297\u8840\u7ba1\u751f\u6210\u6cbb\u7597<\/p>\n<p>\u5728NSCLC\u9aa8\u8f6c\u79fb\u7684\u6297\u8840\u7ba1\u751f\u6210\u6cbb\u7597\u7814\u7a76\u4e2d\uff0c\u6709\u7814\u7a76[4]\u63ed\u793a\u8d1d\u4f10\u5355\u6297\u5bf9NSCLC\u9aa8\u8f6c\u79fb\u7684\u7279\u5f02\u6027\u7597\u6548\uff0c\u8d1d\u4f10\u5355\u6297\u7ec4\u60a3\u8005\u7684\u9aa8\u8f6c\u79fb\u53cd\u5e94\u7387\u548c\u75be\u75c5\u63a7\u5236\u7387\u663e\u8457\u63d0\u9ad8\u3002\u5bf9\u6bd4\u5148\u524d\u5173\u4e8e\u5511\u6765\u81a6\u9178\u7684\u7814\u7a76\uff0c\u542b\u8d1d\u4f10\u5355\u6297\u7684\u5316\u7597\u65b9\u6848\u53ef\u80fd\u5bf9\u9aa8\u8f6c\u79fb\u53cd\u5e94\u7387\u66f4\u9ad8\u3002<\/p>\n<p>4.3&nbsp; &nbsp; \u9547\u75db\u6cbb\u7597<\/p>\n<p>\u7531\u4e8e\u9aa8\u53d7\u7d2f\u662f\u764c\u75c7\u76f8\u5173\u6027\u75bc\u75db\u7684\u4e3b\u8981\u539f\u56e0\u4e4b\u4e00\uff0c\u4e5f\u662f\u665a\u671f\u6076\u6027\u80bf\u7624\u60a3\u8005\u51fa\u73b0\u91cd\u5ea6\u75bc\u75db\u7684\u4e3b\u8981\u539f\u56e0[52]\u3002\u80ba\u764c\u9aa8\u8f6c\u79fb\u75bc\u75db\u7684\u5904\u7406\u5e94\u4f18\u5148\u91c7\u7528\u75c5\u56e0\u6cbb\u7597\u3001\u836f\u7269\u548c\u975e\u836f\u7269\u534f\u540c\u9547\u75db\u7684\u539f\u5219\uff0c\u53ca\u65e9\u6309\u9636\u68af\u3001\u4e2a\u4f53\u5316\u7ed9\u836f\uff0c\u540c\u65f6\u9884\u9632\u548c\u63a7\u5236\u836f\u7269\u4e0d\u826f\u53cd\u5e94\u3002\u75c5\u56e0\u6cbb\u7597\u662f\u6307\u9488\u5bf9\u80ba\u764c\u7684\u6297\u80bf\u7624\u6cbb\u7597\uff0c\u975e\u836f\u7269\u6cbb\u7597\u5305\u62ec\u653e\u7597\u3001\u624b\u672f\u548c\u4ecb\u5165\u6cbb\u7597\u7b49\u5c40\u90e8\u6cbb\u7597[53-54]\u3002\u5bf9\u4e8e\u5c40\u9650\u6027\u9aa8\u75db\uff0c\u53ef\u8003\u8651\u5c40\u90e8\u653e\u7597\u3001\u795e\u7ecf\u963b\u6ede\u672f\u3001\u690e\u4f53\u6210\u5f62\u672f\u6216\u7ecf\u76ae\u6d88\u878d\u672f\u7b49\u3002\u5f53\u9aa8\u8f6c\u79fb\u75bc\u75db\u5c40\u9650\u4e8e\u4e00\u5904\u6216\u5c11\u6570\u51e0\u5904\u65f6\uff0c\u4e5f\u53ef\u4ee5\u4f7f\u7528\u5916\u7167\u5c04\u7684\u65b9\u6cd5[4]\uff0c\u5177\u4f53\u53ef\u53c2\u89c14.4.1\u3002\u672c\u5c0f\u8282\u4e3b\u8981\u4ecb\u7ecd\u80ba\u764c\u9aa8\u8f6c\u79fb\u75bc\u75db\u7684\u836f\u7269\u6cbb\u7597\u3002<\/p>\n<p>4.3.1&nbsp; &nbsp; \u75bc\u75db\u8bc4\u4f30<\/p>\n<p>\u5bf9\u4e8e\u80ba\u764c\u9aa8\u8f6c\u79fb\u5408\u5e76\u75bc\u75db\u7684\u60a3\u8005\uff0c\u5145\u5206\u8fdb\u884c\u75bc\u75db\u8bc4\u4f30\u662f\u9547\u75db\u6cbb\u7597\u7684\u524d\u63d0\u3002\u764c\u75db\u8bc4\u4f30\u5e94\u9075\u5faa\u56db\u5927\u539f\u5219\uff1a\u5e38\u89c4\u3001\u91cf\u5316\u3001\u5168\u9762\u3001\u52a8\u6001[55]\u3002\u5e38\u89c4\u8bc4\u4f30\u4e2d\u9700\u7279\u522b\u6ce8\u610f\u9274\u522b\u662f\u5426\u6709\u56e0\u75c5\u7406\u6027\u9aa8\u6298\u6216\u810a\u9ad3\u538b\u8feb\u7b49\u5f15\u8d77\u7684\u7206\u53d1\u75db\u3002\u91cf\u5316\u8bc4\u4f30\u6709\u6570\u5b57\u5206\u7ea7\u6cd5\u3001\u4e3b\u8bc9\u75bc\u75db\u7a0b\u5ea6\u5206\u7ea7\u6cd5\u3001\u9762\u90e8\u8868\u60c5\u8bc4\u4f30\u91cf\u8868\u6cd5\u548c\u7b80\u660e\u75bc\u75db\u8bc4\u4f30\u91cf\u8868\u7b49\u3002<\/p>\n<p>4.3.2&nbsp; &nbsp; \u836f\u7269\u9547\u75db\u3000<\/p>\n<p>4.3.2.1&nbsp; &nbsp; \u975e\u753e\u4f53\u7c7b\u6297\u708e\u836f\u548c\u5bf9\u4e59\u9170\u6c28\u57fa\u915a<\/p>\n<p>\u8f7b\u5ea6\u75bc\u75db\u4f18\u9009\u6b64\u7c7b\u836f\u7269\uff0c\u5e38\u89c1\u7684\u6709\u963f\u53f8\u5339\u6797\u3001\u5e03\u6d1b\u82ac\u548c\u585e\u6765\u6614\u5e03\u7b49\u3002\u5bf9\u4e59\u9170\u6c28\u57fa\u915a\u6700\u5927\u7528\u91cf\u4e0d\u5b9c\u8d85\u8fc74 g\/d\u3002\u5bf9\u4e8e\u5c40\u90e8\u5173\u8282\u75bc\u75db\u53ef\u5916\u7528NSAIDs\uff0c\u59821% \u53cc\u6c2f\u82ac\u9178\u94a0\u51dd\u80f6\uff0c\u6bcf\u65e54 \u6b21\uff1b\u62161.3%\u53cc\u6c2f\u82ac\u9178\u8d34\u5242\uff0c1\uff5e2\u7247\/d\u3002<\/p>\n<p>4.3.2.2&nbsp; &nbsp; \u963f\u7247\u7c7b\u836f\u7269<\/p>\n<p>\u963f\u7247\u7c7b\u836f\u7269\u662f\u80ba\u764c\u9aa8\u8f6c\u79fb\u60a3\u8005\u4e2d\u81f3\u91cd\u5ea6\u75bc\u75db\u7684\u4e00\u7ebf\u9547\u75db\u7528\u836f\u3002\u963f\u7247\u7c7b\u836f\u7269\u5242\u91cf\u6362\u7b97\u53ca\u4e0d\u826f\u53cd\u5e94\u5904\u7406\u8be6\u89c1\u300a\u80ba\u764c\u9aa8\u8f6c\u79fb\u8bca\u7597\u4e13\u5bb6\u5171\u8bc6\uff082019 \u7248\uff09\u300b[4]\u3002\u8fd9\u4e9b\u836f\u7269\u53ef\u9884\u9632\u9aa8\u76f8\u5173\u4e8b\u4ef6\u5e76\u63d0\u9ad8\u751f\u5b58\u8d28\u91cf\u3002\u5728\u75bc\u75db\u5f97\u5230\u6709\u6548\u7f13\u89e3\u540e\uff0c\u5e94\u8003\u8651\u9010\u6b65\u51cf\u5c11\u6216\u5b8c\u5168\u7ec8\u6b62\u963f\u7247\u7c7b\u836f\u7269\u7684\u4f7f\u7528\u3002\u5efa\u8bae\u91c7\u7528\u9010\u6e10\u51cf\u91cf\u6cd5\uff0c\u5373\u6bcf\u65e5\u630910%\uff5e25%\u7684\u6bd4\u4f8b\u9012\u51cf\u836f\u7269\u5242\u91cf\uff0c\u76f4\u81f3\u8fbe\u5230\u65e5\u5242\u91cf\u76f8\u5f53\u4e8e30 mg\u53e3\u670d\u5417\u5561\u7684\u836f\u91cf\u3002\u6b64\u5242\u91cf\u6c34\u5e73\u7ef4\u63012 d \u540e\uff0c\u65b9\u53ef\u8003\u8651\u505c\u6b62\u963f\u7247\u7c7b\u836f\u7269\u6cbb\u7597\u3002<\/p>\n<p>4.3.2.3&nbsp; &nbsp; \u8f85\u52a9\u9547\u75db\u836f<\/p>\n<p>\u82e5\u60a3\u8005\u5bf9\u963f\u7247\u7c7b\u836f\u7269\u7684\u53cd\u5e94\u6b20\u4f73\uff0c\u5219\u8003\u8651\u8054\u5408\u8f85\u52a9\u9547\u75db\u836f\u7269\u3002\u9aa8\u6539\u826f\u836f\u7269\u3001\u7cd6\u76ae\u8d28\u6fc0\u7d20\uff08\u5982\u5f3a\u7684\u677e\u3001\u5730\u585e\u7c73\u677e\uff09\u3001\u5c40\u90e8\u9ebb\u9189\u836f\uff08\u5982\u5229\u591a\u5361\u56e0\uff09\u3001\u6297\u60ca\u53a5\u7c7b\u836f\u7269\uff08\u5982\u52a0\u5df4\u55b7\u4e01\u3001\u666e\u745e\u5df4\u6797\uff09\u3001\u9547\u75db\u6027\u6297\u6291\u90c1\u836f\uff08\u5982\u5ea6\u6d1b\u897f\u6c40\u3001\u7c73\u90a3\u666e\u4ed1\uff09\u3001\u9aa8\u9776\u5411\u653e\u5c04\u6027\u6838\u7d20\u836f\u7269\uff3b\u5982\u9536-89\uff0889Sr\uff09 \uff3d\u7b49\u5747\u5c5e\u4e8e\u6b64\u7c7b\u3002<\/p>\n<p>\u9aa8\u6539\u826f\u836f\u7269\u53ef\u6539\u5584\u80bf\u7624\u9aa8\u7ec4\u7ec7\u7684\u9178\u6027\u5fae\u73af\u5883\u3001\u904f\u5236\u9aa8\u6eb6\u89e3\uff0c\u5e76\u51cf\u5c11\u9547\u75db\u836f\u7684\u4f7f\u7528\u91cf[56]\u3002\u56e0\u6b64\uff0c\u5982\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u60a3\u8005\u4f34\u6709\u5f3a\u70c8\u9aa8\u75db\uff0c\u6211\u4eec\u63a8\u8350\u4f7f\u7528\u9aa8\u6539\u826f\u836f\u7269\u8054\u5408\u963f\u7247\u7c7b\u836f\u7269\u3002\u7cd6\u76ae\u8d28\u6fc0\u7d20\u53ef\u80fd\u5bf9\u963f\u7247\u7c7b\u836f\u7269\u96be\u6cbb\u6027\u9aa8\u75db\u60a3\u8005\u6709\u7528\uff0c\u7279\u522b\u662f\u795e\u7ecf\u538b\u8feb\u7684\u60a3\u8005\u3002\u9aa8\u9776\u5411\u653e\u5c04\u6027\u6838\u7d20\u53ef\u7528\u4e8e\u96be\u6cbb\u6027\u591a\u7076\u6027\u9aa8\u75db\u60a3\u8005\uff0c\u8be6\u89c14.4.3\u3002<\/p>\n<p>4.4&nbsp; &nbsp; \u653e\u5c04\u6cbb\u7597<\/p>\n<p>4.4.1&nbsp; &nbsp; \u5916\u7167\u5c04<\/p>\n<p>\u5916\u7167\u5c04\u662f\u6cbb\u7597\u5355\u7eaf\u6027\u9aa8\u8f6c\u79fb\u7684\u6807\u51c6\u6cbb\u7597\uff0c\u53ef\u4f7f50%\uff5e80% \u7684\u60a3\u8005\u75bc\u75db\u7f13\u89e3\uff0c\u591a\u8fbe1\/3\u7684\u60a3\u8005\u5b9e\u73b0\u75bc\u75db\u5b8c\u5168\u7f13\u89e3\u3002\u5916\u7167\u5c04\u524d\u56e0\u8fdb\u884c\u8bc4\u4f30\u4f53\u80fd\u72b6\u6001\u8bc4\u5206\uff0c\u5e76\u660e\u786e\u9aa8\u8f6c\u79fb\u7076\u7684\u90e8\u4f4d\u3002\u5bf9\u4e8e\u5355\u7eaf\u9aa8\u8f6c\u79fb\uff0c\u7f8e\u56fd\u653e\u5c04\u80bf\u7624\u5b66\u4f1a\uff08ASTRO\uff09\u548c\u6b27\u6d32\u80bf\u7624\u5185\u79d1\u5b66\u4f1a\uff08ESMO\uff09[57]\u8ba4\u4e3a\uff0c\u5355\u6b218 Gy\u65b9\u6848\u548c\u5206\u5272\u65b9\u6848\u7684\u75bc\u75db\u7f13\u89e3\u6548\u679c\u76f8\u540c\uff0c\u4e14\u53ef\u80fd\u66f4\u65b9\u4fbf\u3001\u6027\u4ef7\u6bd4\u66f4\u9ad8\uff0c\u5373\u4fbf\u6709\u7684\u60a3\u8005\u9700\u8981\u518d\u6b21\u5916\u7167\u5c04\u6cbb\u7597\u3002\u5916\u7167\u5c04\u9002\u5e94\u8bc1\u3001\u5242\u91cf\u53ca\u5206\u5272\u65b9\u5f0f\u89c1\u300a\u80ba\u764c\u9aa8\u8f6c\u79fb\u8bca\u7597\u4e13\u5bb6\u5171\u8bc6\uff082019\u7248\uff09\u300b[4]\u3002<\/p>\n<p>4.4.2&nbsp; &nbsp; \u7acb\u4f53\u5b9a\u5411\u653e\u5c04\u6cbb\u7597<\/p>\n<p>\u8fd1\u5e74\u6765\uff0cSBRT\u9010\u6e10\u5728\u4e34\u5e8a\u666e\u53ca\uff0c\u76f8\u6bd4\u5916\u7167\u5c04\u63d0\u9ad8\u4e86\u60a3\u8005\u7684\u5c40\u90e8\u63a7\u5236\u7387\uff0cSBRT\u5bf9\u5c0f\u4f53\u79ef\u9aa8\u5be1\u8f6c\u79fb\u60a3\u8005\u4f18\u52bf\u66f4\u4e3a\u660e\u663e\uff0c\u53ef\u663e\u8457\u7f13\u89e3\u9aa8\u8f6c\u79fb\u5f15\u8d77\u7684\u75bc\u75db\u75c7\u72b6[4]\uff0c\u5c24\u5176\u662f\u6709\u690e\u9aa8\u8f6c\u79fb\u3002\u4f46SBRT\u4e5f\u53ef\u80fd\u4f1a\u589e\u52a0\u690e\u9aa8\u538b\u7f29\u9aa8\u6298\u7684\u98ce\u9669\u3002\u56e0\u6b64\uff0cSBRT\u5e94\u4e3b\u8981\u7528\u4e8e\u671f\u671b\u5bff\u547d\u8f83\u957f\uff08&gt;6\u4e2a\u6708\uff09\uff0c\u5728\u6807\u51c6\u7597\u7a0b\u5916\u7167\u5c04\u540e\u4ecd\u6709\u9aa8\u75db\u6216\u9aa8\u75db\u590d\u53d1\uff0c\u5e76\u9700\u8981\u518d\u6b21\u7167\u5c04\u7684\u60a3\u8005\u3002<\/p>\n<p>4.4.3&nbsp; &nbsp; \u9aa8\u9776\u5411\u653e\u5c04\u6027\u6838\u7d20<\/p>\n<p>\u9aa8\u9776\u5411\u653e\u5c04\u6027\u6838\u7d20\u662f\u653e\u5c04\u6027\u4eb2\u9aa8\u6027\u5206\u5b50\uff0c\u76ee\u524d\u5df2\u83b7\u6279\u7528\u4e8e\u7f13\u89e3\u6210\u9aa8\u6027\u9aa8\u8f6c\u79fb\u60a3\u8005\u7684\u75bc\u75db\u3002\u4e00\u822c\u6765\u8bb2\uff0c\u9aa8\u9776\u5411\u653e\u5c04\u6027\u6838\u7d20\u6cbb\u7597\u66f4\u9002\u7528\u4e8e\u7ecf\u5916\u7167\u5c04\u548c\/\u6216\u5176\u4ed6\u5f62\u5f0f\u6cbb\u7597\u540e\u4ecd\u6709\u75bc\u75db\u6216\u75bc\u75db\u590d\u53d1\u7684\u591a\u7076\u6027\u9aa8\u75db\u60a3\u8005\uff0c\u800c\u4e0d\u662f\u4f5c\u4e3a\u521d\u59cb\u6cbb\u7597\u3002<\/p>\n<p><sup>89<\/sup>Sr\u662f\u5e38\u7528\u7684\u653e\u5c04\u6027\u6838\u7d20\uff0c\u80fd\u591f\u53d1\u5c04\u03b2\u7c92\u5b50\uff0c\u53ef\u6709\u6548\u7f13\u89e3\u75bc\u75db\uff0c\u7f13\u89e3\u7387\u4e3a40%\uff5e95%\u3002\u5173\u4e8e<sup>89<\/sup>Sr\u7684\u9002\u5e94\u8bc1\u3001\u7528\u6cd5\u7528\u91cf\u548c\u7981\u5fcc\u8bc1\u7b49\u89c1\u300a\u80ba\u764c\u9aa8\u8f6c\u79fb\u8bca\u7597\u4e13\u5bb6\u5171\u8bc6\uff082019 \u7248\uff09\u300b[4]\u3002\u6b64\u5916\uff0c\u956d-223\uff08233Ra\uff09\u662f\u4e00\u79cd\u65b0\u578b\u7684\u7ecf\u9759\u8109\u6ce8\u5c04\u7684\u9aa8\u9776\u5411\u653e\u5c04\u6027\u540c\u4f4d\u7d20\uff0c\u53ef\u53d1\u5c04\u03b1\u7c92\u5b50\uff1b\u76ee\u524d\u5728\u524d\u5217\u817a\u80bf\u7624\u9aa8\u8f6c\u79fb\u7814\u7a76\u4e2d\uff0c\u603b\u751f\u5b58\u60c5\u51b5\u548c\u9996\u6b21\u51fa\u73b0\u75c7\u72b6\u6027SREs \u7684\u65f6\u95f4\u5747\u5f97\u5230\u6539\u5584\u3002\u4f46\u5728\u80ba\u764c\u9aa8\u8f6c\u79fb\u4eba\u7fa4\u4e2d\u7684\u7597\u6548\u4ecd\u5f85\u89c2\u5bdf\u3002<\/p>\n<p>4.5&nbsp; &nbsp; \u5916\u79d1\u6cbb\u7597<\/p>\n<p>4.5.1&nbsp; &nbsp; \u5916\u79d1\u6cbb\u7597\u76ee\u7684<\/p>\n<p>\u5916\u79d1\u6cbb\u7597\u4e3b\u8981\u76ee\u7684\u5728\u4e8e\u7f13\u89e3\u75bc\u75db\u3001\u51cf\u8f7b\u6216\u907f\u514d\u8fd0\u52a8\u7cfb\u7edf\u529f\u80fd\u53d7\u635f\u6216\u810a\u9ad3\u53d7\u538b\u5f15\u8d77\u7684\u4e00\u7cfb\u5217\u5e76\u53d1\u75c7\u3001\u9884\u9632\u6216\u6cbb\u7597\u75c5\u7406\u6027\u9aa8\u6298\u65b9\u6cd5\u3001\u63d0\u9ad8\u751f\u6d3b\u8d28\u91cf\u4ece\u800c\u95f4\u63a5\u5ef6\u957f\u60a3\u8005\u751f\u5b58\u671f\uff0c\u4e0e\u6b64\u540c\u65f6\uff0c\u901a\u8fc7\u5bf9\u624b\u672f\u83b7\u5f97\u7684\u9aa8\u8f6c\u79fb\u75c5\u7076\u8fdb\u884c\u7ec4\u7ec7\u5b66\u8bca\u65ad\uff0c\u4e5f\u53ef\u6307\u5bfc\u540e\u7eed\u6cbb\u7597[58]\u3002<\/p>\n<p>4.5.2&nbsp; &nbsp; \u5916\u79d1\u6cbb\u7597\u9002\u5e94\u8bc1<\/p>\n<p>\u9aa8\u8f6c\u79fb\u7684\u624b\u672f\u6cbb\u7597\u901a\u5e38\u4ec5\u7528\u4e8e\u6709\u5b8c\u5168\u6027\u75c5\u7406\u6027\u9aa8\u6298\u6216\u75c5\u7406\u6027\u9aa8\u6298\u503e\u5411\u7684\u75c5\u53d8\uff0c\u5e76\u4e14\u624b\u672f\u5e72\u9884\u5e94\u7b26\u5408\u6cbb\u7597\u76ee\u6807\u3002\u5bf9\u4e8e\u4e25\u683c\u9009\u62e9\u7684\u665a\u671f\u764c\u75c7\u60a3\u8005\uff0c\u5373\u9aa8\u75c5\u53d8\u662f\u539f\u53d1\u90e8\u4f4d\u4ee5\u5916\u552f\u4e00\u8f6c\u79fb\u7076\u7684\u60a3\u8005\uff0c\u6574\u5757\u5207\u9664\u8f6c\u79fb\u7076\u53ef\u4f7f\u5c40\u90e8\u80bf\u7624\u63a7\u5236\u6700\u4f73\uff0c\u6301\u4e45\u7f13\u89e3\u75bc\u75db\uff0c\u5e76\u53ef\u80fd\u5ef6\u957f\u60a3\u8005\u751f\u5b58\u671f\u3002\u810a\u67f1\u8f6c\u79fb\u5bfc\u81f4\u673a\u68b0\u6027\u4e0d\u7a33\u5b9a\u65f6\uff0c\u53ef\u8003\u8651\u624b\u672f\u5e72\u9884\uff1b\u4f46\u9664\u5355\u7eaf\u6027\u810a\u67f1\u6216\u80f8\u9aa8\u53d7\u7d2f\u7684\u7279\u5b9a\u60a3\u8005\u5916\uff0c\u5f88\u5c11\u8fdb\u884c\u9aa8\u8f6c\u79fb\u7076\u7684\u6839\u6cbb\u6027\u5207\u9664\u3002<\/p>\n<p>4.5.3&nbsp; &nbsp; \u5916\u79d1\u6cbb\u7597\u7684\u65f6\u673a\u9009\u62e9<\/p>\n<p>\u5f53\uff081\uff09\u786e\u8bca\u80ba\u764c\u9aa8\u8f6c\u79fb\uff1b\uff082\uff09\u4fdd\u5b88\u6cbb\u7597\u540e\uff0c\u9aa8\u7834\u574f\u548c\/\u6216\u75bc\u75db\u75c7\u72b6\u4ecd\u6301\u7eed\u52a0\u91cd\uff1b\uff083\uff09\u5df2\u7ecf\u51fa\u73b0\u75c5\u7406\u6027\u9aa8\u6298\uff1b\uff084\uff09\u4fdd\u5b88\u6cbb\u7597\u540e\uff0c\u8fd0\u52a8\u7cfb\u7edf\u529f\u80fd\u4ecd\u65e0\u6cd5\u6062\u590d\uff1b\uff085\uff09\u51fa\u73b0\u795e\u7ecf\u538b\u8feb\u75c7\u72b6\uff1b\uff086\uff09\u810a\u67f1\u51fa\u73b0\u4e0d\u7a33\u5b9a\u8868\u73b0\uff0c\u5bb9\u6613\u53d1\u751f\u622a\u762b\u98ce\u9669\uff1b\uff087\uff09\u9aa8\u8f6c\u79fb\u75c5\u7076\u5bf9\u653e\u3001\u5316\u7597\u5747\u4e0d\u654f\u611f\u65f6\uff0c\u5efa\u8bae\u91c7\u53d6\u5916\u79d1\u6cbb\u7597\u5e72\u9884[59-61]\u3002<\/p>\n<p>4.5.4&nbsp; &nbsp; \u4e0d\u540c\u8f6c\u79fb\u90e8\u4f4d\u7684\u5916\u79d1\u6cbb\u7597\u3000<\/p>\n<p>4.5.4.1&nbsp; &nbsp; \u957f\u9aa8\u8f6c\u79fb<\/p>\n<p>\u75c5\u7406\u6027\u9aa8\u6298\u662f\u80ba\u764c\u957f\u9aa8\u8f6c\u79fb\u7624\u6700\u4e25\u91cd\u7684\u5e76\u53d1\u75c7\uff0c\u5f71\u54cd\u60a3\u8005\u7684\u65e5\u5e38\u6d3b\u52a8\u548c\u751f\u6d3b\u8d28\u91cf\uff0c\u53ef\u5bfc\u81f4\u60a3\u8005\u6b7b\u4ea1\u7b49\u4e25\u91cdSREs\u3002\u96be\u4ee5\u5fcd\u53d7\u7684\u75bc\u75db\u548c\u75c5\u7406\u6027\u9aa8\u6298\u662f\u624b\u672f\u7684\u660e\u786e\u6307\u5f81[62]\u3002\u957f\u9aa8\u4ee5\u75c5\u7076\u4f4d\u7f6e\u4e0d\u540c\u533a\u5206\uff0c\u9aa8\u7aef\u75c5\u7076\u53ef\u9009\u62e9\u884c\u7624\u6bb5\u5207\u9664\u3001\u5047\u4f53\u91cd\u5efa\uff1b\u9aa8\u5e72\u75c5\u7076\u53ef\u8003\u8651\u9aa8\u6c34\u6ce5\u586b\u5145\u5185\u56fa\u5b9a\u6216\u8282\u6bb5\u5047\u4f53\u91cd\u5efa\u3002\u4e0d\u540c\u90e8\u4f4d\u957f\u9aa8\u8f6c\u79fb\u7624\u7684\u624b\u672f\u65b9\u5f0f\u5e94\u8fdb\u884c\u4e2a\u4f53\u5316\u9009\u62e9[63]\u3002\u82e5\u5176\u4ed6\u6cbb\u7597\u65b9\u5f0f\u4ecd\u65e0\u6cd5\u63a7\u5236\u9aa8\u7834\u574f\uff0c\u60a3\u8005\u5b58\u5728\u987d\u56fa\u6027\u75bc\u75db\uff0c\u4e3b\u8981\u8840\u7ba1\u3001\u795e\u7ecf\u53d7\u7d2f\uff0c\u5e7f\u6cdb\u8f6f\u7ec4\u7ec7\u4fb5\u72af\uff0c\u4e3a\u63d0\u9ad8\u751f\u5b58\u8d28\u91cf\u53ef\u91c7\u7528\u622a\u80a2\u624b\u672f[10]\u3002<\/p>\n<p>4.5.4.2&nbsp; &nbsp; \u810a\u67f1\u8f6c\u79fb<\/p>\n<p>\u80ba\u764c\u810a\u67f1\u8f6c\u79fb\u7624\u624b\u672f\u4ee5\u59d1\u606f\u6027\u624b\u672f\u4e3a\u4e3b\uff0c\u624b\u672f\u65e8\u5728\u5bf9\u810a\u9ad3\u548c\u795e\u7ecf\u6839\u51cf\u538b\u4ee5\u53ca\u91cd\u5efa\u810a\u67f1\u7a33\u5b9a\uff0c\u4ece\u800c\u51cf\u8f7b\u75c7\u72b6\uff0c\u63d0\u9ad8\u751f\u6d3b\u8d28\u91cf\uff0c\u4e3b\u8981\u5206\u4e3a\u51cf\u538b\u624b\u672f\u548c\u51cf\u7624\u624b\u672f\uff0c\u5177\u4f53\u5305\u62ec\u690e\u677f\u5207\u9664\u51cf\u538b\u672f\u3001\u7ecf\u7624\u690e\u4f53\u5207\u9664\u672f\u3001\u5206\u79bb\u624b\u672f\u4ee5\u53ca\u5fae\u521b\u7ecf\u76ae\u690e\u4f53\u6210\u5f62\u672f\u7b49[64-65]\u3002\u4f46\u5e94\u907f\u514d\u5355\u7eaf\u540e\u8def\u690e\u677f\u51cf\u538b\u672f\uff0c\u9632\u6b62\u52a0\u91cd\u810a\u67f1\u4e0d\u7a33\u5b9a\u3002<\/p>\n<p>4.5.4.3&nbsp; &nbsp; \u9aa8\u76c6\u8f6c\u79fb<\/p>\n<p>\u80ba\u764c\u9aa8\u76c6\u8f6c\u79fb\u7624\u4ee5\u59d1\u606f\u6027\u6cbb\u7597\u4e3a\u4e3b\uff0c\u624b\u672f\u4e3b\u8981\u76ee\u7684\u4e3a\u6700\u5927\u53ef\u80fd\u5207\u9664\u80bf\u7624\uff0c\u51cf\u8f7b\u75bc\u75db\uff0c\u6062\u590d\u884c\u8d70\u80fd\u529b\uff0c\u63d0\u9ad8\u751f\u6d3b\u8d28\u91cf\u3002\u624b\u672f\u65b9\u5f0f\u591a\u9009\u62e9\u53bb\u9664\u80bf\u7624\u8f6c\u79fb\u7076\u540e\u7528\u7532\u57fa\u4e19\u70ef\u9178\u7532\u916f\uff08PMMA\uff0c\u53c8\u79f0\u9aa8\u6c34\u6ce5\uff09\u6210\u5f62\u3002\u5bf9\u4e8e\u5c1a\u672a\u7d2f\u53ca\u9acb\u81fc\u7684\u75c5\u53d8\uff0c\u53ef\u4ee5\u9009\u62e9\u690d\u5165\u7269\u6216\u9aa8\u6c34\u6ce5\u5f3a\u5316\u5e94\u529b\u4f20\u5bfc\u533a\uff1b\u7d2f\u53ca\u9acb\u81fc\u8005\uff0c\u5219\u53ef\u4ee5\u8003\u8651\u884c\u5168\u9acb\u5173\u8282\u7f6e\u6362\u672f\uff1b\u5bf9\u4e8e\u75c5\u53d8\u4f4d\u4e8e\u803b\u9aa8\u3001\u5750\u9aa8\u7b49\u975e\u5e94\u529b\u4f20\u5bfc\u533a\u7684\u75c5\u53d8\uff0c\u53ef\u884c\u5355\u7eaf\u5207\u9664\u672f\u3002<\/p>\n<p>4.6&nbsp; &nbsp; \u4ecb\u5165\u6cbb\u7597<\/p>\n<p>\u75c7\u72b6\u6027\u80ba\u764c\u9aa8\u8f6c\u79fb\u7624\u60a3\u8005\u5728\u63a5\u53d7\u5916\u7167\u5c04\u3001\u5916\u79d1\u3001\u836f\u7269\u9547\u75db\u6cbb\u7597\u540e\u6216\u6cbb\u7597\u7684\u540c\u65f6\uff0c\u4ecd\u4f1a\u6709\u90e8\u5206\u60a3\u8005\u75bc\u75db\u5e76\u672a\u7f13\u89e3\u6216\u7f13\u89e3\u4e0d\u5145\u5206\uff1b\u6216\u60a3\u8005\u7684\u671f\u671b\u5bff\u547d\u6709\u9650\u4e0d\u9002\u5b9c\u5916\u79d1\u7b49\u5176\u4ed6\u7efc\u5408\u6cbb\u7597\uff0c\u9aa8\u8f6c\u79fb\u7624\u7684\u5c40\u90e8\u4ecb\u5165\u6cbb\u7597\u53ef\u6709\u6548\u63a7\u5236\u8fd9\u7c7b\u60a3\u8005\u7684\u5c40\u90e8\u75c7\u72b6\uff0c\u6210\u4e3a\u7cfb\u7edf\u6cbb\u7597\u7684\u6709\u529b\u8865\u5145\u3002\u5404\u7c7b\u4ecb\u5165\u6cbb\u7597\u7684\u9002\u5e94\u8bc1\u548c\u7981\u5fcc\u8bc1\u7b49\u89c1\u300a\u80ba\u764c\u9aa8\u8f6c\u79fb\u8bca\u7597\u4e13\u5bb6\u5171\u8bc6\uff082019\u7248\uff09\u300b[4]\u3002&nbsp;<\/p>\n<p>4.6.1&nbsp; &nbsp; \u6d88\u878d\u6cbb\u7597<\/p>\n<p>\u4e34\u5e8a\u4e0a\u5e38\u7528\u7684\u6d88\u878d\u6cbb\u7597\u5305\u62ec\u5c04\u9891\u6d88\u878d\u3001\u5fae\u6ce2\u6d88\u878d\u3001\u51b7\u51bb\u6d88\u878d\u4ee5\u53ca\u805a\u7126\u8d85\u58f0\u3002\u6d88\u878d\u6cbb\u7597\u65e0\u5916\u79d1\u624b\u672f\u6307\u8bc1\u7684\u9aa8\u8f6c\u79fb\u7624\u5b89\u5168\u3001\u6709\u6548\uff0c\u53ef\u663e\u8457\u7f13\u89e3\u75bc\u75db\u3001\u9884\u9632SREsR \u7684\u53d1\u751f\uff0c\u5e76\u53ef\u6301\u4e45\u63a7\u5236\u5c40\u90e8\u80bf\u7624[66-68]\u3002\u6d88\u878d\u5e38\u7528\u4e8e\u6cbb\u7597\u80ba\u764c\u5df2\u7ecf\u8fdb\u5c55\u7684\u9aa8\u8f6c\u79fb\u60a3\u8005\uff1b\u62d2\u7edd\u653e\u7597\u6216\u8005\u653e\u7597\u540e\u4ecd\u6709\u75bc\u75db\u7684\u60a3\u8005\u3002\u5728\u7f8e\u56fd\u56fd\u5bb6\u7efc\u5408\u764c\u75c7\u7f51\u7edc\uff08NCCN\uff09\u764c\u75db\u6307\u5357\u4e2d\uff0c\u5c40\u90e8\u6d88\u878d\u73b0\u5df2\u6210\u4e3a\u65e0\u9aa8\u79d1\u6025\u75c7\u65f6\u8f6c\u79fb\u6027\u9aa8\u75db\u7684\u63a8\u8350\u6cbb\u7597\u3002\u6b64\u5916\uff0c\u59d1\u606f\u6027\u6cbb\u7597\u4e2d\u4e5f\u53ef\u4f7f\u7528\u9aa8\u8f6c\u79fb\u7624\u6d88\u878d\u6cbb\u7597\u4ee3\u66ff\u624b\u672f\uff0c\u4ee5\u4fdd\u7559\u627f\u91cd\u9aa8\u7684\u529f\u80fd\u6216\u9632\u6b62\u5176\u53d1\u751f\u75c5\u7406\u6027\u9aa8\u6298\u3002<\/p>\n<p>4.6.2&nbsp; &nbsp; \u7ecf\u76ae\u9aa8\u6210\u5f62\u672f<\/p>\n<p>\u65e2\u5f80\uff0c\u7ecf\u76ae\u9aa8\u6c34\u6ce5\u6210\u5f62\u672f\u4ec5\u7528\u4e8e\u4e0d\u9002\u5408\u5f00\u653e\u624b\u672f\u7684\u60a3\u8005\uff0c\u4f46\u968f\u7740\u5f71\u50cf\u5b66\u5f15\u5bfc\u4e0b\u7684\u5fae\u521b\u6280\u672f\u7684\u5174\u8d77\uff0c\u62d3\u5bbd\u4e86\u7ecf\u76ae\u9aa8\u6c34\u6ce5\u6210\u5f62\u672f\u7684\u5e94\u7528\u8303\u56f4\uff0c\u5e38\u4e0e\u5c40\u90e8\u6d88\u878d\u6cbb\u7597\u8054\u5408\uff0c\u4f5c\u4e3a\u5916\u79d1\u624b\u672f\u7684\u66ff\u4ee3\u65b9\u6848\u4e4b\u4e00[69] \uff0c\u9002\u7528\u4e8e\u5404\u79cd\u6eb6\u9aa8\u6027\u9aa8\u539f\u53d1\u80bf\u7624\u6216\u9aa8\u8f6c\u79fb\u7624[4]\u3002\u6d88\u878d\u6cbb\u7597\u4f7f\u75c5\u7076\u5c40\u90e8\u51dd\u56fa\u6027\u574f\u6b7b\uff0c\u540e\u7eed\u5bf9\u6d88\u878d\u533a\u57df\u8fdb\u884c\u9aa8\u6c34\u6ce5\u586b\u5145\uff0c\u52a0\u5f3a\u4e86\u8f6c\u79fb\u9aa8\uff08\u7279\u522b\u662f\u627f\u91cd\u9aa8\u5982\u690e\u4f53\uff09\u7684\u7a33\u5b9a\u6027\u548c\u652f\u6491\u529b\u3002\u7ecf\u76ae\u9aa8\u6c34\u6ce5\u6210\u5f62\u672f\u964d\u4f4e\u4e86\u9acb\u81fc\u5468\u56f4\u9aa8\u76c6\u548c\u80a1\u9aa8\u8fd1\u7aef\u7684\u9aa8\u8f6c\u79fb\u7076\u7684\u5904\u7406\u96be\u5ea6\uff1b\u5728\u63a7\u5236\u75bc\u75db\u7684\u540c\u65f6\uff0c\u6062\u590d\u8f6c\u79fb\u9aa8\u7684\u5b8c\u6574\u6027\uff0c\u662f\u9884\u9632SREs\u7684\u6709\u6548\u65b9\u6cd5[70-71]\u3002<\/p>\n<p>4.6.3&nbsp; &nbsp; \u8fd1\u8ddd\u79bb\u6cbb\u7597<\/p>\n<p>\u8fd1\u8ddd\u79bb\u653e\u7597\u662f\u5c06\u653e\u5c04\u6e90\u7f6e\u4e8e\u9700\u6cbb\u7597\u533a\u57df\u5185\u90e8\u6216\u9644\u8fd1\u3002\u53d1\u51fa\u7684\u8f90\u5c04\u901a\u5e38\u4ec5\u5728\u76f8\u5bf9\u8f83\u77ed\u7684\u8ddd\u79bb\u5185\u6709\u6d3b\u6027\uff0c\u5176\u4f18\u70b9\u5728\u4e8e\u53ef\u5bf9\u80bf\u7624\u4e88\u4ee5\u5927\u5242\u91cf\u7167\u5c04\uff0c\u540c\u65f6\u51cf\u5c11\u5468\u56f4\u6b63\u5e38\u7ec4\u7ec7\u7684\u7167\u5c04\u5242\u91cf\u3002\u8fd1\u8ddd\u79bb\u6cbb\u7597\u53ef\u7528\u4e8e\u7f13\u89e3\u5e38\u89c4\u6cbb\u7597\u5931\u8d25\u6216\u62b5\u6297\u540e\u7684\u9aa8\u8f6c\u79fb\u75bc\u75db\uff0c\u53ef\u6539\u5584\u75bc\u75db\u75c7\u72b6\uff0c\u80bf\u7624\u5c40\u90e8\u63a7\u5236\u826f\u597d[72]\uff0c\u56e0\u5176\u4e3a\u5fae\u521b\u64cd\u4f5c\uff0c\u5e76\u53d1\u75c7\u53ef\u63a7\uff0c\u5728\u4e34\u5e8a\u4e2d\u53ef\u4e0e\u9aa8\u6c34\u6ce5\u6cbb\u7597\u534f\u540c\u5e94\u7528\u3002\u6211\u56fd\u7528\u4e8e\u80ba\u764c\u9aa8\u8f6c\u79fb\u7684\u653e\u5c04\u6e90\u4e00\u822c\u4e3a\u7898-125\u3002\u9700\u8981\u6ce8\u610f\u7684\u662f\uff0c\u8fd1\u8ddd\u79bb\u6cbb\u7597\u9700\u8981\u4fb5\u5165\u6027\u64cd\u4f5c\uff0c\u56e0\u6b64\u5fc5\u987b\u6743\u8861\u6cbb\u7597\u76ca\u5904\u4e0e\u53ef\u80fd\u4ea7\u751f\u7684\u5e76\u53d1\u75c7\u3002<\/p>\n<p>4.7&nbsp; &nbsp; \u5fc3\u7406\u652f\u6301\u6cbb\u7597<\/p>\n<p>\u80ba\u764c\u60a3\u8005\u6291\u90c1\u60a3\u75c5\u7387\u662f\u6240\u6709\u6076\u6027\u80bf\u7624\u4e2d\u53d1\u75c5\u7387\u6700\u9ad8\u7684[4]\uff0c\u56e0\u6b64\uff0c\u6709\u6548\u7684\u5fc3\u7406\u652f\u6301\u5bf9\u4e8e\u80ba\u764c\u9aa8\u8f6c\u79fb\u7efc\u5408\u5e72\u9884\u4e5f\u662f\u5fc5\u8981\u7684\u3002\u5fc3\u7406\u652f\u6301\u4e3b\u8981\u4e3a\u5fc3\u7406-\u793e\u4f1a\u5e72\u9884\uff0c\u5305\u62ec\u8ba4\u77e5-\u884c\u4e3a\u5b66\u3001\u5bb6\u5ead\u652f\u6301\u4ee5\u53caCALM \uff08managing cancer and living meaningfully\uff09\u6cbb\u7597\uff0c\u8fd9\u4e9b\u5df2\u88ab\u8bc1\u5b9e\u662f\u7f13\u89e3\u75db\u82e6\u3001\u6539\u5584\u751f\u6d3b\u8d28\u91cf\u7684\u6709\u6548\u63aa\u65bd\u4e4b\u4e00\u3002\u5982\u60a3\u8005\u5408\u5e76\u7126\u8651\u6291\u90c1\u969c\u788d\uff0c\u53ef\u8054\u5408\u7cbe\u795e\u836f\u7269\u6cbb\u7597\uff0c\u7279\u522b\u662f\u91cd\u5ea6\u7126\u8651\u6291\u90c1\u969c\u788d\u60a3\u8005\u3002<\/p>\n<p>\u5229\u76ca\u51b2\u7a81\uff1a\u65e0\u3002<\/p>\n<p>\u300a\u4e2d\u56fd\u80ba\u764c\u9aa8\u8f6c\u79fb\u4e34\u5e8a\u8bca\u7597\u6307\u5357(2024\u7248)\u300b\u7f16\u5199\u59d4\u5458\u4f1a\u540d\u5355<\/p>\n<p>\u4e3b\u7f16\uff1a\u652f\u4fee\u76ca\uff08\u9996\u90fd\u533b\u79d1\u5927\u5b66\u5ba3\u6b66\u533b\u9662\uff09\uff0c\u738b\u6d01\uff08\u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662\u80bf\u7624\u533b\u9662\uff09 \uff0c\u5218\u4f26\u65ed\uff08\u56db\u5ddd\u5927\u5b66\u534e\u897f\u533b\u9662\uff09<\/p>\n<p>\u6267\u7b14\uff1a\u8d75\u519b\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09<\/p>\n<p>\u6210\u5458\uff08\u6309\u59d3\u6c0f\u6c49\u8bed\u62fc\u97f3\u6392\u5e8f\uff09<\/p>\n<p>\u3000\u3000\u66f9\u5b9d\u5c71\uff08\u5317\u4eac\u5927\u5b66\u7b2c\u4e09\u533b\u9662\uff09\uff0c\u9648\u9ea6\u6797\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u4e01\u51ef\uff08\u5929\u6d25\u533b\u79d1\u5927\u5b66\u603b\u533b\u9662\uff09\uff0c\u6bb5\u5efa\u6625\uff08\u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662\u80bf\u7624\u533b\u9662\/\u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662\u80bf\u7624\u533b\u9662\u5c71\u897f\u533b\u9662\uff09\uff0c\u9f9a\u656c\uff08\u590d\u65e6\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u90ed\u9510\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u80e1\u7267\uff08\u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u53cb\u8c0a\u533b\u9662\uff09\uff0c\u80e1\u6500\u6500\uff08\u5317\u4eac\u5927\u5b66\u7b2c\u4e09\u533b\u9662\uff09\uff0c\u674e\u4e1c\uff08\u5317\u4eac\u4eac\u897f\u80bf\u7624\u533b\u9662\uff09\uff0c\u674e\u7433\uff08\u5317\u80bf\u7624\u5185\u79d1\uff09\uff0c\u674e\u56e1\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u674e\u6653\u71d5\uff08\u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u5929\u575b\u533b\u9662\uff09\uff0c\u5218\u7389\u826f\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u67f3\u6668\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u725b\u6653\u8f89\uff08\u5317\u4eac\u79ef\u6c34\u6f6d\u533b\u9662\uff09\uff0c\u6f58\u5cf0\uff08\u5317\u4eac\u5927\u5b66\u4eba\u6c11\u533b\u9662\uff09\uff0c\u77f3\u5b89\u8f89\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u5b59\u6606\u6606\uff08\u5317\u4eac\u5927\u5b66\u4eba\u6c11\u533b\u9662\uff09\uff0c\u5510\u4e3d\u4e3d\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u5510\u5a01\uff08\u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662\u80bf\u7624\u533b\u9662\uff09\uff0c\u4e07\u854a\uff08\u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662\u80bf\u7624\u533b\u9662\uff09\uff0c\u738b\u9759\u9759\uff08\u5317\u4eac\u5927\u5b66\u80bf\u7624\u533b\u9662\uff09\uff0c\u738b\u5a1f\uff08\u5317\u4eac\u5927\u5b66\u9996\u94a2\u533b\u9662\uff09\uff0c\u97e6\u5cf0\uff08\u5317\u4eac\u5927\u5b66\u7b2c\u4e09\u533b\u9662\uff09\uff0c\u5f90\u851a\u7136\uff08\u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u5929\u575b\u533b\u9662\uff09\uff0c\u6613\u798f\u6885\uff08\u5317\u4eac\u5927\u5b66\u7b2c\u4e09\u533b\u9662\uff09\uff0c\u5f20\u5efa\u65b0\uff08\u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662\u80bf\u7624\u533b\u9662\u5c71\u897f\u533b\u9662\/\u5c71\u897f\u7701\u80bf\u7624\u533b\u9662\u533b\u5b66\uff09\uff0c\u5468\u8212\u7545\uff08\u534e\u4e2d\u79d1\u6280\u5927\u5b66\u540c\u6d4e\u533b\u5b66\u9662\u9644\u5c5e\u540c\u6d4e\u533b\u9662\uff09\uff0c\u5468\u6c38\uff3b 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association for thoracic surgery\uff0cAATS\uff09\u53ca\u6b27\u6d32\u80f8\u5916\u79d1\u533b\u5e08\u534f\u4f1a\uff08European society of thoracic surgeons\uff0cESTS\uff09\u56fd\u9645\u59d4\u5458\uff1b\u56fd\u5bb6\u536b\u751f\u5065\u5eb7\u59d4\u5458\u4f1a\u7a81\u51fa\u8d21\u732e\u4e2d\u9752\u5e74\u4e13\u5bb6\uff1b\u56fd\u5bb6\u536b\u751f\u5065\u5eb7\u59d4\u533b\u7597\u5e94\u6025\u5de5\u4f5c\u4e13\u5bb6\u7ec4\u80f8\u5916\u79d1\u7ec4\u7ec4\u957f\uff1b\u4e2d\u534e\u533b\u5b66\u4f1a\u80f8\u5fc3\u8840\u7ba1\u5916\u79d1\u5206\u4f1a\u526f\u4e3b\u4efb\u59d4\u5458\uff1b\u4e2d\u56fd\u533b\u5e08\u534f\u4f1a\u80f8\u5916\u79d1\u533b\u5e08\u5206\u4f1a\u526f\u4f1a\u957f\uff0c\u4e2d\u56fd\u6297\u764c\u534f\u4f1a\u4e2d\u897f\u6574\u5408\u80ba\u764c\u4e13\u4e1a\u59d4\u5458\u4f1a\u4e3b\u4efb\u59d4\u5458\uff1b\u56fd\u5bb6\u7ea7\u80f8\u5916\u79d1\u4e13\u4e1a\u533b\u7597\u8d28\u91cf\u63a7\u5236\u4e2d\u5fc3\u4e3b\u4efb\uff1b\u56db\u5ddd\u5927\u5b66\u534e\u897f\u533b\u9662\u80f8\u90e8\u80bf\u7624\u7814\u7a76\u6240\u6240\u957f\uff1b\u56db\u5ddd\u7701\u201c\u5929\u5e9c\u4e07\u4eba\u8ba1\u5212\u201d\u5929\u5e9c\u540d\u533b\uff0c2022\u5e74\u88ab\u8bc4\u4e3a\u201c\u63a8\u52a8\u884c\u4e1a\u524d\u884c\u7684\u529b\u91cf\u201d\u5341\u5927\u533b\u5b66\u5f71\u54cd\u529b\u4e13\u5bb6\uff1b2023\u5e74\u88ab\u8bc4\u4e3a\u56db\u5ddd\u7701\u201c\u5929\u5e9c\u9752\u57ce\u8ba1\u5212\u201d\u6770\u51fa\u79d1\u5b66\u5bb6\uff1b\u56db\u5ddd\u7701\u6297\u764c\u534f\u4f1a\u7406\u4e8b\u4f1a\u526f\u7406\u4e8b\u957f, 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