Kev kawm txog kev tiv thaiv kab mob tiv thaiv kab mob thiab kev tshem tawm ntawm yam uas ua rau nws qhov kev puas tsuaj yog teeb meem tseem ceeb hauv cov tshuaj niaj hnub. Malignant neoplasms nyob hauv ib qho ntawm cov chaw ua haujlwm ntawm kev tuag thiab kev tsis taus nyob rau hauv cov teb chaws tsim. Feem ntau, qhov sib npaug ntawm tus lej ntawm kev faib thiab tuag hlwb yog tswj hwm ib txwm muaj. Yog hais tias cell reproduction ua uncontrolled, ces malignant qog tshwm sim. Lub tswv yim ntawm kev tswj cov txheej txheem no los ntawm lub cev tiv thaiv kab mob nyob ntawm ntau yam uas cuam tshuam lossis txhawb cov txheej txheem ntawm kev faib ntau dhau.
Kev piav qhia dav dav
Kev tiv thaiv kab mob feem ntau nkag siab tias yog txheej txheej tiv thaiv ntawm cov kab mob muaj sia los ntawm qhov tsis zoo ntawm cov neeg ua haujlwm txawv teb chaws. Feem ntau, cov txheej txheem no cuam tshuam nrog kev kis kab mob (cov kab mob, kab mob, fungal, protozoal) kab mob. Txawm li cas los xij, muaj lwm txoj hauv kev tiv thaiv, ib qho ntawm cov tshuaj tiv thaiv kab mob.
Nyob rau hauv kev ua ub ua no ntawm kev ua neej nyoblub cev muaj lub sijhawm thaum nws xav tau kev faib cov cell sai (kev raug mob, mob, thiab lwm yam). Nrog rau kev txhim kho ntawm qee yam kev tiv thaiv kab mob, cov xov tooj ntawm cov hlwb nkag siab rau cov teebmeem ntawm cov tshuaj antigen (cov molecule txuam nrog cov tshuaj tiv thaiv) nce ntau txhiab zaus. Hauv cov txheej txheem ib txwm muaj, tom qab ua tiav cov tshuaj tiv thaiv no, qhov kev faib tawm nrawm nrawm nres.
Rau cov qog nqaij hlav malignant yog tus cwj pwm los ntawm kev ua txhaum ntawm cov txheej txheem no. Kev tsim tawm ntawm cov hlwb txuas ntxiv tas li thiab muaj tus cwj pwm ywj pheej. Maj mam, cov ntaub so ntswg ib txwm raug hloov hauv cov khoom nruab nrog cev thiab cov qog loj hlob mus rau thaj chaw ib puag ncig. Tsiv raws cov hlab ntsha, cov qog hlwb txuas ntxiv mus faib rau lwm qhov chaw, uas ua rau cov tsos mob ntawm metastases. Qhov tsis xws luag hauv kev faib tsis tu ncua yog tau txais los ntawm tag nrho cov xeeb leej xeeb ntxwv ntawm cov qog hlwb. Lawv daim nyias nyias tau hloov kho raws li tib neeg lub cev pom cov khoom txawv teb chaws.
Ntawm qhov tod tes, muaj ib txoj hauv kev hauv lub cev uas tuaj yeem nres cov txheej txheem no - tshuaj tiv thaiv kab mob. Hauv kev tiv thaiv kab mob, qhov tshwm sim ntawm cov qog yog pov thawj tias kev ua txhaum ntawm kev tiv thaiv ntuj tau tshwm sim.
Discovery keeb kwm
Txawm tias nyob rau xyoo pua 18th, nws tau pom tias qee cov neeg mob uas muaj kab mob sib kis tau ploj lawm cov qog nqaij hlav. Thaum kawg ntawm lub xyoo pua 19th, American oncologist kws phais William Coley tau txheeb xyuas qhov kev sib raug zoo ntawm cov kab mob hemolytic streptococcus Streptococcus pyogenes thiab txo qis (thiab qee zaum txawm tias tag nrho ploj) ntawm cov qog.xwm txheej phem. Nws tsim cov tshuaj tiv thaiv kab mob qog noj ntshav raws li cov kab mob no los kho cov neeg mob sarcoma. Lub sijhawm ntawd, cov txheej txheem ntawm kev tiv thaiv kab mob hauv kev tiv thaiv kab mob tseem tsis tau paub, yog li nws txoj haujlwm tau raug kev thuam hnyav, thiab tom qab ntawd tau hnov qab yuav luag 100 xyoo.
Nyob rau hauv nruab nrab ntawm lub xyoo pua 20th, nws tau tshawb pom tias qhov kev taw qhia ntawm liposaccharide macromolecules, uas ua rau cov membranes ntawm microbial hlwb, tuaj yeem ua rau cov qog tuag. Txawm li cas los xij, hauv 70s. xyoo pua 20th Cov kws tshawb fawb tau pom tias cov txheej txheem no tsis yog tshwm sim los ntawm liposaccharide nws tus kheej, tab sis los ntawm cov protein ntau (cov qog nqaij hlav necrosis, lossis TNF), tsim los ntawm cov kab mob hauv qab no ntawm lub cev tiv thaiv kab mob thaum sib cuag nrog microbes:
- activated macrophages;
- neutrophils;
- T-lymphocytes;
- mast cells;
- astrocytes;
- NK cells (natural killer cells).
Kev sib raug zoo ntawm kev tiv thaiv kab mob thiab qog tsim
Cov lus tseeb hauv qab no ua pov thawj pom zoo ntawm kev sib txuas ntawm lub xeev kev tiv thaiv thiab kev loj hlob ntawm cov qog malignant:
- nce ntau ntawm cov neoplasms hauv cov neeg mob tiv thaiv kab mob, nrog rau cov neeg laus (koom nrog txo qis hauv lub cev tiv thaiv);
- kuaj pom hauv cov neeg mob ntawm cov tshuaj tiv thaiv tshwj xeeb thiab T-hlwb rhiab rau qog antigens;
- muaj peev xwm tsim cov tshuaj tiv thaiv kab mob tiv thaiv kab mob thiab cov kab mob immunoproliferative (nrog kev tswj hwm cov tshuaj tiv thaiv kab mob thiab tiv thaiv kev tiv thaiv kab mob, ntsig txog).
Kev tiv thaiv kev tiv thaiv tsis yog tsuas yog ua kom puas tsuaj ntawm cov neeg ua haujlwm txawv teb chaws (cov kab mob, cov kab mob thiab cov kab mob), tab sis kuj mutant hlwb los ntawm cov qog tsim. Lawv yog cov yam ntxwv ntawm antigenic tshwj xeeb, uas nyob ntawm qhov ua rau ntawm neoplasm:
- kab mob (papillomas, leukemia thiab lwm yam);
- tshuaj carcinogens (methylcholanthrene, benzopyrene, aflatoxins thiab lwm yam);
- endocrine ntshawv siab (metabolic immunosuppression);
- lub cev ib puag ncig (txhua hom hluav taws xob).
Natural antitumor tiv thaiv muaj me ntsis cuam tshuam rau ib qho uas twb tsim malignant neoplasm. Qhov no yog ntaus nqi rau cov hauv qab no:
- kev loj hlob sai ntawm cov qog, ua ntej ntawm kev ua kom lub zog tiv thaiv kab mob;
- cais tawm los ntawm cov qog hlwb ntawm antigens uas khi cov receptors sib raug rau ntawm qhov chaw ntawm cov lymphocytes killer;
- tiv thaiv cellular tiv thaiv los ntawm neoplasm.
Txoj Cai Ua Haujlwm
Lub tshuab tiv thaiv kab mob tiv thaiv kab mob hauv kev kho mob tseem tsis tau nkag siab. Txawm hais tias qhov tseeb tias nws txoj haujlwm tiv thaiv tau raug txheeb xyuas, cov tshuaj tiv thaiv tuaj yeem cuam tshuam cov qog antigens yam tsis muaj kev puas tsuaj ntawm cov kab mob malignant. Qee qhov xwm txheej, kev tiv thaiv kab mob txawm tias rov qab los, ua rau kev loj hlob tuaj.
Raws li cov tswv yim niaj hnub no, qhib cov macrophages thiab killer cells ua lub luag haujlwm tseem ceeb hauv cov txheej txheem no. Ib tug feature ntawm antitumor tiv thaiv yog hais tias nwsNws tshwm sim los ntawm ib tug complex mechanism ntawm kev sib cuam tshuam ntawm tus tswv tsev kab mob thiab cov neoplasm. Muaj 4 pawg tseem ceeb ntawm yam:
- Antiblastoma - humoral thiab cellular (T-lymphocytes, TNF, macrophages, NK- thiab K-cells, tshwj xeeb cov tshuaj tiv thaiv, interferons, interleukins), inhibiting kev loj hlob ntawm cov qog thiab rhuav tshem nws cov hlwb.
- Immunoresistance ntawm neoplasm, lossis nws lub peev xwm los tiv thaiv kev tiv thaiv kab mob.
- Problastoma: immunosuppressive (cov tshuaj-suppressors tsim los ntawm macrophages thiab lymphocytes; cov tshuaj zoo li cov tshuaj hormones, interleukin-10, circulating tiv thaiv complexes, cov proteins ntawm TGFβ pawg, muaj cov antigens, tshuaj tiv thaiv thiab ntxiv cov khoom xyaw); txhim khu kev tiv thaiv kab mob (TNF tsim los ntawm macrophages; gamma-interferon, interleukins 2 thiab 6, endothelial kev loj hlob yam; immunodeficiency xeev).
Effector mechanisms
Lub luag haujlwm tseem ceeb ntawm cov txheej txheem ntawm cov tshuaj tiv thaiv kab mob yog los thaiv thiab rhuav tshem cov kab mob. Muaj 2 pawg ntawm receptors uas xaiv khi rau cov antigens tshwj xeeb. Raws li qhov no, 2 hom effector mechanisms kuj txawv:
- Humoral, ua haujlwm vim muaj qhov sib luag (humoral) yam - cov tshuaj tiv thaiv uas khi thiab tshem tawm cov antigen.
- Cellular (antibody-independent), paub nrog kev koom tes ntawm cov hlwb ntawm lub cev tiv thaiv kab mob, qhov tseem ceeb tshaj plaws yog T-lymphocytes, macrophages, NK-cells. Lawv ncaj qha rhuav tshem cov kab mob txawv teb chaws, kab mob thiab qog nqaij hlav.
Yog tias lub xovtooj hloov pauv hloov pauv tau zam kev tuag nyob rau hauv kev cuam tshuam ntawm cov txheej txheem cuam tshuam, ces lub sijhawm sib npaug ntawm nws txoj kev faib thiab kev cuam tshuam loj ntawm kev tiv thaiv yuav pib. Nrog rau kev loj hlob ntawm cov txheej txheem malignant, cov qog nqaij hlav tawm ntawm kev tswj ntawm lub cev tiv thaiv kab mob.
Lub luag haujlwm tseem ceeb tshaj plaws hauv kev tawm tsam ntawm kev faib cell yog ua los ntawm 2 hom lymphocytes uas ua rau cov txheej txheem ntawm necrosis - T-lymphocytes thiab NK-hlwb uas paub txog kev ntxhov siab molecules uas neoplasm tso tawm. T-lymphocytes yog tsim nyob rau lub sij hawm ntev, thiab lawv cov precursors paub cov qog antigens. Th1-lymphocytes ua rau cov txheej txheem ntawm o, uas ua rau ua kom cov macrophages. Cov khoom siv zais cia tom kawg ua rau muaj kev cuam tshuam ntawm cov ntshav hauv zos rau cov ntaub so ntswg, uas tseem ua rau cov qog nqaij hlav tuag.
Kev koom tes ntawm T-lymphocytes yog tshwm sim hauv impregnation ntawm cov qog nqaij hlav malignant nrog cov qog ntshav, uas ua rau nws cov hlwb los ntawm kev sib cais, lossis cytolysis. Kev ua kom cov lymphocytes tshwm sim nyob rau hauv kev ua ntawm cytokines - cov ntaub ntawv protein molecules, uas lawv nkag mus rau hauv cov qog ua ke.
Gamma-interferon kuj tseem ceeb heev ntawm cov khoom siv sab hauv uas muaj nyob hauv lub cev tiv thaiv kab mob ntawm tib neeg lub cev. Nws cov haujlwm yog raws li hauv qab no:
- Txhim kho qog cell division.
- Ua kom cov txheej txheem ntawm lawv qhov programmed tuag.
- Txhawb kev tsim cov cytokines uas nyiam T-lymphocytes rau neoplasm.
- Ua kom cov macrophages thiab kev loj hlob ntawm T-helpers,xav tau los ntxiv dag zog rau kev tiv thaiv kab mob.
- Txhob tsim cov hlab ntsha tshiab, uas ua rau cov khoom noj tsis zoo ntawm cov qog thiab ua rau nws cov hlwb tuag sai dua.
Tshuaj tiv thaiv kab mob antiineoplastic: yog vim li cas rau nws cov txiaj ntsig qis
Kev loj hlob ntawm malignant neoplasms thiab lawv tiv thaiv kev tiv thaiv yog piav qhia los ntawm cov laj thawj hauv qab no:
- tsis muaj peev xwm ua rau muaj kev tiv thaiv kab mob hauv qog antigens;
- ciaj sia taus (natural xaiv) ntawm lub cev tiv thaiv kab mob qog;
- hloov pauv tsis tu ncua ntawm antigens;
- muaj tshuaj ntsiav hauv qog;
- tso tawm cov qog antigens hauv daim ntawv soluble, ua rau muaj kev tawm tsam ntawm lub cev tiv thaiv kab mob;
- Qhov chaw ntawm cov neoplasm nyob rau hauv qhov chaw uas qhov tshwm sim ntawm cov tshuaj tiv thaiv tsis ua rau lub cev tsis muaj zog tiv thaiv kab mob (lub npe hu ua "tsim cai" thaj chaw - pob txha pob txha, paj hlwb, endocrine thiab cov kab mob qog noj ntshav, thymus);
- poob ntawm qee yam ntawm cov txheej txheem effector los ntawm cov caj ces lossis tau txais (thib ob) kev tiv thaiv kab mob;
- tsim tawm ntawm cov khoom problastoma los ntawm cov qog hlwb uas tiv thaiv kev tiv thaiv kab mob thiab txhawb cov qog loj hlob;
- hauv cov menyuam yug tshiab - immaturity ntawm effector systems, ua rau tsis paub txog cov qog hlwb.
Cov txheej txheem ntawm kev tsis muaj peev xwm ntawm kev tiv thaiv kab mob tiv thaiv kab mob ua rau qhov tseeb tias neoplasm dhau los ua cov tshuaj tiv thaiv tsawg dua thiab tsis pom los ntawm lub cev.raws li lub ntsiab lus txawv teb chaws. Yog li ntawd, kev tiv thaiv kev tiv thaiv yog txo. Cov txheej txheem tiv thaiv kab mob tsis tuaj yeem ua rau tsis lees txais cov qog nqaij hlav uas twb tsim lawm.
Ntse
Cov yam ntxwv ntawm kev tiv thaiv kab mob muaj xws li:
- Lub luag haujlwm tseem ceeb hauv kev tiv thaiv kab mob yog ua los ntawm T-lymphocytes, macrophages thiab NK hlwb uas rhuav tshem cov qog nqaij hlav. Tus nqi ntawm kev tiv thaiv kev lom zem yog tsawg dua.
- Cov kab mob qog noj ntshav tau lees paub ncaj qha los ntawm macrophages thiab dendritic hlwb lub luag haujlwm rau kev tiv thaiv kab mob hauv lub cev thiab yoog raws, lossis los ntawm cov pab cuam Th1.
- Kev sib cuam tshuam ntawm cov kab mob thiab cov qog tshwm sim nyob rau hauv peb txoj kev: ntuj thiab tau txais kev tiv thaiv rau malignant neoplasms, kev tiv thaiv los ntawm cov qog. Kev sib xyaw ua ke ntawm cov xwm txheej no suav nrog kev tiv thaiv kab mob.
- Malignant hlwb nyob rau hauv cov txheej txheem ntawm kev xaiv ntuj tau txais kev tiv thaiv mechanisms tiv thaiv innate. Lawv cov phenotype tshiab tau tsim, cov neoplasm yog hloov zuj zus.
Tumor-associated antigens tau muab faib ua 2 pawg - thawj hom (tus yam ntxwv ntawm ntau hom neoplasms, yog cov kab mob kis) thiab qhov thib ob, tshwj xeeb tshaj yog thiab pom nyob rau hauv txhua tus neeg mob uas muaj hom qog no.
Ib yam ntawm cov yam ntxwv ntawm kev tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob yog tias nws yog ob qho tib si tshwj xeeb, uas yog, qhia tawm tsam qee hom kab mob, thiab tsis tshwj xeeb (ua kom puas tag nrho.txawv teb chaws rau lub cev). Cov yam tsis muaj tshwj xeeb yog mononuclear thiab NK hlwb tau qhib los ntawm kev cuam tshuam ntawm interleukin 2 thiab interferons, nrog rau lymphokine-activated killer cells thiab cytokines.
Immunodiagnostics
Nyob rau xyoo tas los no, kev tiv thaiv kab mob ntawm cov qog nqaij hlav malignant neoplasms tau siv los ua tshuaj. Nws yog raws li kev tshawb pom ntawm cov protein sib txuas hauv qab no hauv cov ntshav:
- antigens cuam tshuam nrog qog;
- antibodies;
- lymphocytes raug rau qog antigens.
- PSA (prostate).
- P-53 (zais zis).
- SCC (ntsws, esophagus, qhov quav).
- CA-19-9 (txo)
- CA-125 (ovaries).
- CA-15-3 (mammary qog).
Txawm li cas los xij, cov tshuaj tiv thaiv rau qee yam antigen hauv cov ntshav ntawm cov neeg mob qog noj ntshav tau txiav txim siab tsis tu ncua (hauv 10% ntawm cov neeg mob). Immunoglobulins rau qog-mob nrog antigens tau kuaj pom ntau dua - hauv 50% ntawm cov neeg mob. Lub zej zog kev kho mob tam sim no tab tom tshawb nrhiav lwm yam antigens los pab kuaj mob qog noj ntshav.
Immunoprophylaxis thiab kho
Txhawm rau txhawm rau tiv thaiv kab mob, immunomodulators yog siv los ua kom tsis muaj zog ntawm lub cev tiv thaiv kab mob:
- Interleukins 1 thiab 2. Cov protein sib txuas nobelongs rau cov pab pawg neeg ntawm pro-inflammatory cytokines (cov ntaub ntawv molecules) thiab yog biologically active tshuaj uas tsim los ntawm leukocytes. Interleukins yog cov koom nrog tseem ceeb hauv kev tsim cov tshuaj tiv thaiv kab mob thaum lub sij hawm qhia cov kab mob hauv microbiology. Antitumor tiv thaiv kab mob yog qhib los ntawm kev faib cov lymphocytes (T-killers, NK-cells, T-helpers, T-suppressors thiab antibody producers). Interleukin 2 kuj tseem ua rau kev tsim cov qog necrosis.
- Tshuaj los ntawm pab pawg ntawm interferons. Lawv txhawb kev tiv thaiv kab mob los ntawm kev nthuav tawm antigens rau T-lymphocytes uas tau coj los ntawm macrophages thiab dendritic hlwb. T-pab pab zais cov ntaub ntawv protein molecules uas qhib kev ua haujlwm ntawm lwm lub hlwb ntawm lub cev tiv thaiv kab mob. Qhov tshwm sim yog qhov nce hauv kev tiv thaiv kab mob antitumor. Qee hom interferons (interferon gamma) tuaj yeem cuam tshuam ncaj qha rau macrophages thiab killers.
- Txhob Cia Siab. Lawv tau noj ua ke nrog cov tshuaj immunobiological tseem ceeb thiab pab txhawm rau txhim kho cov lus teb ntawm lub cev tiv thaiv. Feem ntau lawv siv rau cov neeg noj qab haus huv thaum txhaj tshuaj tiv thaiv. Ib qho ntawm cov yam ntxwv ntawm antitumor tiv thaiv kab mob hauv microbiology hais txog hom tshuaj no yog tias lawv tuaj yeem mloog cov antigens ntawm lawv qhov chaw. Qhov no muab cov nyhuv ntev dua. Rau lub hom phiaj xa khoom ntawm antigens mus rau lub cev ntawm cov kab mob lymphatic, liposomes yog siv - vesicles nrog lipid biolayers. Cov tshuaj feem ntau hauv pawg no yog ua tiav thiab tsis tiav Freund's adjuvant,aluminium hydroxide, hnoos hawb pob tso rau ntawm aluminium alum; Polyoxidonium.
- Cov ntsiab lus ntawm cov kab mob hlwb (immunostimulators Prodigiosan, Likopid, Romurtide thiab lwm yam).
Kev sim ua rau tsiaj txhu pom tias thaum cov qog antigens raug txhaj, lub cim xeeb tiv thaiv kab mob raug tsim. Yog li ntawd, cov qog nqaij hlav qog nqaij hlav hloov pauv tom qab ntawd tsis lees paub. Nyob rau hauv xyoo tas los no, kev txhim kho nquag tau ua tiav hauv cov tshuaj, uas yuav ua rau nws muaj peev xwm tsim tau cov tshuaj tiv thaiv kab mob tiv thaiv kab mob los ntawm kev txhaj tshuaj. Txog tam sim no, ib hom tshuaj tiv thaiv tau tsim nyob rau hauv cov lus qhia no - txhawm rau txhim kho kev tiv thaiv kab mob rau tib neeg papillomaviruses, uas ua rau muaj mob qog noj ntshav hauv cov poj niam ("Gardasil" thiab "Cervarix" ntawm cov khoom txawv teb chaws).
Type of qog
Immunotherapy muaj txiaj ntsig tiv thaiv cov qog qog hauv qab no:
- melanoma tshwm sim los ntawm melanocytes - pigment cells;
- non-Hodgkin's lymphomas muab los ntawm lymphocytes;
- mob raum, qhov quav, zes qe menyuam;
- hairy cell leukemia (kev puas tsuaj rau B-lymphocytes, cov qe ntshav dawb);
- glioma (mob hlwb);
- cov nqaij mos sarcoma, lub hauv paus chiv keeb uas cuam tshuam nrog cov hlwb epithelial thiab cov ntaub so ntswg sib txuas.
